Lisa Barton called me recently to say she opposes Question 3 and to volunteer to help. She said she was “Connor’s mom’’ and said her son died suddenly and tragically at the Comcast Center this summer from drug use. Lisa emphasized that marijuana was at the heart of Connor’s problems. “It’s really strong – not like marijuana years ago,’’ she said.
As a licensed physician in Massachusetts, trained in family medicine, sports medicine, and addiction medicine, Question 3 puts me in a mess: I am supposed to make a professional judgment about whether the benefits of using marijuana outweigh the risks for a particular patient and then provide written certification. Several problems exist.
One, as the proponents agree, marijuana is a soup of a hundred or so active cannabinoid compounds along with several hundred additional compounds. Many of the cannabinoids, particularly THC, are psychoactive and responsible for the addiction we see in about 10 percent of those who use. As a result of an expose of patent medicines in 1905-1906, we have developed a system for assuring the safety and effectiveness of prescription medicines to protect us from such “soup.’’ Today, the Food and Drug Administration is responsible for evidence-based testing of potential medicines.
Two, since marijuana is a soup, the FDA will not approve it because the dose of each of the hundreds of components cannot be standardized from one inhalation or ingestion to another, from one preparation to another, or from one person to another.
That’s not surprising – what we want in the U.S. is to have prescription medicine that is a pure component (or two), purified and standardized to determine a dose that’s safe and effective, and to characterize potential side effects and adverse reactions.
The FDA does that, and that lets me make a professional judgment about recommending a medicine for a patient. There’s no question that components of the marijuana soup have great potential medicinal value. Two medications, dronabinol and nabilone, both purified THC, have been available for over a decade, and I have prescribed both of them. Another medication, a combination of THC and cannabidiol sold under the trade name Sativex, is in Phase III FDA trials and approved for prescription use in Canada and many European countries. I expect the FDA will approve Sativex in 2013 with clinical indications for treating the spasticity of multiple sclerosis and, perhaps, neuropathic pain.
Three, we get prescription medicines at a retail pharmacy from a pharmacist who has a pharmacy degree and is licensed by the state. The pharmacist works with the prescribing physician to ensure the medication is the right dose and can identify and explain drug interactions and side effects. Question 3 requires only that the person working in a marijuana retail store be at least 21 years old and not have been convicted of a drug-related felony. A caregiver — someone authorized to obtain marijuana from a dispensary on behalf of a person certified under the law to use the drug — needs to be at least 21 but no criminal records check is needed.
Four, the definition of “debilitating medical condition’’ offers a list of nine diagnoses so broad in scope as to be clinically useless. More worrisome is the final phrase: “and other conditions as determined in writing by a qualifying patient’s physician.’’
This is the loophole in California and Colorado that has led to hundreds of thousands receiving “medical’’ marijuana for treatment of hundreds of diagnoses from patchy baldness to writer’s cramp!
As an addiction physician, I am concerned about the diversion of prescription drugs. In Massachusetts the explosion of the narcotics supply, associated with increased pressure to treat pain more aggressively coupled with the decreased sense of risk related to these drugs prescribed by a physician, has led to greater use by our young people. Our response was to create the Prescription Monitoring Program in 2010.
The program requires pharmacists to report all scheduled medications they dispense: how much, to whom, and from which doctor. It has been successful at detecting diversion and was strengthened by legislation signed into law in August.
Question 3 does NOT mention the PMP at all — even though physicians regard marijuana as a psychoactive drug that should be scheduled. Rather, proponents allege that the initiative includes a “best practices’’ registry — but a close reading reveals the only mention is in Section 15 and describes “a confidential list of the persons issued medical marijuana registration cards’’ with no mention of who signed the credential, for what condition, when marijuana is dispensed, how often, and how much.
The result of this initiative is precisely the same as with narcotics: a dramatic increase in the supply and a decreased perception of risk that will lead to the same result, more use by our young people. Indeed the decriminalization law passed in 2008 caused a decreased perception of risk, and Prevention Alliances in Northampton and Wayland measured significant increases in marijuana use by high-school students in the past four years.
Information available about diversion of “medical’’ marijuana in Colorado includes data on teenagers in active treatment for marijuana addiction. Patients were asked how they obtained marijuana, and 74 percent reported they got it from people who received it as “medical’’ marijuana, indicating a ready and steady supply of diverted high-grade marijuana.
As a citizen, I am concerned that Question 3 does not specify that physicians must be licensed in Massachusetts; that workplaces, schools, youth centers, and correctional facilities cannot prohibit marijuana use but only do not have to provide “accommodation’’ (Americans with Disabilities Act language) for marijuana use; that no protections exist for hospitals, nursing homes, rehabilitation facilities, drug treatment facilities or smoke-free housing; that, regardless of this initiative, marijuana will remain illegal under the federal Controlled Substances Act, and landlords and property owners could lose their homes and that physicians could lose their licenses.
I’ve had many calls objecting to my opposition to Question 3, many saying no one dies from marijuana and that “it’s safer than alcohol.’’ If that’s the case then let’s have a debate about legalizing this drug – which IS the agenda of Peter Lewis, the retired Ohio Progressive Insurance Company billionaire who has poured over $1 million into Massachusetts to convince you to support this sham of “medical’’ marijuana.
As for people dying, ask Lisa Brandon about Connor.