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Medical Marijuana: What No One is Talking About

medical marijuanaOn 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

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Scot Chadwick is the legislative counsel at the Pennsylvania Medical Society. He can reached at schadwick@pamedsoc.org, or (717) 558-7814.

(Photo by David Trawin via Flickr)

20 comments

  1. This is such bull, cigs cause cancer because of radio active chemicals used to grow it. If cannabis is so dangerous, where are the marijuana only cancer patients, emphazyma, or lung disease patients? You have none! You cant show us one single case! If someone did exist, they would be the drug free america poster child. Where the hell is your poster child? Drug free america heavily funded by anhieser busch by the way.

  2. The reason these doctors have a problem with medical marijuana is that they will no longer be getting any kick backs from Big Pharma for prescribing their drugs because MJ can replace many of them. Especially the HIGHLY addictive pain medications like Oxycontin, which is an opioid.

    How hypocritical is it that it’s legal to prescribe that dangerous drug, yet they have a problem with MJ which is MUCH safer. Could it be that it cuts into Big Pharma’s profits.

  3. “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.”

    Yet, according to the best research yet done, pot smokers actually have lower rates of lung cancer than non-smokers. Google “Donald Tashkin, marijuana lung cancer”.

    This author didn’t bother to do any real research on this topic before he wrote.

  4. So, tell us Doc, do you support jailing your patients who don’t agree with you?

    There is a greater point here. The greater point is that there is no productive purpose in punishing anyone who has harmed no one but themselves — even if you disagree with their choice of medicine.

    The first rule of medicine is “First – Do no harm.” Even if you think the marijuana is not good for them, punishing them doesn’t produce anything but harm. Any doctor who thinks that patients should be punished when they have harmed no one but themselves is not fit to have a medical license.

  5. The question of what to do about drugs is not a new one. Over the last 100 years there have been numerous major government commissions around the world that have studied the drug laws and made recommendations for changes. You can find the full text of all of them at druglibrary.org/schaffer under Major Studies of Drugs and Drug Policy.

    They all reached remarkably similar conclusions, no matter who did them, or where, or when, or why. They all agreed that the current laws were based on ignorance and nonsense, and that the current policy does more harm than good, no matter what you assume about the dangers of drugs. You don’t have to take my word for that. Read them yourself.

    If you are new to the collection, start with Licit and Illicit Drugs at druglibrary.org/schaffer. That is the best overall review of the drug problem ever written. If you only read one book on the subject, make it that one. It will give you a good summary of what you would learn if you read all the other major reports.

    In 1973, President Nixon’s US National Commission on Marihuana and Drug Abuse completed the largest study of the drug laws ever done. At the end of their study, they said the real drug problem was not marijuana, or heroin, or cocaine. The real drug problem, they said, was the ignorance of our public officials who keep spouting off with solutions but have never read the most basic research on the subject.

    In a perfect illustration of their point, Nixon refused to read his own commission’s report.

  6. Marijuana was outlawed for two major reasons. The first was because “All Mexicans are crazy and marijuana is what makes them crazy. The second was the fear that heroin addiction would lead to the use of marijuana – exactly the opposite of the modern “gateway” nonsense.

    Only one MD testified at the hearings for the Marihuana Tax Act of 1937. The representative of the American Medical Association said there was no evidence that marijuana was a dangerous drug and no reason for the law. He pointed out that it was used in hundreds of common medicines at the time, with no significant problems. In response, the committee told him that, if he wasn’t going to cooperate, he should shut up and leave.

    The only other “expert” to testify was James C. Munch, a psychologist. His sole claim to fame was that he had injected marijuana directly into the brains of 300 dogs and two of them died. When they asked him what he concluded from this, he said he didn’t know what to conclude because he wasn’t a dog psychologist. Mr. Munch also testified in court, under oath, that marijuana could make your fangs grow six inches long and drip with blood. He also said that, when he tried it, it turned him into a bat. He then described how he flew around the room for two hours.

    Mr. Munch was the only “expert” in the US who thought marijuana should be illegal, so they appointed him US Official Expert on marijuana, where he served and guided policy for 25 years.

    If you read the transcripts of the hearings, one question is asked more than any other: “What is this stuff?” It is quite apparent that Congress didn’t even know what they were voting on. The law was shoved through by a small group of lunatics with no real awareness by anyone else of what was happening.

