Republicans in the state senate have taken odds-makers by surprise lately. First, they reversed course and joined Democrats in supporting the expansion of Medicaid coverage to make affordable healthcare accessible for more low-income families.
Then, in a broad bipartisan vote on Thursday, most of the Senate's GOP majority put its weight behind a bill that would legalize medical marijuana.
Allowing patients with debilitating illnesses and medical conditions to use cannabis to ease their suffering would move North Carolina closer to the mainstream. More than three dozen states, the District of Columbia and a host of U.S. territories have legalized medical marijuana.
For State Sen. Wiley Nickel, the issue is personal.
"My father died of cancer and used marijuana illegally during his final days and I would never want to deny anybody else that same opportunity to get help that they need," said Nickel, a progressive Democrat from Wake County.
Under a bill co-sponsored by Nickel, North Carolina law would allow the use of cannabis-based products including marijuana for managing pain and other symptoms associated with serious medical conditions such as cancer, epilepsy, sickle cell anemia and Post-Traumatic Stress Disorder.
Nickel said the bill would establish one of the most strict regulatory structures for medical marijuana in the country.
"This isn't, you know, 'I hurt my toe' or 'I'm having anxiety, give me medical marijuana,' Nickel said. "This will be very, very defined and very strict in terms of people who have very legitimate medical needs."
The bill would require patients to obtain written certification from a qualified physician and then apply for a registered, medical marijuana I.D. card issued by the state health department.
A commission would oversee cannabis production and supply and regulate dispensaries. And smoking or vaping medical marijuana in public places or near schools and churches would be prohibited.
Nickel said if it were up to him marijuana would be fully legalized in North Carolina, medicinally and recreationally. But Nickel said that oversight in North Carolina is essential to passage of the medical marijuana measure.
"That's the kind of language and the kind of bill that is bringing along conservatives because they know that this is something that is narrowly tailored to people who are truly suffering and really need the help," he explained.
Winning over Republicans in the state Senate is not an issue, as evidenced by Thursday's 35-10 vote.
""It's just a good bill," Sen. Bill Rabon (R-Bladen, Brunswick, New Hanover, Pender), one of the bill's key sponsors, told his colleagues ahead of Thursday's vote.
"It is showing that we do care about our fellow man and that we do care about North Carolinians and that we do want people to be able to legally and safely enjoy the time they have left," he added.
Representatives from two conservative Christian groups spoke out against the measure at a committee meeting on Wednesday. But the legislation's big political hurdle is the state House, where Republican Speaker Tim Moore has said, without providing specific reasons, that the bill will not get a hearing, at least this session.
According to Duke University Medical Prof. David Casarett, there is science-based evidence rooted in randomized control trials to back the benefits of medical marijuana for certain conditions, especially pain and nausea.
"I think if we go into this with the honest assessment that it's not a wonder drug, it's not a panacea, it's not a cure-all and it has some risks," Casarett said, "as long as we go into it with eyes wide open and an honest assessment of risks and potential benefits, I think it is the right time."
Such risks include anxiety, paranoia, and impairment. But Casarett notes that approved medicines such as pain-relieving opioids come with high risks, too, like addiction and respiratory depression. And a patient suffering from intense gastrointestinal pain from Crohn's Disease or gnarled joints from rheumatoid arthritis may decide with their doctor that the risks of cannabis are worth taking with its benefits.
Casarett is Duke's chief of palliative care. His patients face life-threatening illnesses and Casarett says 10-15% of them are thinking about using medical marijuana. He believes the medical community and state government share a responsibility to ensure such they have access to a safe, contaminant-free supply of cannabis.
"I think cannabis is in a really nice spot where it offers some benefits, its risk profile is really pretty minimal and the legalization of medical cannabis gives patients a chance to take some control back over their health and well being," Casarett said.
What is more, Casarett added, it is difficult to advance the science if cannabis is illegal.
"So if we are going to learn more and if we're going to harness some of the strengths of some great universities here in North Carolina to advance that science you've got to bite the bullet and make it legal," Casarett argued.
In a position statement, the American Medical Association has said that marijuana used for medicinal purposes should not be legalized by state legislatures or popular referenda but should undergo the same kind of clinical trials conducted under the federal process for new drug applications. The AMA position statement also said that "effective patient care requires the free and unfettered exchange of information on treatment alternatives and that discussion of these alternatives between physicians and patients should not subject either party to criminal sanctions."
North Carolina already allows the use of industrial hemp-based products that contain less than .3 percent of THC, the chemical that causes a person to get high.
Recent polls suggest public support outweighs opposition for legalizing medical marijuana in North Carolina. Last year, an Elon University poll showed 73 percent of respondents expressed support for legalizing medical marijuana. That's around the same number found in a poll, in April, from WRAL and SurveyUSA.
But just like Medicaid Expansion, despite bipartisan support in the Senate, the medical marijuana bill faces a dead end in the House.
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