On Feb. 25, the Senate State Government Committee held a public hearing on Senate Bill 3, which would legalize marijuana for medical use in Pennsylvania. As was the case with last year’s Senate hearing, the room was packed with advocates of legalization, and the bill’s prime sponsors spent a lot of time extolling the medical uses of cannabis despite a dearth of large peer-reviewed, double-blinded Phase 3 studies (medicine’s “gold standard”) documenting its safety and efficacy.
In the absence of much hard evidence, it’s understandable that the media focuses on anecdotes – assertions by individuals that marijuana has aided them or a loved one in dealing with a disease or condition. And indeed, maybe it has.
I do think marijuana may have promise in treating symptoms like epileptic seizures in children and chemotherapy-induced nausea in cancer patients. That’s why PAMED has called on the FDA to reconsider marijuana’s status as a Schedule I drug to facilitate more testing.
What troubles me, though, is that no one seems to be talking about the other side of the equation, because there is clearly a downside associated with marijuana, even for medical use.
Let’s start with side effects. Cesamet is an FDA-approved Schedule II drug that utilizes a synthetic cannabinoid to treat chemotherapy-associated nausea. A review of the risk information associated with Cesamet provided by its maker, Meda Pharmaceuticals, reveals much about the need for caution in approving marijuana for medical use.
According to Meda, Cesamet can cause patients to see and hear things that are not real and can affect a patient’s mental state. For this reason the company recommends that other drugs should be tried before Cesamet is prescribed. Further, Meda warns that Cesamet can be abused, and states that prescriptions should only last for a few days.
Smoking marijuana, which advocates would like to have included in the legislation, presents its own set of problems. According to the American Lung Association, marijuana smoke, like tobacco smoke, contains 33 cancer-causing chemicals.
Marijuana smoke also deposits tar into the lungs. Worse, the Lung Association asserts that when equal amounts of marijuana and tobacco are smoked, marijuana deposits four times as much tar into the lungs, because marijuana joints are un-filtered and often more deeply inhaled than cigarettes.
Then there’s the problem of diversion. According to a Jan. 23, 2015, Associated Press story, marijuana-related calls to poison control centers in Washington and Colorado have spiked since those states began allowing legal sales of marijuana. And while both states have now legalized recreational marijuana, the article makes it clear that in Washington those calls “began rising steadily several years ago as medical marijuana dispensaries started proliferating in the state.”
And, a 2011 Colorado study reached this disturbing conclusion: “Diversion of medical marijuana is common among adolescents in substance treatment. These data support a relationship between medical marijuana exposure and marijuana availability, social norms, frequency of use, substance-related problems and general problems among teens in substance treatment. Adolescent substance treatment should address the impact of medical marijuana on treatment outcomes.”
Another 2011 study by researchers at Columbia University showed that the odds of marijuana use were 1.92 times higher among residents of states with medical marijuana laws than in states without such laws. The odds of marijuana abuse/dependence were 1.81 times higher in states with legalized medical marijuana than in states where medical marijuana has not been legalized.
A review in the February 2015 Journal of Developmental & Behavioral Pediatrics, the official journal of the Society for Developmental and Behavioral Pediatrics, states that a growing body of evidence links cannabis to “long-term and potentially irreversible physical, neurocognitive, psychiatric, and psychosocial adverse outcomes.”
I could go on, but hopefully I’ve made my point. There is a side of medical marijuana that no one is talking about, and lawmakers need to know the whole story before they vote on a bill that goes far beyond legalizing non-psychoactive cannabidiol oil for kids with epileptic seizures.
Senate Bill 3 would allow up to 65 growers and processors to produce THC-laced edibles that could be “recommended” to patients by physicians, nurse practitioners, physician assistants, podiatrists and nurse midwives.
I’m sure there will be amendments, but I suspect that some version of Senate Bill 3 may reach Gov. Wolf’s desk this year. If so, given the known risks and lack of definitive evidence of safety and efficacy, I hope they scale it back. I don’t want to see a Pennsylvania study in a few years that finds, as the 2011 Colorado study found, that, “diversion of medical marijuana is common among adolescents in substance treatment.”
By Scot Chadwick