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Medical Marijuana: The Local Debate

September 26, 2014  |  Falmouth Enterprise

Dr. Michael Bihari

In 1972 as part of the “war on drugs” Congress placed marijuana in Schedule I of the Controlled Substances Act because the drug was considered to have "no accepted medical use." Since then, 23 of 50 states and DC have legalized the medical use of marijuana and two states have approved the recreational use of marijuana.

Earlier this week, members of the Massachusetts Patient Advocacy Alliance  (MPAA) and medical marijuana advocates from around the state of Massachusetts held a press conference to draw attention to the state’s failure to implement the medical marijuana program approved by the voters.

According to a press release from the MPAA prior to the event, “Massachusetts citizens with a wide range of qualifying conditions will be speaking, including individuals with conditions such as seizure disorders, cancer, multiple sclerosis (MS) and severe chronic pain.

The patients speaking will focus on both how the implementation of the law so far as been too slow and too prohibitive for many patients as well as on how the state program can move forward.” 

The Massachusetts medical marijuana program, which was scheduled for implementation earlier this year, will most likely not begin serving patients until sometime in 2015. And when the state’s marijuana dispensaries do open, the initial number of facilities will be 11, not the projected 20, after the state disqualified nine previously approved applicants.

The state cited a number of different violations including “questionable corporate structures”, “diverting revenues”, “misrepresenting local support”, and failing to mention “one investor’s drug conviction.”

Whether you’re for or against it, the decision by state officials represents a predicament for patients in need of medical marijuana. Because of the state’s decisions, the cannabis supply in Massachusetts got cut in half, the wait got much longer, and obtaining medical marijuana will now be much more difficult.

Pros and Cons

According to ProCon.org, a nonpartisan, nonprofit website that presents research, studies, and pro and con statements on questions related to whether or not marijuana should be a medical option:

“Proponents of medical marijuana argue that it can be a safe and effective treatment for the symptoms of cancer, AIDS, multiple sclerosis, pain, glaucoma, epilepsy, and other conditions. They cite dozens of peer-reviewed studies, prominent medical organizations, major government reports, and the use of marijuana as medicine throughout world history.”

“Opponents of medical marijuana argue that it is too dangerous to use, lacks FDA-approval, and that various legal drugs make marijuana use unnecessary. They say marijuana is addictive, leads to harder drug use, interferes with fertility, impairs driving ability, and injures the lungs, immune system, and brain. They say that medical marijuana is a front for drug legalization and recreational use.”

Local Physicians Not Getting Involved

In 2012, the Massachusetts Medical Society (MMS) with more than 24,000 members, issued the following policy statement, “That until such time as marijuana is approved for use by the Food and Drug Administration and is no longer classified in schedule I by the Drug Enforcement Administration, the MMS cannot support legislation intended to involve physicians in certifying, authorizing, or otherwise directing persons in the area of medicinal marijuana outside of scientific clinical trials.”  The vast majority of physicians practicing on Cape Cod have decided not to be certified by the state to write prescriptions for medical marijuana.

With 15,000 patients, the Community Health Center of Cape Cod (CHC), with offices in Mashpee, Falmouth, and Bourne is one of the largest providers of primary healthcare in the region. The health center recently sent a newsletter to its patients that included an article about CHCCC’s stance on medical marijuana. That article, Alternatives to Medical Marijuana, is excerpted below:

For virtually every condition for which medical marijuana is touted, there is a medication with an established track record. 

The use of medical marijuana is a hot topic on Cape Cod and feelings are strong on both sides of the issue. For community health centers, though, the issue is cut and dry: under federal law marijuana is illegal and since CHC receives federal funding, providers are prohibited from certifying patients to use it. To do so would jeopardize that funding, which is essential to CHC’s operations.

Chief Medical Officer David Tager, MD explains that even if there was no federal ban, CHC providers are not convinced of the efficacy of medical marijuana at this time. “The evidence is just not clear on its usefulness or possible downsides,” he says. “These can include side-effects, interactions with other drugs, and the potential for abuse and addiction.” Although there are studies that show that the active ingredient in marijuana, tetrahydrocannabinol, or THC, does offer some medical benefits to stimulate appetites, reduce nausea, and lower eye pressure related to glaucoma, this drug is already available for use.

So, how does CHC help patients who are looking for help in managing symptoms and side effects of certain medical conditions? “As a patient -centered medical home,” Dr. Tager says, “we bring a coordinated,’ whole-person’ approach to the medical, behavioral health, and pharmacological issues our patients face.”

First, alternative medications. There are proven, safe options. For virtually every condition for which medical marijuana is touted, there is a medication with an established track re- cord. For example, for a patient dealing with muscle spasticity from multiple sclerosis, there is Baclofan. For someone experiencing nausea from chemo- therapy, Zofran is prescribed. And, Megace is very effective in stimulating appetites in people with HIV and arthritic disease.

Second, behavioral health support. Many people with chronic conditions experience anxiety and depression, and understandably so. CHC’s behavioral health counselors can offer non-drug treatments such as cognitive behavioral therapy, stress management and relaxation techniques, and individual and group counseling to help patients cope with the medical and lifestyle issues they face. None of these have the potential for a harmful interaction with another medication the patient may be taking!

Third, medication management. Patients with chronic health conditions often rely on several different medications to properly manage their health. CHC pharmacists and providers work closely to resolve medication questions and make sure that there are no dangerous interactions.

Dr. Tager acknowledges that the issue is here to stay. More study is needed to be definitive on either side of the issue. In the meantime, he is confident that CHC and other community health centers offer effective, safe, and evidence-based options to help patients manage their conditions.

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