Medical marijuana

Moderated by Tom Sabulis

Today, we offer the second of a two-part series on medical marijuana. A law professor specializing in forensic medicine writes about factors complicating the decriminalization of medical marijuana in Georgia, called for in HB 1 (a gutted version of the original bill that endorsed growing and regulating the plant in Georgia). A doctor outlines current research that can guide the state. And an advocate endorses the senate bill calling for full legalization, saying it’s the fastest way to help families with members enduring seizure-related illnesses.

Politics mixing with medicine

By Jessica D. Gabel

Medical marijuana is an oft-debated and polarizing subject. It inspires images of everything from a drive-thru dispensary on a sunny California beach to an ailing cancer patient desperately seeking a reprieve from the effects of chemotherapy.

For my own part, I have no dog in the fight. To me, the real question is simple “what does the science tell us?” As with most pharmacy-grade medicines, we should be looking to studies, clinical trials, and research to objectively assess the benefits of treatment against the possible harmful effects.

More than a dozen states now legalize the medical use of marijuana, and a few (most notably Colorado) permit recreational uses without a prescription. Some states narrow the list of conditions that qualify for a marijuana prescription while others are far more liberal defining the boundaries of medical use.

Many of these laws came to be through ballot measures sent to voters or through the state legislative process. This is an extremely unconventional method of making assessments about medicine. Pharmaceuticals are generally approved for medical use through scientific research, development and clinical trials.

Imagine if drugs as common as Prozac or Adderall or even Oxycontin became available only through a political process. We would condemn such practices as frustrating the advancement of medicine and technology.

A bill is now pending that would decriminalize medical marijuana in Georgia, but it comes with two unavoidable and politically-motivated obstacles: (1) no one in Georgia can legally grow it; and (2) federal law still views marijuana as an illegal substance. The practical effect is that patients must leave Georgia to obtain medical marijuana and the movement of marijuana across state lines is a technical violation of federal law.

To be clear, the chances of a federal prosecution for possession of medical marijuana are slight, but the risk cannot be utterly ignored. In the past, the Supreme Court has told us that medical necessity is not a defense to federal drug charges related to medical marijuana. In another case, the Supreme Court concluded that federal law trumps state law even when cultivation and possession of medical marijuana does not cross state lines.

This means that someone can be charged with federal crimes even if he or she is obeying state regulations, and by leaving a gaping hole in the Georgia legislation, that is the risk that exists. It is, perhaps, the price of doing business.

Of course, at the federal level, Congress possesses the power to reclassify marijuana, but by listing marijuana as a “Schedule I” drug, the federal government disavows any medical benefit from marijuana. This decision is political and not scientifically defensible. Even the Georgia Legislature noted that the medicinal purposes of marijuana have been known for thousands of years. But as it stands, medical marijuana policy is the fragmented byproduct of political negotiation rather than sound science and medicine.

There are many issues when it comes to crafting an appropriate medical marijuana policy. It seems to me that the easiest ones — like access for the patients who need it and the economics of decriminalizing it — are the ones bogged down the most by politics.

Unfortunately, this prevents us from reaching the more difficult issues: who gets to use medical marijuana (qualifying conditions, patient age, responsiveness to conventional treatments), efficacy studies, and long-term consequences. We cannot seriously approach evidence-based medicine in the case of marijuana unless we can move past the territorial puffery.

Professor Jessica D. Gabel teaches forensic medicine at Georgia State University College of Law.

Gathering research to guide state

Manoj. H. Shah

The Medical Association of Georgia (MAG) supports the use of marijuana in strictly controlled medical research programs for patients who have cancer or glaucoma or who suffer from seizures as a result of refractory epilepsy.

This is an important issue for MAG, which is the leading voice for the medical profession in Georgia with more than 7,500 member physicians who represent every specialty and practice setting in the state.

MAG appreciates the steps that lawmakers in Georgia are taking to reach out to physicians as they craft legislation to address medical marijuana. We also applaud them for seeking solutions for the patients and family members who have to cope with these serious medical conditions on a daily basis.

The medical profession does not have any definitive, black-and-white research (i.e., evidence) when it comes to the efficacy of medical marijuana.

Our policy is based on “uncontrolled” research that suggests that there is a good chance that cannabidiol – an ingredient in the marijuana plant that does not get the patient high – may provide some patients with some health benefits (e.g., ameliorating epilepsy in children).

