Petitions seeking to add anxiety, depression and insomnia to the list of “debilitating medical conditions” that qualify Hawaii patients for medical cannabis use will undergo a public hearing Thursday.

If approved by the Department of Health director, the trio of conditions would be the first added to the list since 2017 and would make Hawaii one of only a handful of states to accept anxiety as a qualifying condition.

The Health Department is required to hold public hearings at least once a year on formal petitions seeking to add conditions to Hawaii’s medical cannabis program. Petitions may be filed by a physician or “potentially qualifying patient” and should include medical or scientific evidence and letters of support from physicians.

The health director has until 90 days after the hearing to take action.

As of Sept. 30 there were 29,226 patients registered with the Hawaii Medical Cannabis Registry, according to the Department of Health. Severe pain overwhelmingly was the top medical condition cited by patients at 84%, followed by post-traumatic stress disorder (14.6%), persistent muscle spasms (8.6%), cancer (6.25%) and severe nausea (5.8%). (Some patients cited multiple conditions.)

Since Hawaii’s medical cannabis statute became law in 2000, six ailments have been added to the list of debilitating medical conditions. Lupus, epilepsy, multiple sclerosis and rheumatoid arthritis were approved in 2017 and post-traumatic stress disorder in 2015, all via legislation; amyotrophic lateral sclerosis, known as Lou Gehrig’s disease, made the list in 2017 by petition.

The other qualifying conditions are cancer, glaucoma, HIV/AIDS, cachexia or wasting syndrome, severe pain, severe nausea, seizures and severe and persistent muscle spasms.

A 2019 petition to add opioid use disorder to the list was denied, as was a 2017 petition for general anxiety disorder. In both cases, officials cited insufficient supporting evidence.

The latest petitions were filed by a single potential qualifying patient, whose name was redacted in the publicly available documents.

Thirty-three states have comprehensive medical cannabis programs, but only four — Pennsylvania, Nevada, North Dakota and New Jersey — name anxiety or anxiety disorders as a qualifying medical condition, according to a search of state websites. Depression and insomnia do not appear on any of them.

Commonly cited debilitating conditions that do not appear on Hawaii’s list include autism, migraines, Tourette syndrome, anorexia and hepatitis C.

While there is ample anecdotal evidence of cannabis’ effectiveness as a therapeutic treatment, in-depth scientific and medical research on the subject is relatively skimpy. Research has been hampered by cannabis’ classification under the federal Controlled Substances Act as a Schedule I substance, in a league with heroin as considered to have a high potential for dependency and no accepted medical uses.

A comprehensive analysis of 83 studies found inadequate evidence that cannabinoids, the chemical compounds found in cannabis, relieve depression, anxiety disorders or four other mental health disorders. The study, published Oct. 28, 2019, in The Lancet medical journal, also highlighted the “limited evidence and the low quality of the evidence that exists around using cannabinoids for treatment of mental health conditions.”

A similar review in 2017 by the private nonprofit National Academies of Sciences, Engineering and Medicine found “limited evidence” that cannabis improved anxiety symptoms. And in a 2018 statement, the American Psychiatric Association said “there is currently no scientific evidence to support the use of cannabis as an effective treatment for any psychiatric illness.”

On its medical cannabis website, Washington state, an early adopter in 1998, specifically states that mental health conditions have been rejected and do not qualify “due to a lack of scientific evidence supporting improved health outcomes from the use of medical marijuana for mental health conditions such as bipolar disorder, depression and anxiety.”

Separately, a June 2017 report by the University of Washington Alcohol & Drug Abuse Institute said the psychoactive cannabinoid THC appears to decrease anxiety at lower doses and increase anxiety at higher doses.

In testimony submitted in February 2017 on a Hawaii Senate bill proposing anxiety, depression, insomnia, stress and several other ailments be added to the list of debilitating conditions, the state Health and Attorney General departments both opposed the measure.

One reason was that the agencies favored delaying any new laws until medical cannabis dispensaries had opened, but the Health Department also noted there was a process in place “grounded in science” to review petitions for new conditions annually. (The first medical cannabis dispensaries in Hawaii opened in August 2017.)

Those submitting testimony in support of the measure, which was deferred, included the Drug Policy Forum of Hawai‘i, which argued the “broad conditions” contained in the bill, such as anxiety, had symptoms “that are arguably better relieved with medical cannabis than with various prescription pharmaceutical products.”

Testimony from the Hawai‘i Dispensary Alliance said the measure would “provide greater access to less invasive medical solutions, by expanding the applicability of cannabis-based medicine.”

When asked Friday whether the Health Department had since changed its position, the agency’s medical cannabis program staff replied, “In 2017 we reviewed the literature for ‘General Anxiety Disorder,’ this year it is for ‘Anxiety.’ We are not able to report if our stance has changed since UH is still working on reviewing the literature. A final decision will be made by the health director 90 days from the public hearing date.”

Public hearing

A public hearing on petitions to add anxiety, depression and insomnia to the list of debilitating medical conditions that qualify for medical cannabis use will be held 9 a.m. today via Zoom. For details, visit health.hawaii.gov/medicalcannabisregistry. The public also may register for free at the same website and receive the Zoom link via email.