Medical Marijuana Legalization Issues: An Appeal for Reefer

Sanity

Kevin A. Sabet, Ph.D.

Director, Drug Policy Institute and Assistant Professor, University of Florida President, Policy Solutions Lab, Cambridge, MA www.kevinsabet.com

All or nothing?

Legalization vs. Prohibition

Ultimately the Question is:

“Is the right to get high and buy legal marijuana in a store • • profits

worth the risk

greater addiction and learning deficits to kids, society, and the economy in the form of: a new, legal industry relying on addiction for • • increased safety and health costs (like car crashes or the costs to health care and the costs of a newly regulated system) compromising our scientific system in the name of politics and medicine a la public opinion”?

Is Marijuana Medicine?

NO:

SMOKED OR INHALED RAW MARIJUANA IS NOT MEDICINE YES: THERE ARE MARIJUANA-BASED PILLS AVAILABLE AND OTHER MEDICATIONS COMING SOON

MAYBE:

RESEARCH IS ONGOING IN LOOKING AT MJ’s COMPONENTS

Bottom Line

We don ’ t smoke opium to get the effects of morphine.

So why would we smoke marijuana to get its potential medical effects?

Bypassing the FDA Process Before FDA approves a drug as medicine, testing is done to: Determine the benefits and risks of the drug Determine how it may interact with other drugs Assure standardization of the drug Determine the appropriate dosage levels Identify and monitor side effects Identify safe drug administration

FDA Determines Medicine

“ No sound scientific studies supported medical use of marijuana for treatment in the United States, and no animal or human data supported the safety or efficacy of marijuana for general medical use. There are alternative FDA-approved medications in existence for treatment of many of the proposed uses of smoked marijuana.

”

Distinction must be made between raw, crude marijuana and marijuana

’

s components So we should research marijuana

’

s components

• •

Snapshot of Promising Research: Sativex

Sativex is a drug, approved in Canada, the UK, and other parts of Europe for the treatment of MS Spasticity and Cancer Pain.

It combines THC and CBD to eliminate the “ high ” from marijuana

Current Medical Marijuana Laws

• 17 States and D.C.

• They vary in degree and implementation – Started as “ affirmative defense criminal penalties if “ medical ” ” for marijuana use for medicinal purposes; or removal of use is claimed – Evolved into state-based production and distribution • Rely not on the FDA, but unregulated businesses

State Medical Marijuana Programs Increase Drug Use

• Two independent, peer-reviewed studies looking at medical marijuana states in the 2000s concluded that:

States with medical marijuana programs had an increased in marijuana use not seen in other states

Cerda, M. et al. (2011). Medical marijuana laws in 50 states: investigating the relationship between state legalization of medical marijuana and marijuana use, abuse and dependence.

Drug and Alcohol Dependence

. Found at http://www.columbia.edu/~dsh2/pdf/MedicalMarijuana.pdf

. Wall, M. et al (2011). Adolescent Marijuana Use from 2002 to 2008: Higher in States with Medical Marijuana Laws, Cause Still Unclear,

Annals of epidemiology, Vol

21 issue 9 Pages 714-716.

Increased access and availability lead to decreased perceptions of harm and increased use

Effects of

“

Medical

”

Marijuana

• • • California Oregon Colorado

Compassionate care increased access to marijuana?

<5%

■ Less than 5% of card holders have cancer, HIV/AIDS, or life-threatening diseases ■ 90% are registered for ailments such as general pain or headaches

Compassionate care or increased access to marijuana?

>80%

■ Most card holders in CA and CO are white men between the ages of 17 and 35 ■ No history of chronic illness ■ History of Alcohol and Drug Use

•

California Profile

Average user: 32 y/o WM – No history of chronic illness – History of cocaine and alcohol use • Recent study by legalization advocates report : 44% of users received marijuana for “ headaches ” , similar number for “ exhaustion ” • Fridays at 2:00 PM – Sundays at noon: – Primary foot traffic

Oregon

• 2011: Currently 49,337 registered individuals.

