Position Statement on Medical Cannabis and the Federal Government

Background:

Medicine stands at the threshold of numerous applications for medical marijuana. If the US adopts a thoughtful and comprehensive policy to deliver access to medical marijuana, we have the opportunity to improve public health and simultaneously improve healthcare policy across the board for all Americans. By adopting a policy that is compassionate to patients, captures tax revenues from sales, and reinvests in the public well-being via healthcare or other means, we will effectively create an entirely new industry and revenue stream for our GDP.

Until prohibition was implemented by the US government and others around the world early in the last century, marijuana was widely accepted as a medical treatment. The first description of marijuana as medicine is believed to be found in the ancient Chinese Pen Ts’ao, the world’s oldest pharmacopeia circa 2800 BCE.  Kaneh-bosem, the anointing oil described in the Old and New Testaments and used by Jesus, was a plant extract whose description matches that of cannabis. Modern medicine has finally caught up with history. Policy must now do the same.

Recent studies about medical cannabis have opened the floodgates of potential treatments for a multitude of common disease states encountered in today’s medical environment. The human body produces compounds similar to those found in the cannabis sativa plant. Indeed, it is referred to as the endocannabinoid—meaning “internal cannabis”—system. These compounds, synthesized in the plant and in all animal species, are used by the body to promote homeostasis, or self-regulation, by both stimulating and inhibiting cell function. There are strains of cannabis that produce psychoactive effects, and others that do not.

Indeed, the preponderance of evidence suggests that cannabis can aid the immune system in recognizing cancers and inhibiting the vascular blood supply of cancers, in addition to treating the side effects of both cancer and chemotherapy. Cannabis can treat some seizure disorders more effectively and with fewer side effects than prescription medications. Many pain syndromes are not adequately treated with opioids, and medical marijuana is a safer alternative that reduces dependence on opioids with a much lower risk of dependence. The incidence of opioid related deaths has decreased by an estimated 25% in states with legal medical marijuana. Unlike opioids, there are no receptor sites for cannabis in the brain stem, the area of the brain responsible for life sustaining functions like breathing. The incidence of overdose deaths attributed to marijuana is zero.

The list of ailments that can benefit from medical marijuana goes on. While US policy on medical cannabis research has only recently been expanded, countries like Israel and Spain lead the world in clinical research and trials. So, while much is known about the efficacy and safety of cannabis and the function of the endocannabinoid system, there is much yet to be discovered. Expanding policies and funding of research will surely increase the applications of medical marijuana.

The growing acceptance of medical cannabis has raised some concerns that must be addressed. While some studies show an increase in reported motor vehicle accidents in which drivers used cannabis, studies also show decreased motor vehicle fatalities in the same states. There are numerous factors that can account for these findings, including changes in testing for cannabis, decreased drunk driving—which is 5 to 6 times more dangerous than driving under the influence of cannabis, and the inability of current blood tests to distinguish recent from past use. There are also known drug interactions and temporary side effects of cannabis, though these tend to be minor. And while there are cases of marijuana addiction, the rate is lower than that of other legal substances with addiction potential. For example, 35% of tobacco users and 16% of alcohol users will develop dependence, compared to (the oft cited, but likely inflated estimate of) 9% of recreational cannabis users. Cannabis has a similar addiction rate to caffeine. There is evidence that medical marijuana can be an effective exit drug used to treat opioid addiction. Given our aging population, cost effective treatments for older adults must be considered, and cannabis is indeed less expensive than many conventional treatments and pharmaceuticals. In short, current evidence shows that the benefits of medical cannabis use outweigh the risks.

By introducing federal medical cannabis legislation, the United States can significantly reduce healthcare spending and improve outcomes and the quality of life for many Americans. Cannabis tax revenues may be invested in harm reduction programs such as opioid treatment programs, smoking cessation and nutrition programs which will boost work productivity and GDP. The US federal government has the opportunity to legalize the compassionate use of cannabis for the American people while spurring the economy by harnessing the potential of medical marijuana as an emerging industry.

Currently, cannabis is still classified as a Schedule I substance under the Controlled Substances Act, making it more restricted than even cocaine. At the state level, Colorado, Washington, Oregon, Alaska, DC, Massachusetts, Maine, Nevada and California have all legalized cannabis for personal use by adults. That’s 25% of the US population. Medical marijuana programs have now been adopted by 29 states and DC. That’s 63% of the US population. If Texas passes its medical marijuana legislation as expected, that would make 72% of the US population. For the federal government to ignore this phenomenon at the state level is to miss a huge opportunity to generate wealth and well-being at a national level.

