Riff Raff: Don’t just say no

The medical marijuana debate will ramp up now that at least one medical marijuana issue is on Arkansas’ November ballot. Let’s hope the debate from all sides has more depth than that recently posited by Gov. Asa Hutchinson and his surgeon general.

The governor, a former head of the federal Drug Enforcement Administration, and his surgeon general oppose the legalization of medical marijuana. In recent interviews with Talk Business & Politics, they said more study is needed. They say medical industry leaders aren’t calling for it. The dangers could outweigh the positives. The learned Surgeon General Dr. Greg Bledsoe said only a “narrow band” of “certain cases” have shown limited benefits of medical marijuana and therefore legalization could be a bad thing for the state.

“If there should be changes in it, it should be based upon recommendations from the medical community, and thus far the American Medical (Association) has not said we need to have smoking marijuana that is beneficial that outweighs its harm,” Gov. Hutchinson said, adding later that marijuana can already be used medicinally through the pharmaceutical drug Marinol.

Bledsoe said “no medical organization or any research paper has said this (medical marijuana) should be a first-line agent.”

Let’s consider a few reasons why the governor and his surgeon general need more substantive talking points if they want to convince Arkansas voters that voters in 25 other states made a mistake in approving medical marijuana.

• Marinol? Really? C’mon, governor. You were once the DEA chief. You know better. Marinol – a man-made form of THC commonly used to treat nausea – is to medical marijuana what a paper airplane is to a modern fighter jet.

• Notice in the governor’s quote he refers to “smoking” marijuana. Medical marijuana is much more than just rolling papers and a dimebag. Maybe the governor wants you to have a mental image of Drs. Cheech and Chong instead of physicians and researchers at places like the Salk Institute and Stanford University who tout the benefits of medical marijuana.

• The governor and his surgeon general are half correct on the need for more research. Most medical researchers say more work is needed on the many and various forms of cannabis that have medical benefits. But few say all access to medical marijuana should be blocked until more research is completed.

“It’s not that we don’t have a lot of information,” Lester Grinspoon, who has researched marijuana since the 1960s and is an associate professor emeritus of psychiatry at Harvard Medical School, said in an April 2016 Scientific American article. “If you go to PubMed you’ll find that there are 23,000 papers published on cannabis.”

The University of California conducted seven medical marijuana trials between 2002 and 2012, with studies saying medical marijuana has definite therapeutic value.

“Every one of the studies showed a benefit,” said Dr. Igor Grant, a neuropsychiatrist and director of the Center for Medicinal Cannabis Research.

There are more than 60 peer-reviewed research articles about medical marijuana. Just a few of the findings from the research includes:
• Patients with bipolar disorder report that marijuana is more effective than conventional drugs;
• Cannabidiol inhibits proliferation of breast cancer cells;
• Cannabidiol extract relieved pain in patients with advanced cancer;
• Oncologists have favorable opinions on the use of marijuana to prevent vomiting in cancer chemotherapy patients;
• Among patients with schizophrenia, cannabis users had better cognitive functioning; and
• Sativez – a cannabis-based medicine – improved pain while moving and at rest in patients with rheumatoid arthritis.

Other studies show medical marijuana is an effective treatment for nerve pain associated with AIDS, diabetes and spinal cord injuries, is a viable overall pain treatment alternative to legal drugs that have more negative side effects, provides benefits for those with epilepsy, and is proven to reduce tremors associated with Parkinson’s Disease. A Tel Aviv University study found positive results for medical marijuana in treating Crohn’s Disease. Even more research details can be found at this page on the Realm of Caring website.

To the point of Hutchinson and Bledsoe, not all findings were positive. Some studies showed that marijuana lowers resistance to infection, that some forms of cannabis lower blood pressure to dangerous levels, and several studies show conflicting results for cannabis use for Multiple Sclerosis. Benefits for Lupus were also mixed.

• Many in the medical community believe medical marijuana has benefits. A 2013 report from the New England Journal of Medicine indicated that a clear majority of physicians around the world favored the use of medical marijuana,

“We were surprised by the outcome of polling and comments, with 76% of all votes in favor of the use of marijuana for medicinal purposes — even though marijuana use is illegal in most countries,” noted authors of the report. “Physicians in favor of medicinal marijuana often focused on our responsibility as caregivers to alleviate suffering. Many pointed out the known dangers of prescription narcotics, supported patient choice, or described personal experience with patients who benefited from the use of marijuana. Those who opposed the use of medicinal marijuana targeted the lack of evidence, the lack of provenance, inconsistency of dosage, and concern about side effects, including psychosis.”

• A recent study by the University of Georgia found that medical marijuana reduced state and federal costs with Medicare’s prescription drug benefit program in states that have legalized its use.

The savings were the result of lower prescription drug use and were estimated to be $165.2 million in 2013. The results suggest that if all states had implemented medical marijuana the overall savings to Medicare would have been around $468 million.

“Compared to Medicare Part D’s 2013 budget of $103 billion, those savings would have been 0.5 percent. But it’s enough of a difference to show that, in states where it’s legal, some people are turning to the drug as an alternative to prescription medications for ailments that range from pain to sleep disorders,” noted this report on the study.

W. David Bradford, a researcher on the project said, “We wouldn’t say that saving money is the reason to adopt this. But it should be part of the discussion.”

More medical marijuana research is indeed needed, and many of the links in this essay include info about the unknowns of medical marijuana. But the consensus is it is a viable and safe option for many ailments – even without being a “first-line agent.” And there have been no deep or dangerous problems in the states that have some form of legalized marijuana. In fact, the fatal options are the options now legal. In the 13 states that passed laws allowing for the use of medical marijuana between 1999 and 2010, 25% fewer people died of overdoses of opioid drugs each year. In 2014, there were an estimated 18,893 deaths related to prescription opioid overdoses. In that same year, there were zero (0) deaths related to medical marijuana overdoses. If we are indeed worried about healthcare safety, we might be more concerned about government-approved pills than government-opposed plants.

We may learn that the medical marijuana proposals on the ballot are not good for Arkansas. But let’s have an adult conversation about the issue and not seek to persuade with superficial fears and outdated biases.