April 20 arrived last week with the requisite stoner jokes and, one assumes, related recreational activities. For decades, 420 has been shorthand for smoking marijuana, first as a time of day and then expanding to a calendar date, which is now recognized internationally.

While recreational marijuana use has been legalized or decriminalized in nine states and 30 allow it for medicinal purposes, Iowa continues to limp along behind the curve. Our state has yet to get an effective, legally enforceable medical marijuana law. The existing state law allows possession of only cannabis oil and only for epilepsy treatment. But even for that narrow purpose, it’s impossible to obtain because federal law prohibits moving it across state lines, and Iowa law prevents manufacturing or distributing it.

Iowa could get a new law if the governor signs the bill passed by both houses of the Legislature in a compromise consensus agreement in the final hours of this session. But it's just a degree stronger than the existing one. Though it would allow marijuana to be grown and processed for cannabis oil, it would limit the amount of THC in the oil to 3 percent. That's way short of other states' laws. Twenty-nine states and Washington, D.C., allow patients to obtain and use various amounts of marijuana in plant form for medical purposes. Oregon allows possession of 24 marijuana plants.

Sally Gaer, who has been a leader in lobbying for a decent Iowa medical marijuana law, says that 3 percent is inadequate for pain treatment. The West Des Moines mother of a daughter with epilepsy thinks such decisions should be left up to doctors to decide.

She’s right.

I couldn't get a comment from the National Institute on Drug Abuse, which is a subsidiary of the National Institutes of Health. But they referred me to 2015 testimony from Director Nora D. Volkow, at a Senate Caucus hearing on narcotics control. She said cannabidiol (CBD) is one of the main active chemical compounds found in marijuana but doesn’t produce euphoria or intoxication: “The euphoric effects of THC are caused by its activation of CB1 receptors. CBD has a very low affinity for these receptors (100 fold less than THC) and when it binds it produces little to no effect."

The most potent strains of marijuana used recreationally are said to contain about 20 percent THC.

Volkow said more studies were needed on its clinical potential of CBD to treat specific conditions. "However, pre-clinical research (including both cell culture and animal models) has shown CBD to have a range of effects that may be therapeutically useful, including anti-seizure, antioxidant, neuroprotective, anti-inflammatory, analgesic, anti-tumor, anti-psychotic, and anti-anxiety properties.”

Voters in California approved a Compassionate Use referendum 21 years ago, which allows the use and acquisition of marijuana to treat cancer, anorexia, AIDS, chronic pain, spasticity, glaucoma, arthritis, migraine, “or any other illness for which marijuana provides relief.” The state has subsequently added recreational use as well.

A majority (61 percent) of Americans believe marijuana should be legal for social use by adults, according to a CBS News poll. That’s up five points from a year ago and 16 points from 2013.

But a federal amendment that protects people in states where medical marijuana is legal against federal prosecution is set to expire after this Friday. It has been reissued every year since 2014 with the annual budget, to specify that federal funds can’t be used to prevent states from implementing their own laws on distribution, possession or cultivation of medical marijuana.

NORML, a national organization dedicated to reforming marijuana laws, used the occasion of April 20 to urge people to write their Congress members calling for an end to federal “prohibition.” NORML believes Americans should not be subject to arrest and prosecution for, in its words, “responsibly consuming marijuana.”

President Donald Trump has said he supports medical marijuana. But his spokesman has said he expects federal agents to enforce federal laws against marijuana in the states. Press Secretary Sean Spicer noted that federal drug laws still list marijuana as an illegal substance. That's a reversal from the Obama administration's stance, which issued a memo saying the federal government wouldn't interfere in states where nonmedical use of marijuana is allowed.

Meanwhile, Israel is leading the way in government-sponsored medical marijuana research, and is now conducting promising clinical trials using CBD on young people with autism.

Is it social conservatism that holds a majority of Iowa lawmakers back from making bolder strides on medical marijuana, as other states have done? And how does lawmakers' fear of inadvertently getting people high square with their lack of fear about inadvertently getting people shot, with the stand-your-ground and concealed-carry (just about anywhere) provisions of Iowa's new gun law? Those seemingly inconsistent positions could have only one outcome in common: More painful deaths.

Rekha Basu is an opinion columnist for The Des Moines Register. Contact: rbasu@dmreg.com Follow her on Twitter @RekhaBasu and at Facebook.com/ColumnistRekha. Her 2013 book, "Finding Her Voice: A collection of Des Moines Register columns about women's struggles and triumphs in the Midwest," is available at ShopDMRegister.com/FindingHerVoice