Recommendations

There are several actions that President Trump can take to ensure that his Administration honors the will of the people, none of which require approval by Congress. Here are a few simple recommendations:

1) Conserving taxpayer dollars

The Department of Justice (DoJ) must not waste precious resources on the enforcement of antiquated federal marijuana laws. States should be free to regulate marijuana for medical use without fear of federal prosecution.

What President Trump can do: Reaffirm existing DoJ policy established by the Cole Memo of 2013, which outlines the DoJ’s enforcement priorities with respect to states’ medical marijuana and adult-use laws. This keeps the federal government focused on serious crimes rather than shutting down well-regulated medical marijuana dispensaries.

2) Creating American jobs by encouraging businesses

Direct the Financial Crimes Enforcement Network of the Department of Transportation (DoT) to update its guidance memo issued on February 14, 2014. Current guidelines put the burden on banks to “consider whether a marijuana-related business implicates one of the Cole Memo priorities” when determining whether to allow state-legal businesses to open accounts. Banks are not law enforcement agencies, and should not be coerced or permitted to make that decision.

What President Trump can do: Amend the DoT memo to make clear that potential bank clients are compliant with the Cole Memo guidelines if the client has a valid and current license to do business in the state in which it is situated. Giving state-legal marijuana businesses access to banking services will increase tax revenue and dramatically enhance public safety in those states.

3) Protecting our vets

Direct the Department of Veterans Affairs to update its marijuana policy once and for all. VA physicians should be allowed to recommend medical marijuana to their patients who reside in states with medical marijuana programs. Current VA policy (VHA Directive 2011-004, issued January 31, 2011) allows veterans to participate in state medical marijuana programs, but prohibits VA physicians from recommending its use. This creates unnecessary stress for veterans, forcing them to pay physicians outside the VA system who are expensive and unfamiliar with their medical history. This is textbook federal red tape.

What President Trump can do: Amend VHA Directive 2011-004.

4) Fostering cannabis research

Instruct the National Institutes of Health to simplify the process for researchers to conduct rigorous, gold-standard studies into the potential medical benefits of whole plant marijuana and marijuana extracts. Currently, researchers who want to conduct FDA-approved clinical trials are forced to acquire marijuana exclusively through DEA-approved cultivators. Currently, only the University of Mississippi is authorized under contract with the National Institute on Drug Abuse (NIDA) to supply research cannabis to the entire country, which can sell marijuana for research but not for prescription use, making its marijuana unacceptable to FDA for use in Phase 3 studies. The University of Mississippi farm grows a limited range of potencies, is not organic, and needs to be supplemented by privately-funded production facilities.

What President Trump can do: Issue an Executive Order allowing researchers to work directly with state-licensed medical marijuana providers and producers to obtain products that are currently being used by medical marijuana patients.

5) Improving access to healthcare

Direct the DoJ to allow more interstate marijuana transportation. More than a dozen states have enacted laws that allow seriously ill patients to use non-psychoactive marijuana preparations but have no access to those cannabis oils in their state. Some of those states—such as Iowa, Utah, and Georgia—issue ID cards to patients so they can obtain cannabis from other states. Currently, the Cole memo prevents “the diversion of marijuana from states where it is legal under state law in some form to other states.”

What President Trump can do: Revise the Cole Memo to ensure patients have the legal access to cannabis oil that their state legislatures intended. Interstate marijuana transportation should only be a federal enforcement priority where it would be illegal in the state to which it is transported. This would allow, for example, licensed CBD oil producers in Florida to provide cannabis oils to patients enrolled in Georgia’s program, and licensed producers in Missouri to provide marijuana to patients in Iowa.

By: Dr. Tanya Adams and Dr. David Nathan

Dr. Tanya Adams is a family practitioner and addiction medicine expert in private practice in Setauket, NY with 14 years of experience. As an early adopter and prescriber of medical marijuana under the New York Compassionate Care Act, Dr. Adams has been helping her patients find relief for some of the effects of their qualifying medical conditions, using medical marijuana as part of their overall treatment plan. She has also advocated for the compassionate use of medical marijuana in New York.

David L. Nathan, MD, DFAPA (DFCR Founder, Board President) is a psychiatrist, writer, and educator in Princeton NJ. He is a Distinguished Fellow of the American Psychiatric Association and Clinical Associate Professor of Psychiatry at Rutgers Robert Wood Johnson Medical School. While maintaining a full-time private practice, he serves as Director of Continuing Medical Education for the Princeton HealthCare System (PHCS) and Director of Professional Education at Princeton House Behavioral Health (PHBH). While serving on the steering committee of New Jersey United For Marijuana Reform (NJUMR.org), Dr. Nathan was surprised by the absence of any national organization to act as the voice of physicians who wish to guide our nation along a well-regulated path to cannabis legalization. This need was the inspiration for Doctors for Cannabis Regulation.

Posted in DFCR, Op-Eds / Letters.