Thousands of Iowans would lose access to the medicine they need under legislation approved by the Iowa House.

Republicans passed a bill to adjust the limit on tetrahydrocannabinol, or THC, available in Iowa’s heavily regulated medical cannabis products. The current 3 percent limit would be replaced with a 4.5 gram limit over a 90-day period. The bills is now set for Senate consideration.

House File 2589 is being pitched as an expansion of the medical cannabis program, and it has some good provisions, but on the whole it is a step backward.

The 4.5 gram limit would mean about 2,300 Iowa patients would be forced to reduce their THC use, according to figures cited by Democrats and based on actual patient data from the Iowa Department of Public Health. Measured another way, only about half of the patients in the program would be allowed to reach their proper dose.

Those numbers likely obscure the existing lack of access, since some patients already can’t afford their proper dose or can’t consistently access one of only five dispensaries among 99 counties.

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House Democrats voted against final passage after House Republicans rejected their amendments to raise the THC cap. Rep. John Forbes, a pharmacist, railed against the Republican proposal, arguing the 4.5-gram limit is not based on any scientific data.

The bill would allow doctors to recommend exceeding the gram limit, but patients complain there already are too few doctors willing to recommend cannabis treatment. Lacking a safer option such as cannabis, some patients will resort to much harsher drugs.

“We are actually promoting people to go off the program and go back on opioid medications. That’s not right,” Forbes said.

Famously, THC is the part of marijuana that makes users feel “high,” but it also has potentially significant therapeutic benefits and it has been used in medical settings in the United States for many years.

Republicans resist meaningful reform because they are obsessed with the idea of “a recreational program masquerading as a medical program,” as Rep. Jarad Klein put it during the floor debate. In reality, there is zero chance of that happening in Iowa.

As of the latest reporting, only about 4,300 Iowa patients are covered by the program, or about one-tenth of 1 percent of the population. By comparison, neighboring Illinois has nearly 10 million adults who are eligible to buy marijuana.

Even a 25-gram, 90-day limit — which was passed by the Legislature last year, but vetoed by Gov. Kim Reynolds — would be a tiny fraction of the amount of THC people can buy in states with legal marijuana. What’s more, Iowa does not allow plant marijuana or smokable products.

The bill also could jeopardize the rights of patients in the workplace, and throw into the Iowa Code murky language about federal legality.

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The good measures approved by the House — adding two new conditions in the program, and allowing more medical professionals to recommend treatment — are not enough to outweigh the bad. If Republicans can’t come to a more sensible conclusion about THC limits, Iowans may be better off with no reform at all this year.

adam.sullivan@thegazette.com; (319) 339-3156