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Pennsylvania Doctors Are Ready For Medical Marijuana

medical marijuanaBy Lucy J. Cairns, MD
Several factors have recently converged to make passage of a medical marijuana law in Pennsylvania a distinct possibility.

First, public opinion in the state is now overwhelmingly in favor of legalizing marijuana (cannabis sativa) for medical use.  Results of a Franklin and Marshall College poll in February 2013, indicated that 82 percent of Pennsylvanians favored allowing adults to use marijuana for medical purposes if recommended by a doctor.   On March 3, 2014, a Quinnipiac University poll showed support in Pennsylvania at 85 percent.  When analyzed by age, gender, and political orientation groups, a minimum of 78 percent in each group supported medical marijuana.  Editorials urging the passage of a medical marijuana law recently appeared in major news outlets throughout the state.

The second key factor is development of bipartisan support for such a law in the state legislature. Senator Mike Folmer (R-Lebanon) is a prime sponsor of SB 1182, titled the Governor Raymond Shafer Compassionate Use of Medical Cannabis Act.  The other sponsors at the time of this writing include one other Republican senator and nine Democrats (among whom is Senator Judy Schwank).  In the House, Rep. Jim Cox (R-Berks) will shortly be introducing HB 2182, which will be similar to the Senate bill but with updated language based on discussions with the Senate.  Sen. Folmer and Rep. Cox are both motivated by a desire to alleviate suffering on the part of patients with symptoms that cannot be relieved with currently available treatments.

In response to a request for comments for this article, Sen. Folmer provided a statement which included the following: “While the Pennsylvania Medical Society would like to wait for federal approval, there are Pennsylvania patients suffering and leaving Pennsylvania to seek medical treatment.  …  Senate Bill 1182 will provide safe access to patients in a medical environment.”  Rep. Cox explained his involvement in this effort by saying, in part, “I feel that it is our responsibility to address this as a means to help patients who are suffering with ailments whose symptoms cannot be relieved with conventional medications.  I feel that it is imperative that we move forward with the input and expertise of the medical community.”

The third factor making a medical marijuana law more likely in Pennsylvania’s near future is Governor Corbett’s low approval rating.  Governor Corbett does not support access to medical marijuana beyond a very limited program proposed to benefit a small number of children with a severe seizure disorder.  If he is replaced by Democratic challenger Tom Wolf after this year’s election, Pennsylvania will have a Governor who has come out in support of a much broader medical marijuana law.

Thus, a high percentage of Pennsylvanians would trust their doctors to prescribe marijuana for medical conditions, and momentum is building to pass legislation which would allow such prescriptions to be written.  How does this issue look from the other side of the prescription pad—to the physicians who would be faced with implementing such a law?  By an act of Congress– the Controlled Substances Act of 1970–marijuana was placed in the same category of drugs (Schedule I) as heroin: drugs with very high potential for abuse and addiction and no currently accepted medical use.  In contrast, cocaine and methamphetamine were placed in Schedule II, considered to have less potential for abuse and dependency than Schedule I drugs and known to have accepted medical use.  As long as this classification remains in effect, any physician who writes a prescription for marijuana risks federal prosecution and puts their career in jeopardy.  In addition, this classification has been an almost insurmountable hurdle to performing research on the potential medical benefits of products derived from cannabis.  Therefore, the evidence available to physicians on the safety and efficacy of medical marijuana products does not in most cases rise to the level of that available for drugs which have been approved by the FDA based on clinical trials.

Nevertheless, many physicians and other healthcare providers in states with medical marijuana laws do write prescriptions.  The reasons likely include the limitations of conventional medical treatments in alleviating suffering and treating certain diseases, the availability of some evidence for a beneficial effect from use of cannabis in certain conditions, and the perception that cannabis is a relatively safe drug compared to many FDA-approved medications.

