By Lucy J. Cairns, M.D.
Several factors have recently converged to make passage of a medical marijuana law in Pennsylvania a distinct possibility. First, public opinion in the state is now overwhelmingly in favor of legalizing marijuana (cannabis sativa) for medical use. Results of a Franklin and Marshall College poll in February 2013, indicated that 82 percent of Pennsylvanians favored allowing adults to use marijuana for medical purposes if recommended by a doctor. On March 3 a Quinnipiac University poll showed support in Pennsylvania at 85 percent. When analyzed by age, gender and political orientation groups, a minimum of 78 percent in each group supported medical marijuana. Editorials urging the passage of a medical marijuana law recently appeared in major news outlets in Harrisburg’s PennLive/Patriot News (April 11) and Pottstown’s The Mercury (May 13).
The second key factor is development of bipartisan support for such a law in the state legislature. State Sen. Mike Folmer (R-Lebanon) is a prime sponsor of SB 1182, titled the “Governor Raymond Shafer Compassionate Use of Medical Cannabis Act.” The other sponsors at the time of this writing include one other Republican senator and nine Democrat. In the House, state Rep. Jim Cox (R-Berks) will shortly be introducing HB 2182, which will be similar to the Senate bill but with updated language based on discussions with the Senate. Sen. Folmer and Rep. Cox are both motivated by a desire to alleviate suffering on the part of patients with symptoms that cannot be relieved with currently available treatments.
In response to a request for comments for this article, Sen. Folmer provided a statement which included the following: “While the Pennsylvania Medical Society would like to wait for federal approval, there are Pennsylvania patients suffering and leaving Pennsylvania to seek medical treatment. . . Senate Bill 1182 will provide safe access to patients in a medical environment.”
Rep. Cox explained his involvement in this effort by saying, in part, “I feel that it is our responsibility to address this as a means to help patients who are suffering with ailments whose symptoms cannot be relieved with conventional medications. I feel that it is imperative that we move forward with the input and expertise of the medical community.”
The third factor making a medical marijuana law more likely in Pennsylvania’s near future is Gov. Tom Corbett’s low approval rating. Gov. Corbett does not support access to medical marijuana beyond a very limited program proposed to benefit a small number of children with a severe seizure disorder. If he is replaced by Democratic challenger Tom Wolf after this year’s election, Pennsylvania will have a governor who has come out in support of a much broader medical marijuana law.
Thus, a high percentage of Pennsylvanians would trust their doctors to prescribe marijuana for medical conditions, and momentum is building to pass legislation which would allow such prescriptions to be written. How does this issue look from the other side of the prescription pad — to the physicians who would be faced with implementing such a law? By an act of Congress — the Controlled Substances Act of 1970 — marijuana was placed in the same category of drugs (Schedule I) as heroin, a category reserved for drugs with very high potential for abuse and addiction and no currently accepted medical use.
In contrast, cocaine and methamphetamine were placed in Schedule II, considered to have less potential for abuse and dependency than Schedule I drugs and known to have accepted medical use. As long as this classification remains in effect, any physician who writes a prescription for marijuana risks federal prosecution and puts his or her career in jeopardy. In addition, this classification has been an almost insurmountable hurdle to performing research on the potential medical benefits of products derived from cannabis. Therefore, the evidence available to physicians on the safety and efficacy of medical marijuana products does not in most cases rise to the level of that available for drugs which have been approved by the FDA based on clinical trials.
Nevertheless, many physicians and other health-care providers in states with medical marijuana laws do write prescriptions. The reasons likely include the limitations of conventional medical treatments in alleviating suffering and treating certain diseases, the availability of some evidence for a beneficial effect from use of cannabis in certain conditions, and the perception that cannabis is a relatively safe drug compared to many FDA-approved medications.
In the interest of increasing public awareness of physician perspectives on this issue, and of stimulating involvement of the medical community in the shaping of public policy, a number of Berks County physicians were asked for their comments.
There are probably as many physician opinions on this subject as there are physicians in Berks County, but all share the core principles which guide the decision-making of ethical physicians. The maxim to “first, do no harm” is inculcated into every medical student and no drug prescription is written without a calculation of the risk of an adverse reaction relative to the risk of alternative treatments or no treatment for the problem at hand. This is difficult enough when evidence from well-designed long-term clinical trials is available. For at least some of the symptoms or disorders listed in SB 1182, the quality of available evidence is so poor that this calculation would better be characterized as a guess. Further uncertainty is injected into this calculation by the fact that cannabis contains more than 400 chemicals from 18 chemical families, and that more than 2000 chemical compounds are released when it is smoked. When you throw in the availability of different strains of cannabis, each with a different chemical profile, the reluctance of many physicians to prescribe “marijuana” without more research seems the only responsible position.
However, another core principle of medical practice is to use one’s knowledge and skills to alleviate suffering. Indeed, the desire to relieve suffering is one of the most common motivations for pursuing a medical career. Unfortunately, almost all physicians have the experience of caring for patients with debilitating conditions which cannot be effectively treated with currently available medication (or other treatment modalities). If a medical marijuana law is enacted in Pennsylvania, physicians will have another treatment option which is likely to benefit some of these patients, with risks that seem to be no higher, and in some cases lower, than risks posed by a number of commonly-prescribed drugs.
Lucy J. Cairns, M.D. is president-elect of the Berks County Medical Society. The foregoing was published in Medical Record, Summer 2015 edition. The ideas and opinions expressed are not necessarily those of the Business Journal.