  7. “what no one is talking about”….

    Really? Prohibitionists and people in ‘legislative’ positions have been talking about MARIJUANA DANGER! forever. It’s bull. It’s a means to keep something illegal. These people want everyone to know that they don’t smoke marijuana, and that they ‘just don’t approve of ‘drugs”. Of course, if it’s a ‘drug’ that some pharmaceutical company is making crazy money off of, that’s a different story.

    Don’t worry about the things that ‘no one is talking about’, because chances are, there’s a reason no one is talking about it. And chances are, that reason is, they are lies.

    These prohibitionist talk as if the whole world has decided that marijuana is just completely harmless, when that’s NOT what activists are saying. No one is saying pot is completely and totally without harm. What we’re saying is, pot is nowhere near as dangerous as alcohol and tobacco and that as such, Americans should be able to choose to use it instead of these other substances. Yeah, we know, that ideally, all you lawmakers would just prefer that the American public do what you say, not think for themselves, and just not put anything in their bodies that you don’t approve of. Only problem is, Americans have reached the age of enlightenment over their govt. They will no longer blindly accept what the govt tries to force feed them, and with social media now keeping everyone connected to a central collective consciousness, we are able to dissect the BS coming from ‘legislative counsel’ across the globe.

  8. I don’t want to see a Pennsylvania study in a few years that says we are now ranked #1 in opioid overdoses in the country. It’s sad that we are 7th now. A synthetic form is not how our mighty God intended cannabis be used. Please stop thinking that people actually believe this propoganda you speak just because of your title. God bless PA and senate bill 3 to bring true compassion and healing to the keystone state.

  9. The purpose of legalization is to get pot sales and distribution out of the amoral hands of gangsters and abusers and put it under the control of responsible regulated adult supervision. If this article is to be believed responsible, democratically regulated, adult supervision of pot markets does not work as well as gangsters and abusers on street corners at keeping pot out of the hands of kids.

  10. Nobody can deny the Medical effectiveness of Medical Marijuana. Below is a small sampling of Professional Medical Organizations Worldwide that attest to Medical Marijuana’s effectiveness and Support Legal Access to and Use of Medical Marijuana. . Along with over 20 U.S states that have legalized medical marijuana.

    Are they ALL wrong?

    International and National Organizations

    AIDS Action Council
    AIDS Treatment News
    American Academy of Family Physicians
    American Medical Student Association
    American Nurses Association
    American Preventive Medical Association
    American Public Health Association
    American Society of Addiction Medicine
    Arthritis Research Campaign (United Kingdom)
    Australian Medical Association (New South Wales) Limited
    Australian National Task Force on Cannabis
    Belgian Ministry of Health
    British House of Lords Select Committee on Science and Technology
    British House of Lords Select Committee On Science and Technology (Second Report)
    British Medical Association
    Canadian AIDS Society
    Canadian Special Senate Committee on Illegal Drugs
    Dr. Dean Edell (surgeon and nationally syndicated radio host)
    French Ministry of Health
    Health Canada
    Kaiser Permanente
    Lymphoma Foundation of America
    The Montel Williams MS Foundation
    Multiple Sclerosis Society (Canada)
    The Multiple Sclerosis Society (United Kingdom)
    National Academy of Sciences Institute Of Medicine (IOM)
    National Association for Public Health Policy
    National Nurses Society on Addictions
    Netherlands Ministry of Health
    New England Journal of Medicine
    New South Wales (Australia) Parliamentary Working Party on the Use of Cannabis for Medical Purposes
    Dr. Andrew Weil (nationally recognized professor of internal medicine and founder of the National Integrative Medicine Council)

