Jul 032015
 

Dr. Ken Roy

Dr. Ken Roy

By Ken Roy, M.D.

The Louisiana legislature, in its wisdom, passed Senate Bill 143 “Medical Marijuana” in both houses of the legislature, and that bill has now received the signature of the governor. This is a sad day for science, a sad day for medicine and a sad day for the State of Louisiana.

At issue is an end run effort to introduce legal “medical marijuana” into the State of Louisiana without addressing the question of legalization for recreational use. Although government has the right to legalize the recreational use of harmful substances, as with alcohol and tobacco, the current legislation skirts that question and proposes to introduce marijuana for use in a small number of medical conditions. Every time that has happened in other states, the initial legislation has been a “foot in the door,” and subsequent legislation, rules and practice has virtually legalized the recreational use, and massively increased the availability.

There is no such thing as “Medical Marijuana”. There is no medication that is prescribed by physicians where the physician doesn’t know the dose and doesn’t know the indications and doesn’t know the length of treatment and cannot be certain that the prescription will be filled with a product of known purity, known active ingredient content and known delivery system. The healthcare system in the United States, however much it may be flawed, is literally the best in the world at assuring that substances prescribed by physicians are in fact what they are supposed to be and are in fact at the dosage that they are supposed to be and that the product is free of harmful impurities and other substances. Senate Bill 143 proposes to offer marijuana for prescription by physicians that will be of unknown content and concentration and in an untested delivery system.

It is fortunate that the bill as it currently stands prohibits marijuana products designed for inhalation and also prohibits raw or crude marijuana products (whatever that means in reality). However, the law will allow extracts in oil and extract of crude marijuana plants and in fact would not exclude marijuana used by any route other than inhalation or in any one of the number of different forms. I am a physician and I would not know how to prescribe that product as medication. According to Senate Bill 143, the medication can only be prescribed for glaucoma, symptoms resulting from chemotherapy and radiation, and spastic quadriplegia. However, this, again, is a “foot in the door” strategy that is planned for expansion.

Senate Bill 143 also requires that the State Board of Medical Examiners and prescribing physicians violate Federal Law. It is contrary to existing Louisiana Law for a physician to prescribe a Schedule I drug unless that physician has a license from the Drug Enforcement Administration to prescribe Schedule I drugs. Schedule I drugs are drugs with no overriding therapeutic benefit with an extremely high abuse potential. Schedule I contains heroin, PCP, LSD and marijuana. The current rules of the Board of Medical Examiners require that physicians and other prescribers only prescribe legal drugs. Marijuana is not a legal drug in Federal Law and any prescription by a physician will thereby violate Federal Law.

The bill also requires the Board of Medical Examiners on an annual basis to submit a list of medical conditions that should be added to a list of eligible diseases and conditions for prescription. The Board of Medical Examiners certainly regulates the practice of medicine. In my many years of practice I have not had the Board of Medical Examiners tell me what drug I should prescribe for what disease. It is occasional that the Board of Medical Examiners will advise that certain physicians not prescribe certain drugs or not prescribe certain drugs for certain conditions. The converse has not been true. To ask the Board of Medical Examiners to develop a list if disorders for which physicians can violate Federal Law and prescribe Schedule I medication to treat is outside of the purview and expertise of the Board of Medical Examiners.

In every state where “Medical Marijuana” has been introduced there has been an extension of the indications and an increase in availability of marijuana in the community. In every state where “Medical Marijuana” has been legislated the use of marijuana by young people has increased. There is very dramatic, clean and clear scientific evidence that the use of marijuana prior to age 25 injures the development of executive function and the ability to learn in those people who use it. The same might be said for other legal addicting harmful substances, and it is certainly true for marijuana.

And, of course, “Medical Marijuana” is not necessary. Marinol, delta-9 tetrahydrocannabinol, is available for the treatment of chemotherapy related nausea and vomiting, Cesamet, a name for nabilone, a derivative of marijuana, is also available for the treatment of chemotherapy nausea and vomiting and a third, Epidiolex, or pure cannabidiol is available for children with seizures through a special Food and Drug Administration program. A fourth drug, Sativex is in the last stages of approval by the Food and Drug Administration.

There certainly are known benefits in some conditions, and possible applications in other conditions for derivatives of the marijuana plant. However, for the indications authorized by Senate Bill 143 it is well known that marijuana makes Glaucoma worse and Marinol and Cesamet are already available for the treatment of chemotherapy-related nausea and vomiting and there is no consistent research that indicates a benefit of marijuana products in spastic conditions. There are other well-known and less potentially harmful medications that can be used for these conditions. Scientific literature exists in the use of marijuana for medical purposes that has shown benefit for some of its constituents, specifically cannabidiol for seizures and maybe for spasticity; however, the body of research is full of problematic science, small numbers of subjects and inadequate control groups – whereas the science that relates to the harm and potential harm of marijuana products is robust and scientifically valid.

