States, Federal Government, Doctors Disagree Over Medical Marijuana Benefits

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If Oklahomans vote to make state-sanctioned medical marijuana legal June 26, Oklahoma will be one of many states increasingly at odds with the federal government over how marijuana should be viewed and regulated.

Under federal law, marijuana use would continue to be illegal.

The federal government classifies marijuana as a Schedule 1 drug, which it defines as a drug “with no currently accepted medical use and a high potential for abuse.”

But the vast majority of states have adopted laws that disagree with that position — at least to some extent, according to data gathered by the National Conference of State Legislatures.

Oklahoma is among 16 states that so far have taken the relatively cautious approach of sanctioning the use of marijuana derivatives that are high in cannabidiol (CBD) and low in THC for the treatment of certain seizure disorders and other ailments that don’t respond well to other treatments. THC is the main psychoactive ingredient in marijuana.

Thirty states have gone beyond that, approving more comprehensive medical marijuana programs. Nine of those 30 have taken the additional step of approving recreational marijuana, where no doctor’s approval is required.

Oklahomans will consider joining the list of medical marijuana states when they vote June 26. A recent SoonerPoll suggests the state question has a good chance of passing, with 57.5 percent of support and only 29.6 percent opposition.

When other states have approved medical marijuana, they have adopted lists of ailments for which medical marijuana can be recommended.

Some of those lists are short. Others are long.

Illinois has one of the longest lists, identifying 40 qualifying conditions. Cancer, HIV/AIDS, Crohn’s disease, glaucoma, hepatitis C, lupus, multiple sclerosis, muscular dystrophy, Parkinson’s disease, post-traumatic stress disorder, rheumatoid arthritis, seizures and traumatic brain injury are among the ailments on its list.

Oklahoma’s proposed law is unique in that it would not require any qualifying conditions, leaving that decision up to the physician.

No FDA approval

As it currently stands, Oklahoma doctors will get no assistance from the federal Food and Drug Administration in identifying marijuana as an appropriate treatment for any specific ailment.

“The FDA has not approved any product containing or derived from botanical marijuana for any indication,” the FDA says on its website. “This means that the FDA has not found any such product to be safe or effective for the treatment of any condition.”

Because marijuana remains a Schedule 1 drug with no FDA approval, private health insurance policies are not expected to cover medical marijuana purchases in Oklahoma, even if State Question 788 passes, said Mike Rhoads, deputy commissioner of the life and health division of the Oklahoma Insurance Department.

“I would be very surprised if even on the public side any of the benefit plans would cover it,” Rhoads said.

Doctors divided

Doctors differ widely in their assessment of the medicinal value of medical marijuana.

Dr. Sunil Aggarwal, a Washington state medical doctor who had a lot of experience caring for chronically ill, disabled and terminally ill patients, said medical marijuana can play a huge role in caring for all those kinds of patients.

“I can assure you, I’m not some out there crazy doctor, kook, quack. It’s based on solid evidence, solid science and empirical and clinical experience that I’ve had and many of my colleagues in states that I’ve trained in where we’ve had cannabis for medicinal use available, ” he said. “I’ve seen remarkable changes in my own patients. It’s really an essential tool for doctors to have.”

Dr. Aggarwal, who went to high school in Muskogee and at the Oklahoma School of Science and Mathematics in Oklahoma City, said he grew up thinking marijuana use was a bad thing and never imagined that one day he would be recommending it to patients. He said a lot of personal research and witnessing the beneficial impact the drug has had on patients has changed his mind.

He cited a January 2017 study published in The National Academies of Sciences, Engineering and Medicine that considered more than 10,000 scientific abstracts and concluded there was conclusive or substantial evidence that cannabis or cannabinoids are effective for the treatment of chronic pain in adults, spasticity symptoms in multiple sclerosis patients and chemotherapy-induced nausea and vomiting.

Both research and his personal experience have shown medical marijuana can become a substitute for opioids for some patients and a way of reducing the amount of opioids needed by others, Dr. Aggarwal said.

Many Oklahoma doctors remain skeptical that the benefits of medical marijuana are as great as supporters claim and the Oklahoma State Medical Association, Oklahoma Osteopathic Association, Oklahoma Pharmacists Association, Oklahoma Hospital Association and Oklahoma Society of Anesthesiologists are among the many groups that have come out against State Question 788.

“There is not a universally agreed upon therapeutic application of marijuana. There just is not,” said Dr. Kevin Taubman, immediate past-president of the Oklahoma State Medical Association and chairman of a group opposing the state question. “There’s a lot of debate and some data on certain conditions, but in terms of well-researched, regulated therapeutic strategies … There is no overwhelming consensus for most of these conditions the pro side is talking about.”

Opioid crisis impact?

Taubman said he is concerned about the lack of limitations in the state question concerning the ailments marijuana can be recommended to treat, how it will be regulated and where it can be used.

Taubman said he believes there is scientific data to support the beneficial use of marijuana for certain seizure disorders and he would also support its use for end-of-life care.

“I think the problem with everything else is the evidence is not overwhelming in a lot of areas,” he said.

“One of the big arguments they are using is this will solve our opioid crisis,” he said. “There is no data that shows it solves the opioid crisis. The only data that it’s showing recently is that maybe the number of prescriptions is going down.”

“If we just started giving so-called medications to everyone, then it goes back to the days (before) the FDA existed in the 1800s and early 1900s when it was the days of the snake oil salesmen when people just showed up in their buggy and cart and could make universal claims of some … elixir and the reality may have little or no therapeutic benefit and potentially poses risk of somebody’s harm.”