    State and Local Organizations

    Alaska Nurses Association
    Being Alive: People With HIV/AIDS Action Committee (San Diego, CA)
    California Academy of Family Physicians
    California Nurses Association
    California Pharmacists Association
    Colorado Nurses Association
    Connecticut Nurses Association
    Florida Governor’s Red Ribbon Panel on AIDS
    Florida Medical Association
    Hawaii Nurses Association
    Illinois Nurses Association
    Life Extension Foundation
    Medical Society of the State of New York
    Mississippi Nurses Association
    New Jersey State Nurses Association
    New Mexico Medical Society
    New Mexico Nurses Association
    New York County Medical Society
    New York State Nurses Association
    North Carolina Nurses Association
    Rhode Island Medical Society
    Rhode Island State Nurses Association
    San Francisco Mayor’s Summit on AIDS and HIV
    San Francisco Medical Society
    Vermont Medical Marijuana Study Committee
    Virginia Nurses Association
    Whitman-Walker Clinic (Washington, DC)
    Wisconsin Nurses Association

    Additional AIDS Organizations

    The following organizations are signatories to a February 17, 1999 letter to the US Department of Health petitioning the federal government to “make marijuana legally available … to people living with AIDS.”

    AIDS Action Council
    AIDS Foundation of Chicago
    AIDS National Interfaith Network (Washington, DC)
    AIDS Project Arizona
    AIDS Project Los Angeles
    Being Alive: People with HIV/AIDS Action Committee (San Diego, CA)
    Boulder County AIDS Project (Boulder, CO)
    Colorado AIDS Project
    Center for AIDS Services (Oakland, CA)
    Health Force: Women and Men Against AIDS (New York, NY)
    Latino Commission on AIDS
    Mobilization Against AIDS (San Francisco, CA)
    Mothers Voices to End AIDS (New York, NY)
    National Latina/o Lesbian, Gay, Bisexual And Transgender Association
    National Native American AIDS Prevention Center
    Northwest AIDS Foundation
    People of Color Against AIDS Network (Seattle, WA)
    San Francisco AIDS Foundation
    Whitman-Walker Clinic (Washington, DC)

    Other Health Organizations

    The following organizations are signatories to a June 2001 letter to the US Department of Health petitioning the federal government to “allow people suffering from serious illnesses … to apply to the federal government for special permission to use marijuana to treat their symptoms.”

    Addiction Treatment Alternatives
    AIDS Treatment Initiatives (Atlanta, GA)
    American Public Health Association
    American Preventive Medical Association
    Bay Area Physicians for Human Rights (San Francisco, CA)
    California Legislative Council for Older Americans
    California Nurses Association
    California Pharmacists Association
    Embrace Life (Santa Cruz, CA)
    Gay and Lesbian Medical Association
    Hawaii Nurses Association
    Hepatitis C Action and Advisory Coalition
    Life Extension Foundation
    Maine AIDS Alliance
    Minnesota Nurses Association
    Mississippi Nurses Association
    National Association of People with AIDS
    National Association for Public Health Policy
    National Women’s Health Network
    Nebraska AIDS Project
    New Mexico Nurses Association
    New York City AIDS Housing Network
    New York State Nurses Association Ohio Patient Network Okaloosa AIDS Support and Information Services (Fort Walton, FL)
    Physicians for Social Responsibility – Oregon
    San Francisco AIDS Foundation
    Virginia Nurses Association
    Wisconsin Nurses Association

    Health Organizations Supporting Medical Marijuana Research

    International and National Organizations

    American Cancer Society
    American Medical Association
    British Medical Journal
    California Medical Association
    California Society on Addiction Medicine
    Congress of Nursing Practice
    Gay and Lesbian Medical Association
    Jamaican National Commission on Ganja
    National Institutes of Health (NIH) Workshop on the Medical Utility of Marijuana
    Texas Medical Association
    Vermont Medical Society
    Wisconsin State Medical Society

  11. Not studied long enough, you claim? Did you know Marijuana is perhaps the most studied therapeutic substance on Earth? It’s true:

    “Despite the US government’s nearly century-long prohibition of the plant, cannabis is nonetheless one of the most investigated therapeutically active substances in history. To date, there are over 20,000 published studies or reviews in the scientific literature referencing the cannabis plant and its cannabinoids, nearly half of which were published within the last five years according to a keyword search on PubMed Central, the US government repository for peer-reviewed scientific research. Over 1,450 peer-reviewed papers were published in 2013 alone. (By contrast, a keyword search of “hydrocodone,” a commonly prescribed painkiller, yields just over 600 total references in the entire body of available scientific literature.)”

    Let’s Open Our Eyes, End The Lies, and Legalize Nationwide!