It is not in the public interest for Louisiana to establish a Food and Drug Administration and all of that organization and bureaucracy to focus on and develop one drug. It is not in the public interest to open the door to “Big Marijuana” by legislating marijuana for medical purposes (the bill requires the dispensaries to have cash set aside of $2 million to apply to be a dispensary and the grower is required to have a $1 million net worth in order to apply for the license to grow the plant). It is certainly not in the public interest to insert physicians into this public issue by establishing a system that requires physicians to break the law should they participate, and the Board of Medical Examiners to promulgate rules that equate diagnoses to pharmaceutical agents.

Dr. Ken Roy is the founder and medical Director of Addiction Recovery Resources, a Clinical Assistant Professor of Psychiatry at Tulane Medical School, and a member of Governor Bobby Jindal’s Drug Policy Board.

  • Bill Monroe

    I think the writer is confused. Dr. Roy points out to the readers that marijuana is Schedule I with no known medicinal value, is illegal, but that points the readers to Marinol ( Synthetic THC), Epidiolex from GW Pharma (cannabinoid CBD), and Sativex which is not currently legal in the United States. Not sure why Dr. Roy points the reader to not yet FDA approved cannabis medicine. Anyway, I assume Dr. Roy is stating synthetic THC and pharmaceutical THC and other cannabinoids are safe, but the evil organic version is different. Organic cannabinoids, not blessed by really smart doctors, are bad for you. Dr. Roy states THC does not work for glaucoma. Really? Dr. Roy you may want to call the Professor at the University of Mississippi who is in a partnership with NEMUS Bioscience to develop liquid THC drops to lower the ocular pressure in the eye. Liquid THC, according to university studies, lowers ocular pressure. The University of Mississippi’s cannabis program, managed by the DEA, has an exclusive license with NEMUS. The license can be found online.

  • Msrinno

    Good points, doc. I venture that you believe that any healing practices should have scientific value, merit, and, most importantly, approval from the AMA and FDA. Just a hunch. Be careful of letting your dogma get in the way of your karma.

    And I most certainly will not expect you to throw a good party.

  • Kimberly King Jones

    Don’t be mad Doc. I know it is hard to accept but we really do not need your control. This is nature, she knows what she is doing.

    • Jackie Martello

      Gonorrhea is nature too. I don’t go anywhere near it.

      • D, Turgeon

        Death is nature, also, and we all go there whether we want to or not.

  • Jackie Martello

    There are plenty of meds, dozens in fact, that effectively lower IOP. There are a number of outpatient surgeries too. THC is not needed for that purpose, and not as effective as what is available now from what I have read.

    • Bill Monroe

      That argument makes as much sense as saying we have vanilla ice cream so other flavors are not needed nor are the other flavors to be considered ice cream. Cannabis is medicine. The debate is related to the scheduling of cannabis as a Schedule I drug. You cannot schedule synthetic THC as Schedule III and organic as schedule I. That argument is illogical.

      • Jackie Martello

        No. The debate is related to opening the door to recreational use. THC is not nearly as effective in lowering IOP as many other drugs such as prostaglandin analogs which have no recreational use. If Cannabis is “medicine” then so is a vodka martini.

  • Jackie Martello

    Well done Dr Roy.

  • Tim9lives

    How about a more sensible policy such as the Europeans have adopted….”Harm Reduction”

    Even if it is a foot in the door….The sooner America ends marijuana prohibition, the better.

    Incarceration or even a felony record for marijuana possession is much more harmful to the individual and to society than a few stoners IMO.
    I don’t know anyone who can even argue that marijuana is more harmful than alcohol.
    And yet, we have figured out how to tax and regulate alcohol.

  • Argol

    I really trust an article that makes wild claims without citations or links to the relevant studies or papers.

  • 2000 Alumni

    What outdated refer madness blither. There are so many documented cases of Medical Marijuana actually helping critically ill patients that is absurd to suggest that it is small number, problematic science etc… Further there are now years of documentation regarding medical marijuana laws and their non-effect on kids using marijuana. Here is a cite to an article linking a study for you since you don’t seem to cite anything in your article.

    http://www.forbes.com/sites/debraborchardt/2015/06/15/legalized-medical-marijuana-doesnt-increase-teen-usage/

    All blither, no real meat to this article, just outdated opinions. You state that there is scientific evidence and it is clear that teen usage goes up, but then don’t cite any of that evidence.

