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Limiting Factors

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There are a variety of consumable medical cannabis products currently available to patients in Michigan. Some can be smoked (like cannabis flower), others are vaporized (such as oil, wax, shatter, crumble, rosin and live resin) and many are eaten (in the form of edibles). All of these products are ingested in one way or another. Topicals, however, are exclusively absorbed through the skin and come in many varieties such as balms, lotions, salves, rubs, massage oils, personal lubricants and even suppositories. In Michigan, there’s a limitation on how much tetrahydrocannabinol (THC) can be contained in a topical product, which may prevent many patients from getting the most effective cannabis topicals to treat their skin conditions.

Recently The Bureau of Medical Marihuana Regulation (BMMR) imposed a rule setting a limit of six percent THC by volume on topical products (see table in Rule 34 of the Emergency Rules of May 30, 2018). The Director of BMMR, Andrew Brisbois, indicated that the rule is being changed, and we await that revision.

Investigation through the Michigan Freedom of Information Act shows that the BMMR recommended the six percent limit based on rules from the only state in the nation which has any limit on topicals—Oregon. Also, under the current rules, suppositories, which generally are kept frozen until use, will not be available in Michigan, since nothing requiring refrigeration is currently allowed.

“Unfortunately, since RSO is a lot stronger than six percent THC by volume, it will be illegal to sell for use as a topical preparation.”

 

Patients who require more potent cannabis topicals may also be left without options, especially those who choose to use cannabis products such as Rick Simpson Oil (RSO), which is know for its high-THC content. In 2002, a Canadian man named Rick Simpson created and used a cannabis oil formula as a topical to fight his own skin cancer (he suffered from basal cell carcinoma). Unfortunately, since RSO is a lot stronger than six percent THC by volume, it will be illegal to sell for use as a topical preparation in Michigan. Medicines like RSO may still be available for sale, though, for use as an edible if they are microdosed properly.

A June 2018 review in Dermatology Online Journal noted 47 dermatological studies related to cannabis. Entitled “Cannabinoids in dermatology: a scoping review,” researchers found evidence for the successful treatment of various skin conditions by using cannabis topical products. The review notes that cannabis has the potential to treat many conditions, including acne vulgaris, dermatitis, psoriasis and skin cancer, to name a few. Despite the promise of cannabis-infused topicals, it concluded that more studies are necessary to further prove its effectiveness. “There is a requirement for thorough pre-clinical research and large-scale, randomized, controlled trials before cannabinoids can be considered safe and effective treatments for these conditions,” the review states. Through this review alone, it is evident that cannabis-infused topicals are very helpful in treating skin conditions.

While patients will still have access to topicals that are low in THC, there is not enough evidence to back up whether or not this is the most effective medicine for certain skin conditions. It is clear that the future of potent topical medicine in Michigan is bleak at the moment.