Expert Advice on Cannabis
by DR. DAVID BEARMAN
In mid-October, I was contacted by two Utah lawmakers interested in cannabis policy, Representative Brad Daw and Senator Evan Vickers. They wanted my opinion on the medical cannabis bill that will be considered in a special post election session. The general principles that Rep. Daw laid out to me are sound; (1) treat cannabis like any other medicine, (2) have dosing guidelines for specific diagnoses and (3) require pharmacist participation in dispensaries. However, the devil is in the details and at this point my suggested improvements in line with those goals have not been incorporated into the pending legislation. I am sure that they are both busy, so I am hopeful my sharing my suggestions with the Utah public encourages a well-informed research-based approach.
Rep. Daw and Sen. Vickers likely reached out to me because of my broad administrative experience on all levels of government, my almost 20 years of experience in the clinical practice of cannabinoid medicine, and my mainstream approach to cannabis medicinal properties. I am considered by many to be one of the most clinically knowledgeable physicians in the field of medical cannabis in the United States. I have presented at conferences in Australia, New Zealand and Costa Rica, and featured on television programs in Germany and South Africa.
In addition to my expertise in cannabis medicine, I have spent over 50 years working in substance and drug abuse treatment and prevention programs. I was a pioneer in the free and community clinic movement and a co-founder of the Seattle Open Door Clinic, co-director of the Haight-Ashbury Drug Treatment program and founder of the Isla Vista Neighborhood Clinic. I was a member of former California Governor Ronald Reagan’s Interagency Task Force on Drug Abuse and have been a consultant to the National Institute of Drug Abuse (NIDA), the National Parent-Teacher Association, the Department of Education, the Hoffman-LaRoche pharmaceutical company and the Santa Barbara County Schools.
The legislature’s bill in its current form does not adequately create safe and affordable access to medical cannabis. Including some, or all, of my suggestions would help remedy this. Utah patients can benefit from a well-designed program like nearby states Colorado and Nevada. Changing several details in this compromise bill would make it more responsive to the needs of Utah patients. Here are 10 areas that must change to achieve these goals:
Education: Require physicians who intend to make more than 10 recommendations per year have extra training in cannabis, cannabinoids and the endocannabinoid system (ECS). This can be achieved through 8 to 16 hours of category I CME training. Plus, have a requirement that certified cannabinoid medicine physicians must pass a test on their knowledge of the history, science, laws, herbology and physiology related to the endocannabinoid system, cannabinoids and cannabis. The state should require and/or support physician post graduate education on these topics. This is far more effective than limiting the number of patients a doctor can recommend cannabis to. Since the endocannabinoid system is the largest neurotransmitter system in the human body, critical for homeostasis and a very important modulator of the speed of neurotransmission, the state would be remiss not to allocate funds for at least teaching of the endocannabinoid system in all Utah medical schools.
Qualifying conditions: The proposed bill contains an even more restricted list of conditions that qualify for use of medical cannabis than Proposition 2. This really handcuffs physicians in their practice of medicine and unnecessarily limits giving Utah residents from receiving the maximum benefit from legalizing the medicinal use of cannabis. The ECS has a wide range of therapeutic utility. Doctors certified and trained in cannabis medicine should be trusted to make the decision of what conditions may respond to the medical use of cannabis. We can agree that an appropriately educated doctor is more qualified to determine which conditions cannabis would be more beneficial for than the legislature.
Pain and Opiates: Many of the 113 cannabinoid and over 200 terpenes in cannabis have analgesic properties. A study by Noyes et al demonstrates that 20 mg of THC has analgesic properties equal to 60 mg of codeine. A 2014 Journal of the American Medical Association article reported a 25-30% decrease in opiate overdose deaths in states where medical cannabis was legal as opposed to states where it was still illegal. Dr. Nora Volkow, director of the National Institute of Drug Abuse, was the keynote speaker at the 2016 American Society of Addiction Medicine. In her speech on the opiate epidemic, her first bullet point was that cannabis should be the first choice for pain relief.
Dispensaries: The compromise bill reduces the licenses to dispense cannabis from 15 to 5 plus a state-run central fill pharmacy. This puts road blocks between patients and medicine. I would recommend starting with the 15 that are in Proposition 2 and adding the ability to add more stores as demand increases and patient populations grow.
The Central Fill Pharmacy: A state central fill pharmacy and a 15-day review period on doctors’ recommendations sets up another layer of bureaucracy and undercuts private enterprise and thereby patient choice. The lack of appropriate competition could create an unnecessary cost burden for patients. This should be removed completely.
Supporting our Troops: It appears that the legislature may be concerned that PTSD could be over diagnosed because under the compromise legislation veterans are required to seek a second opinion from a psychiatrist. PTSD is an easy diagnosis to make and not particularly easy to fake. A less onerous way to address this concern would be to accept PTSD diagnosed by any physician qualified to dispense cannabis under state law and trained and certified in the practice of cannabinoid medicine. This type of bureaucratic barrier can only contribute to our veterans’ frustration and the intolerable veteran suicide rate of 22 per day.
The Whole Plant: It is not clear why raw cannabis flowers would need to be sold pre-ground or in blister packs when it is quite helpful to many. This packaging adds an unnecessary cost burden to the patient, but more importantly, from a medical perspective, it degrades the quality of the medicine. Other states have package labeling requirements that allow for dosage assessment. There is no need to reinvent the wheel.
Methods of Ingestion: It is not clear why the state wants to require that patients “fail two other methods” before being allowed to use concentrated cannabis in an inhalable form (vaporizing). The respiratory route of administration is critical in treating migraines and other medical conditions where prompt relief is desirable and multiple options can benefit different symptoms.
Home cultivation: Juicing is a non-intoxicating and very promising method of medical cannabis ingestion. A patient needs access to freshly picked raw cannabis. This is only available with access to a living plant.
Safety: Remember cannabis has been a safe effective medicine for over 4,000 years. In the 1920s American doctors wrote three million prescriptions a year that contained cannabis. In 1937 the American Medical Association (AMA) testified AGAINST the Marihuana Tax Act. Dr. William Woodward, AMA spokesperson and former president of the American Public Health Association (1914), told the House Ways and Means Committee that the AMA knew of “no dangers from the medicinal use of cannabis.” In 1988 after a two-year rescheduling hearing, the DEA’s Chief Administrative Law Judge, the late Francis Young, recommended rescheduling cannabis. In his Finding of Fact, he found that cannabis was “one of the safest therapeutic agents known to man.”
Conclusion: Medicinal use of whole plant botanical cannabis is serious science and medicine. I applaud the legislature for working on allowing access to medical cannabis for the citizens of Utah. I look forward to both the passage of Proposition 2 and the legislature crafting a good quality piece of legislation.
Rep. Daw and Sen. Vickers have each received a copy of my new book, CANNABIS MEDICINE: A Guide to the Practice of Cannabinoid Medicine. It contains a lot of useful information pertinent to the proposed legislation. The Utah Legislature has an incredible opportunity to do the right thing for the most vulnerable Utahns. Thank you, Rep. Daw and Sen. Vickers for reaching out to me. I look forward to working with you to make this a workable bill.
Any other Utah legislator interested in educating themselves more on this issue is invited to contact me and/or read my book, which was just published last month.