In the interest of increasing public awareness of physician perspectives on this issue, and of stimulating involvement of the medical community in the shaping of public policy, a number of Berks County physicians were presented with a summary of SB 1182, which, among other things, would legalize prescription of medical marijuana products for a “debilitating medical condition” to include any of the following:

  1. Cancer or the treatment of cancer
  2. Glaucoma or the treatment of glaucoma
  3. Post-traumatic stress disorder or the treatment of post-traumatic stress disorder
  4. Positive status for human immunodeficiency virus, AIDS, or the treatment of either HIV or AIDS
  5. A chronic attenuating disease or medical condition or its treatment that produces one or more of the following: cachexia or wasting syndrome; severe or chronic pain; severe nausea; seizures, including seizures characteristic of epilepsy; severe and persistent muscle spasms, including spasms characteristic of multiple sclerosis or Crohn’s disease; intractable pain; any other medical condition or its treatment that is recognized by licensed medical authorities attending to a patient as being treatable with cannabis in a manner that is superior to its treatment without cannabis.

The bill specifies the marijuana products that would be licensed for production: cannabis flower (i.e. dried leaves, flowers, and seeds) and cannabis concentrate (i.e. extracted oil).  Patients with a valid ‘medical cannabis identification card’ could legally possess up to one ounce of cannabis flower or up to 3 ounces of cannabis concentrate.  The ID cards would be issued by a Medical Cannabis Board upon review of specified documentation from the patient and the prescribing medical professional.

SB 1182 defines “Medical Professionals” as: a physician, registered nurse practitioner, dentist, physician assistant, nurse midwife, psychiatrist, or other professional who is licensed under the laws of this Commonwealth and is permitted to prescribe Schedule III medication under the Controlled Substance, Drug Device, and Cosmetic Act.

The following comments were submitted by Berks County doctors:

Jason T. Bundy, M.D. (Center for Pain Control)
It is well known among pain management physicians that there are few good options to treat nerve dysfunction (neuropathic) pain….The relevant literature suggests that cannabis can prove more effective in treating neuropathic pain than using higher dose opioids – all while incrementally decreasing the risk posed to patients.  Therefore, I am cautiously optimistic that cannibinoid products may help a certain subset of appropriately selected chronic pain patients.
The fact that the federal drug enforcement agency (DEA) still lists cannabis as a schedule I substance (i.e. no accepted medical use / high abuse potential) troubles me though.  Assuming Pennsylvania Senate Bill 1182 passes, I plan to educate myself more on the subject, focus on best practice consensus guidelines and be guided by the anesthesiology adage… start low and go slow… in my practice and for each patient that may receive a cannabis prescription with my DEA number on it.

Diane T. Bonaccorsi, M.D. (Green Hills Family Medicine Associates)
If marijuana remained Schedule I, I would be unable to prescribe it because schedule 1 drugs can only be used for research with a dedicated license. As you are aware, Schedule I drugs are thought to have no current accepted medical use. That being said, I believe this is an unjustified and antiquated designation….It is pretty well known that marijuana is less addictive than heroin, cocaine, caffeine, alcohol and tobacco. So why isn’t tobacco a schedule I drug?

Daniel A. Forman, D.O. (RHPN-Hematology/Oncology)

To be honest, I feel that medical practitioners are being used by those with social and economic agendas to help legalize this substance.   Also, if marijuana is legalized for “Medical Purposes,” it sends the incorrect message that this drug actually has medicinal value, and may be “good for you.” From a medical perspective, legalizing marijuana prior to having the drug proven to be safe and effective for the indications for which it is being promoted is working backwards compared to the usual regulatory process.  Marijuana should undergo the same scrutiny that other drugs go through prior to being allowed to be sold to consumers.

As an oncologist, I can see a very narrow niche for this agent in the rare patient who has neuropathic pain or anorexia not aided with currently available medications.  The patient would have to accept the significant side effects known to this class of drugs, alluded to above….I am also concerned about the fact that smoked marijuana has risks similar to those of inhaled tobacco, namely premature heart disease and cancer of the upper aero-digestive tract.  As a parent, I am concerned that the increased availability and permissiveness of this addicting substance will encourage use among teenagers and young adults, who are at increased risk for abuse and addiction as compared to older adults.

 

There are probably as many physician opinions on this subject as there are physicians in Berks County, but all share the core principles which guide the decision-making of ethical physicians.  The maxim to “first, do no harm” is inculcated into every medical student, and no drug prescription is written without a calculation of the risk of an adverse reaction relative to the risk of alternative treatments or no treatment for the problem at hand.  This is difficult enough when evidence from well-designed long-term clinical trials is available.  For at least some of the symptoms or disorders listed in SB 1182, the quality of available evidence is so poor that this calculation would better be characterized as a guess.  Further uncertainty is injected into this calculation by the fact that cannabis contains more than 400 chemicals from 18 chemical families, and that more than 2000 chemical compounds are released when it is smoked.  When you throw in the availability of different strains of cannabis, each with a different chemical profile, the reluctance of many physicians to prescribe “marijuana” without more research seems the only responsible position.