  12. Why isn’t anyone talking about the dangers of Tylenol? Google “death by tylenol poisoning” Three times the normal. dose of tylenol, which is easy to take by mistake because so many over the counter medications contain tylenol as one of their ingredients, leads to an incredibly painful death by liver failure. If you have three or more drinks a day, even a normal dose of Tylenol or a very small overdose can lead to painful death by liver failure.

    Why isn’t the good doctor talking about he dangers of Alcohol, which kills so many Americans every year?

    Medical Marijuana is a “Wonder Drug” and a “Gift from God” for Cancer patients, and there are multiple biologically active compounds in it that work together, and work far better than synthetic alternatives, and its physically impossible to overdose on Marijuana.

    The question isn’t “Should Marijuana be legalized?” The question is, “Since Marijuana is so much safer than any other medication that treats the conditions it helps with, why isn’t it “front line therapy?”

    Please call the white house comment line at (202) 456-1111 and ask that President Obama get Marijuana removed from Schedule 1 TODAY.

  13. You say “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 documenting its safety and efficacy”. Several times during the hearing Senator Folmer mentioned that he had 300 studies that he offered to the doctors from the PA Medical Society, but they weren’t interested. I’m sure he’d provide them to you if you’d ask.
    You and the doctors believe that marijuana may have promise in treating symptoms, but rather than helping to get this substance into the hands of people who need it, you’d rather take the safe & easy way out by making the big, bold statement that the “FDA (should) reconsider marijuana’s status as a Schedule I drug to facilitate more testing”. WOW, way to go to bat for the patients!
    You say, “that no one seems to be talking about the other side of the equation”. Well, we are and have been. We’ve educated ourselves to the risks of medical cannabis and came to the conclusion that it is FAR SAFER for us than the FDA approved synthetic medications that our doctors have been prescribing for us and have caused us real and permanent harm. We are asking for a system whereby our medical professionals can recommend medical cannabis in a compassionate use scenario, where we accept that it is not FDA approved and we accept the risks, just like is done when our doctors recommend a certain diet, vitamins and supplements – all of which are not FDA approved.
    Then you try to make the case for the “dangers” of medical cannabis by talking about the synthetic drug Cesamet. If you want to talk about the expansive dangers of FDA approved synthetic drugs, be very careful, the Internet is only so big.
    Then you want to scare us with the dangers of smoking cannabis, which is not the preferred method of inhalation of medical cannabis. But since you are apparently in the mood to talk about the other side of the equation, I find it odd (but not surprising) that you only focus on the negative, and misleading, aspects of smoking. You fail to mention that various studies found the following:
    – that cannabis exposure was not associated with FEV1 (forced expiratory volume) decline or deleterious change in spirometric values of small airways disease (Feb 2015, Emory University in Atlanta, reported in Annals of the American Thoracic Society)
    – A separate study published in 2012 in The Journal of the American Medical Association (JAMA) similarly reported that cumulative marijuana smoke exposure over a period of up to 7 joint-years (the equivalent of up to one marijuana cigarette per day for seven years) was not associated with adverse effects on pulmonary function.
    – A 2013 review also published in the Annals of the American Thoracic Society acknowledged that marijuana smoke exposure was not positively associated with the development of lung cancer, chronic obstructive pulmonary disease (COPD), emphysema, or bullous lung disease.
    And of course a “Sky Will Fall” article about any relaxation of cannabis laws would not be complete without a review of how our kids will be harmed. SB3 will institute a regulated program to allow for sick and suffering Pennsylvanians to obtain and use medical cannabis as recommended by their medical professional. It is not recreational marijuana legislation. And if medical cannabis is finding its way into the hands of kids in substance treatment in Colorado, then maybe they need to tighten up their regulations or improve their educational programs. The fact that there are occasional misuses in some programs should not be a reason to withhold a proven treatment for our citizens.
    I don’t want to see a Pennsylvania study in a few years that finds that lives were lost and needless suffering continued because we decided to wait to institute a medical cannabis program until every conceivable study was completed and we were absolutely assured that there would never be an abuse of the program. SB3 has been hailed as among the best medical cannabis legislation in the country. We cannot afford to continue to wait to use a substance that has been used safely and with efficacy for millenia.