    Wow, refer madness is still alive and well it appears. What a shame that a plant is still so inappropriately vilified.

  • Woobniggurath

    The doctor opens his article by stating that medicines must be known and predictable in dosage and quality and implies that this is not possible with cannabis medicine. His point is rather moot as the LA law, as the author indicates, does not allow crude plant matter , i.e. herb, to be distributed. This means that LA dispensaries will be dealing with extracts. Plant extracts have been effectively standardized for over a hundred years now. There is already a nascent independent testing and verification industry (see: http://steephill.com), and clearly that industry is in a position for rapid growth.

    Dr. Roy also states that indications for use must be known, implying that they are not, for cannabis, though In fact he later lists several indications which are already universally recognized.

    It is understandable that an older practitioner not know the state of current science, particularly outside of his own field. There is the well known image of trying to drink from a fire hose as a metaphor for keeping abreast of scientific knowledge in the current day. However it is also well known that one should not exhibit overconfidence in opining about fields in which one is not an expert. Perhaps Dr Roy has not been briefed on the immense amount of research developing around endocannabinoid physiology and it’s seemingly endless supply of targets for new therapies. Dipping into experimental pharmacology, toxicology and oncology journals will provide months worth of reading on the subject. Here is an excellent starting place: http://www.ncbi.nlm.nih.gov/pubmed/23108539 .[Philos Trans R Soc Lond B Biol Sci. 2012 Dec 5;367(1607):3193-200. doi: 10.1098/rstb.2012.0313.] It is the intro to a special topics issue of the Philosophical Transactions of the Royal Society of London, Biology which encompasses a nice precis of the endocannabinoid’s pervasiveness and reach as as regulatory system in all multicellular life.

    In other words, the research is coming out right now by the truckload, if you look for it.

    But all of this is a sideshow. The first question, which has never been answered, is why should people NOT have access to cannabis freely? As a worker in the addiction field, I am sure he knows of the astoundingly low physical toxicity of cannabis, the absence of any physiological addiction, and that the research shows that the majority those who do become abusers of cannabis spontaneously remit from heavy use, frequently from any use, after the span of some years. Some years of “abuse” which have never been demonstrated to produce physical harm, and the social harm of which almost all stems from the illegal status of the plant in question.

  • Woobniggurath

    The
    doctor opens his article by stating that medicines must be known and
    predictable in dosage and quality and implies that this is not possible
    with cannabis medicine. His point is rather moot as the LA law, as the
    author indicates, does not allow crude
    plant matter , i.e. herb, to be distributed. This means that LA
    dispensaries will be dealing with extracts. Plant extracts have been
    effectively standardized for over a hundred years now. There is already a
    nascent independent testing and verification industry (see: http://steephill.com), and clearly that industry is in a position for rapid growth.

    Dr.
    Roy also states that indications for use must be known, implying that
    they are not, for cannabis, though In fact he later lists several
    indications which are already universally recognized.

    It
    is understandable that an older practitioner not know the state of
    current science, particularly outside of his own field. There is the
    well known image of trying to drink from a fire hose as a metaphor for
    keeping abreast of scientific knowledge in the current day. However it
    is also well known that one should not exhibit overconfidence in opining
    about fields in which one is not an expert. Perhaps Dr Roy has not been
    briefed on the immense amount of research developing around
    endocannabinoid physiology and it’s seemingly endless supply of targets
    for new therapies. Dipping into experimental pharmacology, toxicology
    and oncology journals will provide months worth of reading on the
    subject. Here is an excellent starting place: http://www.ncbi.nlm.nih.gov/pu
    .[Philos Trans R Soc Lond B Biol Sci. 2012 Dec 5;367(1607):3193-200.
    doi: 10.1098/rstb.2012.0313.] It is the intro to a special topics issue
    of the Philosophical Transactions of the Royal Society of London,
    Biology which encompasses a nice precis of the endocannabinoid’s
    pervasiveness and reach as as regulatory system in all multicellular
    life.

    In other words, the research is coming out right now by the truckload, if you look for it.

    But
    all of this is a sideshow. The first question, which has never been
    answered, is why should people NOT have access to cannabis freely? As a
    worker in the addiction field, I am sure he knows of the astoundingly
    low physical toxicity of cannabis, the absence of any physiological
    addiction, and that the research shows that the majority those who do
    become abusers of cannabis spontaneously remit from heavy use,
    frequently from any use, after the span of some years. Some years of
    “abuse” which have never been demonstrated to produce physical harm, and
    the social harm of which almost all stems from the illegal status of
    the plant in question.