Unfortunately, more comprehensive studies simply aren’t available because, at least in part, the U.S. Food and Drug Administration has classified every cannabinoid as a controlled substance (i.e., it has been illegal).

The landscape is changing as a result of several key developments. First, President Obama has signed an executive order that cleared the way for clinical research to take place in academic settings (i.e., the federal government won’t actively enforce the law). Second, a number of states have passed laws to decriminalize or legalize cannabinoidal products.

Because a physician can’t legally “prescribe” a cannabidiol to a patient today as a result of the aforementioned FDA classification, these products could end up being classified as supplements. MAG consequently believes that the state should regulate the quality of the products that are used in clinical trials to safeguard patients. MAG is also calling for product labels that include dose and composition and purity information.

Clinical trials are already underway with pediatric neurology patients in Atlanta, and Georgia Regents University will begin two cannabinoid trials for patients who have refractory epilepsy later this year.

MAG will be focused on ensuring that the products that are used in these trials are truly safe for patients. In addition, we will monitor developments to ensure that the physicians who care for these patients aren’t held liable for any civil or criminal penalties for violating the federal statutes in the event they are enforced in the future.

It is also worth noting that in order to avoid being at odds with federal law (i.e., the FDA classification), the patients who participate in the clinical trials in Georgia will obtain the cannabinoid products with a physician’s “recommendation” rather than a prescription.

As a final but important aside, Georgians should know that MAG opposes the use of marijuana and its derivatives (e.g., THC) for any purpose other than medical research. We adopted this policy for good medical reasons.

The bottom line is that MAG supports the use of marijuana in strictly controlled medical research programs so physicians can obtain some much-needed patient safety and product efficacy research so they can do what is best for their patients, and so they can help the state determine what additional steps it should consider taking on this front in the future.

Dr. Shah is the president of the Medical Association of Georgia.

Let Georgia grow marijuana

By James Bell

The push to reform marijuana laws is spreading throughout America. The public debate has reached Georgia thanks to various advocacy groups and a few lawmakers who have pushed the marijuana debate to the forefront of Georgia politics.

I applaud the efforts of State Rep. Allen Peake and State Sen. Curt Thompson for filing marijuana legislation that has sparked a much-needed discussion on how best Georgia should deal with marijuana.

Rep. Peake wants very limited medical legislation (House Bill 1) while Sen. Thompson wants a more comprehensive law (Senate Bill 7), which would allow for in-state cultivation and dispensing of various forms of cannabis. SB 7 is the better approach to getting medicine to the masses.

We know public attitudes have changed dramatically over the past decade. A majority of voters support some form of marijuana decriminalization and more than 80 percent of voters want medical cannabis and, and there are many lawmakers that have shown strong support. With a stroke of a pen, patients and parents of seriously ill children could be receiving cannabis in just months, not years.

So why has medical marijuana legislation stalled in Georgia? I quote Sen. Renee Unterman, “These parents don’t understand how the General Assembly works but this building is nothing but politics,” she said after killing a medical marijuana bill in the final minutes of the 2014 session.

This year, Gov. Nathan Deal has become the obstructionist by forcing Rep. Peake to scrap plans to cultivate cannabis in-state and allow legal access. Instead, they have conjured up an alleged “immunity” bill that forces parents and caregivers to try to acquire cannabis extracts from other states and then smuggle it back to Georgia, risking arrests and violation of other states’ and federal laws.

Peake has gone as far as saying that civil disobedience is in order and will risk going to prison to get the medicine to the children. Admirable perhaps, but foolish considering no one needs to be put at risk to get a natural medicine to children and adults who may benefit.

Why would a lawmaker be willing to take a stand against the federal government and risk prison time, but not stand up against the governor of his own state? Rep. Peake should have followed through with the proposed legislation and allowed the General Assembly to vote. If Gov. Deal rejects it, he has the power to veto.

It is shameful that the leadership of Georgia has forced parents to parade their children in front of the media like a circus and beg for a natural medicine that may improve the child’s quality of life, if not save their lives.

We should get behind legislation like SB 7 that allows in-state cultivation, whole plant therapeutics and doctors to determine how best cannabis should be used as medicine.

Let’s stop kicking the can down the road and pass legislation that does not create an illicit market, protects public safety, provides medicine to those in need and does not criminalize medical patients.

Gov. Deal — have mercy!

James Bell is the director of Georgia C.A.R.E. (Campaign for Access, Reform and Education).

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