However, another core principle of medical practice is to use one’s knowledge and skills to alleviate suffering.  Indeed, the desire to relieve suffering is one of the most common motivations for pursuing a medical career.  Unfortunately, almost all physicians have the experience of caring for patients with debilitating conditions which cannot be effectively treated with currently available medication (or other treatment modalities).  If a medical marijuana law is enacted in Pennsylvania, physicians will have another treatment option which is likely to benefit some of these patients, with risks that seem to be no higher, and in some cases lower, than risks posed by a number of commonly-prescribed drugs.

###
Lucy J. Cairns, MD, is Editor of the Berks County Medical Society Medical Record. This article was also published in the Summer 2015 edition. Sara Braun Radaoui, communications major at Penn State University, contributed research for this article. (Photo by David Trawin via Flickr)

9 comments

  1. Richard Reynolds

    I am from Berks County. I have used for about a year now. I suffer from PTSD, from a triple bypass that got exposed to STAPH and MERSA, Sternal Osteomyelitis with deep wound infection. My right stomach muscle is now my breast plate. For the last 5 years I have been battling severe nerve pain and a list of problems from this medical mistake by a doctor who put dirty wires after my triple bypass. My weight for the past 5 years has been around 100lbs., and didn’t leave bed at all. Since I started smoking pot I now weigh 135 lbs. and get out of bed and eat. My usual eating prior to smoking was maybe 1 time a week. I eat every day now. I take 23 medications daily, none of which are pain medication. I don’t care what these ignorant doctors say, it most definitely works it has given me a resemblance of a better quality of life, before I just wanted to die from the feelings of nerve pain and the burning sensation of my entire chest and abdomen area, with no actual feeling. As far as the Federal classification of pot, it will also be changed. This has been bull since the Reagans made it this way. I personally have smoked pot off and on, on occasion prior to my condition and I can say I have never hallucinated or anything else resembling that. As far as a gateway drug. It is. It opens the gateway to feeling better not just on the mental level, but also the physical level, by giving a better quality of life. Also people need to look at the new Norwegian study over a period of over 30 years doctors studied people who recreationally used pot. The findings were astounding. The only bad indication was tooth decay. Doctors need to decide. They are scared to prescribe Opiates for dependency reasons, which leaves me with nothing for pain. the only real problem with pot is the fact that alternative forms are not available and it hurts my lungs to smoke it. But the future is near and other forms will be available. At this point I don’t even trust the doctors no more the level of incompetence that I have been thru because of doctors not listening to their patients, bad diagnosis’s and ignorance. Oh by the way it was passed and became effective on June 17th, 2016 in Pennsylvania.

  2. Iv been using for years for my Anxiety and ADD but got in trouble at work. but now they said no cant do this but it worked great for me for so many years now I’m on 9 different pills and I hate taking them all. and still dont feel right my head is still all messed up body feels funny went from being happy to hating life.

  3. Same old shit,if it was a war that the congress wanted, we would be there on the front line already , but something for the people there no campaine money for them ,so they don’t give a shit!,like I said,same old crap!

  4. proTHC. educated opinion

    Thc is non addictive only habbit forming if someone wants to abuse anything coffee tobacco alchohal prescription pills they will. All of these substances are more addictive and harmful than THC in any form plant pill etc… It helps people with appetites fall asleep I’m my case foxis , avoid being depressed and alleviate pain as well. Doesn’t impair motor skills but can effect social skills the pros out way the con’s nu far. And of people want to use it recreationally its still safer than any prescribed medicines or alcohol no one ever killed themselves or anyone else because they smoked a joint or ate a pot brownie come on people grow up research it live it and then vote against it. It grows natural not man made like a pill or harmful drugs like herion or crack. God or mother nature put it on this earth for a reason don’t banish it because your scared of it.

