Wendy Shoemaker has lived with chronic pain for decades, and she was prescribed opioids to treat it.

“All you do is stand there and watch your life,” she said.

Shoemaker said she couldn’t do much with her daughter when she took opioids. She has holes in her memory from that time, and she was in heart failure. But almost a year ago, she was weaned off opioids and joined Iowa’s medical cannabis program.

At her home overlooking a lake in Dexter, she held up a bottle of pills that contain chemicals found in cannabis.

“It’s so much better on this,” Shoemaker said. “I don’t know if it’s being reborn or what, but I’ll tell you what, it’s working.”

Shoemaker is not experiencing heart failure anymore. And she’s doing things she couldn’t do for a long time: gardening, traveling with her family, and riding in a boat to watch her daughter water ski.

But she’s afraid that could all change as Iowa lawmakers consider changing how the state’s medical cannabis program handles THC, the compound that can make people feel high.

The state legislature passed a bipartisan bill in 2019 to address that issue, but Republican Gov. Kim Reynolds vetoed it, saying it allowed patients to have more THC than she was comfortable with.

Last week, Reynolds finally laid out what she is willing to sign into law: a bill that limits purchases of THC to 4.5 grams over 90 days. Republican leaders in the House of Representatives say they intend to advance that bill.

That could be a problem for Iowans like Shoemaker. She is already taking more THC to control her pain than what that bill would allow.

Katarina Sostaric / IPR file

Current law caps the percentage of THC in individual medical cannabis products, but there’s no legal limit on how much THC a registered patient can buy. The proposed legislation could cut some people off from doses that are working for them.

Rep. John Forbes, a Democrat from Urbandale who is also a pharmacist, is concerned.

“With the current legislation we have in place, I think it’s better because it gives patients more flexibility in dosing medical cannabis,” Forbes said. “With a 4.5 gram limit, it’s going to really take a lot of patients out of the program that are especially taking it for pain control.”

He worries the limit will push patients back to opioids, which are known to be highly addictive, or to purchase medical cannabis in other states like Illinois, and illegally transport it to Iowa.

There are more than 4,000 active patients in Iowa, and the state public health department said 132 of them have bought more than the proposed limit in any 90-day period. Some other patients feel they need more than that, but can’t afford it.

Rep. Jarad Klein, R-Keota said there would be an exception for terminally ill Iowans, and for patients whose doctors certify them to go over the limit.

“Rather than the individual patient, without any consultation with a doctor, necessarily, taking whatever level they want to take,” Klein said. “Trying to make this much more of a medicine-based approach rather than where we’re at now.”

Klein said this could encourage more health care providers to certify patients for medical cannabis.

But Forbes said this won’t do anything to help with the issue of doctors often hesitating to participate.

“And now if we’re going to ask doctors to go a step above and authorize even higher doses, I think a lot of doctors are going to get very squeamish and not want to even be involved in the program,” Forbes said.

The general manager of the state’s first medical cannabis manufacturer, MedPharm Iowa, said allowing doctors to certify patients for more THC could run afoul of a federal court ruling that says health care providers can recommend, but not prescribe, cannabis.

Where did the proposed 4.5 gram THC limit come from?

The controversial THC limit with exceptions came as a recommendation by the state medical cannabis advisory board.

Reynolds has said she wants to follow the board’s lead.

Klein said he agrees, though he was at odds with the board and some fellow Republicans last year after he championed a bill that would allow for 25 grams of THC over 90 days.

He said the board is made up of mostly medical professionals, and very few House members work in the medical field.

Katarina Sostaric / IPR file

“If we’re going to have a board in place, I believe we need to be listening to them,” Klein said. “Otherwise what’s the point?”

Some board members don’t want to allow more THC because they say it has the potential to cause harm. Dr. Robert Shreck said he hasn’t seen any quality medical studies to support bigger THC doses than what the board is recommending.

“So when they appointed us to tell the legislature--and along the way, the public and physicians--what medical science has to say in support of medical cannabis, then that’s what our job is,” Shreck said after a recent board meeting. “That’s what we’re doing.”

Cannabis is still illegal under federal law.

There is conclusive evidence that specific formulations of cannabis and its components can have therapeutic effects for some specific health conditions. But there is not enough scientific evidence to know the amount of cannabis, or products derived from it, that can help all health conditions that cannabis has been recommended for.

The research director at the UCLA Cannabis Research Initiative, Ziva Cooper, said the same amount of THC can affect different people in very different ways. And it also depends on the form patients take it in.

“At this point in time, it’s really hard to hang our hats on a specific dose of THC per day that would be helpful or produce adverse effects in a patient,” Cooper said.

State cannabis policies as a whole have been outpacing the science, and even the Iowa cannabis advisory board members have made some recommendations based on compassion and personal stories instead of conclusive medical evidence.

Shoemaker is weighing her options if the state limits her access to THC. But she is adamant she won’t take opioids again.

“My state isn’t helping me. It’s not taking care of me,” Shoemaker said. “It’s not giving me opportunities that other states offer that have cannabis legalized. It’s crazy.”

Shoemaker said she might eventually have to cross state lines to go where she can get enough THC.