  14. The PMS position makes no sense. Why would an organization representing physicians ask the state legislature to decide what they can recommend to patients? SB3 does not require physicians to recommend cannabis for any patients. Does the PMS not trust its members to make the right decisions for their patients?

    When something doesn’t make sense, follow the money. Are these doctors afraid they will lose the pharmaceutical perks when patients find relief from cannabis?

  15. A somewhat one sided article in my opinion. Yes, there may be increased marijuana use, but this is usually accompanied by lower use of pain killers and alcohol. Because of this, states that have legalized it are seeing 8% drops in fatal traffic accidents, so legalization may save lives.

    Because people smoke 3-4 joints a week, rather than 20-40 a day, as with cigarettes, most research seems to only show a possible increased cancer risk in heavy marijuana smokers. This can easily be avoided by vaporizing.

    I am opposed to marijuana candy and treats that some states allow due to their appeal, and thus possible ingestion, by children.

    I agree that marijuana use is bad for adolescents and there should be an age limit.

    A look at the country as a whole and the sentiments I believe legalization is only a matter of time.

  16. You are part of the misinformation problem Scot Chadwick!

    80 adolescents (15-19 years) in outpatient substance treatment in Denver, Colorado, completed an anonymous questionnaire developed for the study and the Drug Use Screening Inventory-Revised (DUSI-R).

    So sound science is in sample sizes of 80 subjects limited to one geographic location and is questionairre-based, not observed in any way, shape, or form?

  17. This is just typical. The Pennsylvania Medical Society can’t deny the hard proof anymore. This is ludicrous.

    First of all, who paid for this study, Scot? Secondly, synthetic cannabis is not real cannabis. Please stop overlooking the obvious.

  18. You say that no one is talking about the dangers associated with marijuana, but that is all we’ve heard for decades. If you will do a review of more recent studies, you’ll find that only 9% of marijuana users are “addicted” to marijuana. You’ll also find that the IQ studies have been reviewed, and if alcohol is taken into consideration, there is no reduction in IQ associated with marijuana use. The problem lies in the fact that the dangers have been rigorously studied, while the benefits have been vastly ignored. For instance, there was a 30yr NIDA study that found no link between marijuana smokers and a increased risk of cancer. We worry about protecting the “children”, that is until they grow up and then we say f*** them, and throw them in jail. The madness lies more with the prohibitionists than with the weed smokers. The prohibitionists have their head so far up their a** that they refuse to listen to anything that is contrary to their “beliefs” which in many cases is based on false premises. Legalize it and let’s get some sanity in the discussion. This problem is like the Chinese finger puzzle. The harder you pull, the more trapped you get. Regulation is the only answer to this problem.

    • Fear of Medical Marijuana Legalization is unfounded. Not based on any science or fact whatsoever.

      So please, all prohibitionists, we beg you, give your scare tactics, “Conspiracy Theories” and “Doomsday Scenarios” over the inevitable Legalization of Medical Marijuana a rest. Nobody is buying them anymore these days. Okay?

      Furthermore, if all prohibitionists get when they look into that nice, big and shiny crystal ball of theirs, while wondering about the future of Medical Marijuana Legalization Nationwide, is horror, doom, and despair, well then I suggest they return that thing as quickly as possible and reclaim the money they shelled out for it, since it’s obviously defective.

      The prohibition of marijuana has not decreased the supply nor the demand for medical marijuana at all. Not one single iota, and it never will. Just a huge and complete waste of our tax dollars to continue criminalizing sick patients and senior citizens in pain for choosing a natural, non-toxic, relatively benign plant proven to be much safer than daily handfuls of deadly, toxic, man-made, highly addictive, narcotic pain pills and other pharmaceuticals.

      If prohibitionists are going to take it upon themselves to worry about “saving us all” from ourselves, then they need to start with the drug that causes more death and destruction than every other drug in the world COMBINED, which is alcohol!

      Why do prohibitionists feel the continued need to vilify and demonize marijuana when they could more wisely focus their efforts on a real, proven killer, alcohol, which again causes more destruction, violence, and death than all other drugs, COMBINED?

      Prohibitionists really should get their priorities straight and or practice a little live and let live. They’ll live longer, happier, and healthier, with a lot less stress if they refrain from being bent on trying to control others through Draconian Marijuana Laws.

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