As Maryland joins the ranks of the states that have restored cannabis to the list of medications available for physicians to use for their patients, Natalie LaPrade Medical Cannabis Commission, the state entity overseeing this process, has issued a new set of regulations for the return of medical cannabis.
In my capacity as co-chair of the MedChi Addiction Committee, I was asked to offer a draft response for the organization’s board of trustees to these newest regulations. Overall, as a group, we commended the Commission for its balanced and reasoned approach to this complex and controversial issue and for having produced a thoughtful and evidence-based set of regulations.
We also supported the Commission’s decision to eliminate the term “marijuana” – a relatively recent slang term – to “cannabis” – the traditional term and a more appropriate one for a professional discussion. Below is an abbreviated summary of my remarks before the MedChi Board of Trustees, which focused on four points that I wanted to share with you about the return of medical cannabis.
- First, cannabis is unique in being the only addictive substance for which regulations have been considered for both medicinal and recreational use. By contrast, opioids, stimulants, benzodiazepines, and sedatives are legal for medicinal use only; while alcohol and tobacco are regulated for recreational use only. Confusion results when regulations of these two related areas become entangled. For example, when discussing “medical cannabis,” it is important to distinguish between the smoking of an herbal substance with uncertain contents and the oral administration of pharmaceutical grade cannabinoids.
- Second, the question of the relative safety or dangerousness of recreational cannabis are exaggerated by people on both sides the argument. As addiction specialists, the members of the addiction committee have daily firsthand experience with both the damaging effect that addiction to cannabis can have on the lives of individuals, but at the same time, they recognize the difference between this and the type of devastation resulting from the impact of heroin and cocaine with which cannabis is sometimes equated.
- Third, doubting the effectiveness of medicinal cannabis is a relatively recent phenomenon. This historical anomaly has resulted from the growing dominance of the DEA over organizations with clinical expertise regarding decisions about the substance. As a result, physicians have been deprived of direct clinical experience, researchers have been unable to pursue scientific exploration of its complexities, and pharmaceutical companies have been discouraged from developing preparations.
- Last, physicians are now being asked to make professional recommendations that they are at a disadvantage to make. Laws have been enacted regarding the creation of a separate system of production of smoked and oral formulations by commercial growers that are then distributed by dedicated dispensaries. While regulations written by the Maryland LaPrade Commission are well formulated, the new system will not be able to meet traditional FDA standards of quality and professional pharmacy standards of distribution.
Ideally, this will be a transient situation, but until legislative relief arrives, my hope is that physicians will participate constructively in the process for the return of medical cannabis rather than exempt themselves because of its clear shortcomings.
In conclusion, I would suggest that physicians involved in the ongoing discussions about medical cannabis insist on focusing on the strength of the evidence underlying each argument and press for a shift in the relative influence of federal and state agencies away from dominance by law enforcement towards those with clinical expertise.
Contact us to learn more about the return of medical cannabis.