• 10 physicians made 46% of all recommendations.

• There are 40 Patients under age 18.

– 19 are age 17 – – 12 are age 16 9 are under the age of 15

Colorado

Medical Marijuana Registry by Debilitating Conditions Total Conditions Severe pain 118,133 Muscle spasms 28,304 Severe nausea 15,972 Seizures 1,787 Cancer 2,646 Cachexia 1,653

Severe pain Muscle spasms Severe nausea Seizures Cancer Cachexia HIV/AIDS Glaucoma

Typical Medical Marijuana Legislation

•

Listing conditions for which marijuana can be obtained, including

“

other conditions as determined in writing...

”

Typical Medical Marijuana Legislation

•

Two tier system:

•

Marijuana Stores

•

Home-Grown Cultivation

How Much Marijuana is Medicine?

•

In MA: can possess a 60-day supply of marijuana

•

60-day supply is not defined in proposed law

• • • •

1 ounce = 60-120 joints At 3 joints/day, 1 oz. = 20 days So 60-day supply = 3 oz.

3 oz = 180-360 joints

•

Three times more than what is currently allowed in MA without arrest But it could be more – as a day

’

s supply could be 5 joints…. Or more…..

Typical Medical Marijuana Legislation

•

People could legally grow marijuana their homes.

Typical Medical Marijuana Legislation

•

Pot based products such as foods, oils, ointments, aerosols, may be legally sold as

“

medicine

”

.

Other outstanding issues

•

No expiration date or limit on renewals for “recommendations”

•

No age restrictions

•

State Government would be charged to regulate marijuana dispensaries, card registration and statewide (users/growers free to start before DPH steps in)

•

Federally Illegal System (state employees at risk of arrest)

That doesn’t mean that components in marijuana do not have medical properties.

These are being scientifically developed

.

Let’s do medical marijuana the right way

• Determine all of the medicinal compounds in the marijuana plant.

• Determine which compounds are most effective for cancer patients, which are more effective for pain management, which are most effective for treating other diseases.

• Make them available to doctors and patients legitimately, at pharmacies.

The Government Is Doing Research

• • Robust marijuana research program conducted by the US Government – Not much interest from Pharma 209 active researchers registered with DEA to perform bona fide research with marijuana, marijuana extracts, and THC.

– Every researcher who has put forth a valid research proposal has received permission to study marijuana. – Studies include evaluation of abuse potential, physical/psychological effects, adverse effects, therapeutic potential, and detection. 14 use smoked marijuana with humans

Marijuana-Based Medications

• • • NIH is responsible for research into marijuana-derived medications.

288 NIH-supported projects on cannabinoids.

Scheduling less relevant – Cocaine is Schedule II, no “Dispensaries” allowed – But it Would Be A Symbolic Victory for Advocates – Need an individual FDA-approved product for medical use

A Compassionate Access Proposal

• Before marijuana-based medications become more widely available, offer marijuana, regulated in strength, purity, and composition, to: • Cancer patients • Terminally ill • Those with MS, ALS, and AIDS whose bona fide physicians have recommended marijuana because other medications have not worked

What is this really about?

• 1978: Keith Stroup “We are trying to get marijuana reclassified medically. If we do that, (we'll do it in at least 20 states this year for chemotherapy patients) we'll be using the issue as a red herring to give marijuana a good name.” • 2012: MASSCANN/NORML spokesman: “Stepping stone to legalization? I hope so. That’s the plan. Decrim 2008, Medical 2012, Legal 2016. Yes we want to legalize! We will completely legalize for everybody in 2016.”

Marijuana is NOT approved as medicine by:

•

The FDA

•

The American Medical Association

•

The National Multiple Sclerosis Society

•

The American Glaucoma Society

•

The American Academy of Ophthalmology

•

The American Cancer Society

•

The American Pediatric Society

•

The Massachusetts Medical Society

T

HANK YOU

!

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