  5. well well well, i can not believe anyone here has the brazen audacity to use these words, given the condition of medicine in this country…..”first do no harm”…that creed, if Genuinely applied, which it clearly is not, would Severely limit Any Dr’s range of Safe viable prescriptions..being as most of them are Proven time and again to be Extremely dangerous and all too often deadly. Undeniable Truth.
    Somehow manage to Doubt this statement? Simple to Back it up..Just take notice how many Legitimate Massive lawsuits are currently running, and constantly springing up, brought against “bad drug” effects on patients…Do the Right thing for once, medical community…Support a Safe drug that actually Helps PEOPLE, NOT CORPORATIONS

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  7. The Pennsylvania State Nurses Association (PSNA), representing more than 215,000 registered nurses in Pennsylvania, will host a continuing education series titled “Medical Marijuana: Myths & Medicine.” This half-day event will be offered at four Pennsylvania locations – DeSales University, Wilkes University, Millersville University and Pittsburgh – between September 2014 and April 2015.

    The first of the two Fall offerings will be held Thursday, September 18, 2014 at DeSales University, Center Valley from 8:30 am to 12:30 pm. The second Fall offering will be held October 24, 2014 at Wilkes University from 8:30 am to 12:30 pm. Agenda topics include the history of marijuana, the effects of marijuana on the central nervous system, and Pennsylvania legislation related to medical cannabis.

    “Medical cannabis is a defining patient issue of our time,” stated PSNA Chief Executive Officer Betsy M. Snook, MEd, RN, BSN. “As medical cannabis changes our legislative landscape, it is the responsibility of health care professionals to be informed. This presentation provides an opportunity to explore the myths and realities at the center of this historical debate.”

    Online registration for both sessions is now open. Pricing for this event is: $35, PSNA members / $49, non-PSNA member / $20, non-licensed student. Visit http://www.psna.org/medicalmarijuana to register. This activity has been submitted to PA State Nurses Association for approval to award continuing nursing education.

    The Pennsylvania State Nurses Association (PSNA) is the non-profit voice for nurses in the Commonwealth of Pennsylvania. Representing more than 215,000 nurses, the Association works to be essential in advancing, promoting and supporting the profession of nursing to improve health for all in the Commonwealth. PSNA is a constituent member of the American Nurses Association (www.psna.org).

  8. Neil Capretto D.O.

    I would like to invite Pennsylvania Physicians and any interested health professionals to attend the annual conference of the Pennsylvania Society of Addiction Medicine [PSAM] on October 10 ,2014 at the Caron Foundation.There will be a four hour session in the morning on marijuana which will look at the issue from both a scientific and political perspective. Speakers include Pa. Senator Daylin Leach and Dr. Stuart Gitlow -President of The American Society of Addiction Medicine [ASAM]. Information regarding the conference should be available soon on the PSAM website psam-asam.org . I serve on the Board of Directors for PSAM.

  9. 1. In no medical marijuana state does a physician use a prescription pad to write a prescription for marijuana. Physicians in these states write “recommendations” for medical marijuana. It is an important distinction because physicians are not permitted to write prescriptions for Schedule I drugs.

    2. In response to California’s first in the nation modern medical marijuana law, Prop 215 which passed in 1996, the federal government did indeed try to punish any physicians who even discussed marijuana with their patients, by revoking their federal DEA license. Marcus Conant, MD challenged this federal overreach in court and was successful, even though the federal government fought this all the way to the Supreme Court. The Supreme Court let stand the appeals court Conant decision which affirmed the right of physicians to recommend marijuana for their patients. This is one of the reasons that medical marijuana laws have spread to 23 states and counting so far. Physicians’ fears of the federal government on this issue are groundless.

    3. Marijuana is arguably the most studied drug in the world, and these studies include the gold standard of scientific research, the double blind, placebo controlled clinical trials. Marijuana has been subject to more studies than many drugs that have passed FDA approval. However, the federal government continues to block large scale clinical trials of medical marijuana, so FDA approval is not possible. It does so by insisting on a monopoly of the production of federally approved marijuana and, at the same time, refusing to guarantee a consistent and reliable supply of marijuana with which to conduct these large scale trials. The DEA—federal police—currently play a large role in determining what scientific and medical studies of marijuana can be done, and they have hindered research in this area for decades. Waiting for the federal government to change its mind on this issue does a great disservice to patients who must suffer needlessly because of bureaucratic and political intransigence. I urge physicians in PA to support SB 1182.

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