Robert Kowalski used to take 22 pills a day to combat pain, post-traumatic stress disorder and other conditions stemming from years of military service.
The U.S. Air Force veteran had trouble sleeping and struggled with depression after two combat tours in Iraq. Veterans Affairs diagnosed him with agoraphobia, he said – the fear of certain situations that make people feel trapped or helpless.
But the medication hurt more than it helped. Kowalski said he either slept too much or too little and experienced vivid dreams. He lost his energy and felt like a zombie, as if he was just existing.
"I didn’t like the way that stuff was making me feel or the problems it was causing in my career," said Kowalski, a 33-year-old living in Boardman.
Kowalski turned to marijuana for his sleep troubles and eventually began taking it in place of his other medications. The decision came at a cost – the military discharged him for using an illegal substance – but he said marijuana improved his work ethic and eventually led him to start a nonprofit helping other veterans.
Kowalski qualified for Ohio's medical marijuana program because of his PTSD, but he and other advocates believe the specific list of conditions bars people who could benefit from the drug.
That's where a new bill from doctor and state Sen. Stephen Huffman comes in.
A 'free market' for medical marijuana
Under Senate Bill 261, introduced last week by the Tipp City Republican, the medical marijuana program would be open to Ohioans with the following ailments: arthritis, migraines, autism, spasticity or chronic muscle spasms and opioid use disorder. People in hospice care or with a terminal illness would also be eligible.
Those would be added to 25 conditions already approved under the program.
Most significantly, the bill would allow anyone to use medical marijuana if a physician determines it would alleviate symptoms or otherwise benefit that person.
"You have patients who have rare disorders…and they don’t qualify for these more common conditions," said Mary Jane Borden, co-founder of the medical marijuana advocacy organization Ohio Rights Group. "That’s very helpful. That language should’ve been in there all along."
Beyond that, Huffman views the proposal as a business bill. It would establish a division of marijuana within the department of commerce instead of regulating the program through the board of pharmacy. It also would expand the number of dispensary licenses, allow cultivators to expand their facilities and permit drive-through or curbside pickup at dispensaries.
The ultimate goal, Huffman said, is to drive down prices and make medical marijuana more accessible for those who need it.
"(We're) trying to get close to a free market with an industry that has a lot of government regulations," he said.
Senate Minority Leader Kenny Yuko, D-Richmond Heights, is co-sponsoring the bill with Huffman. Yuko has made medical marijuana a staple of his political career and believes this legislation would ensure patients don't spend hours on the road to reach a dispensary.
"That opens the door to a lot of reasons for helping people," he said.
Red flag or a way to help?
However, the legislation raises red flags for organizations that work to curb addiction and behavioral health problems.
Take the opioid use disorder provision, for example. Ohio would not be the first state to permit medical marijuana for that purpose, and patients across the country have said marijuana helped them break their addiction. But the American Society of Addiction Medicine says there's not enough evidence suggesting marijuana would reduce opioid use or overdose rates.
A 2017 research paper said it's worth exploring whether cannabidiol – one of the compounds in marijuana – could help curb opioid abuse disorder but noted the psychoactive tetrahydrocannabinol is "not a suitable treatment option."
"I don’t know why you would want to trade one substance for another," said Fran Gerbig, executive director of Prevention Action Alliance, a nonprofit that works to prevent substance misuse.
Gerbig and other prevention experts worry medical marijuana could create cognitive or behavioral health problems in the long run. They believe Huffman's bill is too broad and would contribute to the perception that marijuana is an acceptable treatment — a view they disagree with.
"What works for one person doesn’t mean the whole society needs to be taking medical marijuana," said Amanda Conn Starner, a senior director with PreventionFIRST. "We don’t do that with any other medicine."
Still, people like Kowalski stand by the benefits. Veterans have increasingly reduced their prescriptions because of marijuana, he said, which in turn helped them maintain jobs and a better quality of life. It also curbs the perception that veterans are "ticking time bombs," he argued.
"We’re not looked at as functioning members of society," Kowalski said. "When you have a substance that gives you the capability to mitigate the flight or fight mechanism that’s been trained in our body...what we’re seeing is that stigma can be broken and that thought process and cycle can also be trained out."
Haley BeMiller is a reporter for the USA TODAY Network Ohio Bureau, which serves the Columbus Dispatch, Cincinnati Enquirer, Akron Beacon Journal and 18 other affiliated news organizations across Ohio.