Medical Marijuana Statements of Support
California Medical Association
Viewpoint: Patient safety is priority in medical cannabis policy
The following op-ed was written by Paul R. Phinney, M.D., California Medical Association (CMA) president-elect, and Luther F. Cobb, M.D., CMA speaker of the house, and was featured in The Sacramento Bee on November 1, 2011.
Recently, the CMA, representing more than 35,000 physicians, the largest statewide physician organization in America, boldly decided to adopt a different, more pragmatic approach to the polarizing issue of marijuana decriminalization. The decision – the result of a carefully considered process, painstakingly researched and debated for more than one year – is centered on one concern above all others: patient safety.
To be clear: this was a purely medical decision.
Our individual members come from every corner of California and represent every possible political philosophy and partisan leaning. But the one thing we all share is a common commitment to putting patients first. By that standard, we believe that the present system of medical cannabis is flawed, contradictory and dangerously detached from scientific evidence and that a new approach to legalization, regulation, research and enforcement is needed to protect physicians and patients alike.
Under current law, medical cannabis has been decriminalized in California, but is still illegal on a federal level. This puts physicians in an untenable, impractical position as the ultimate gatekeeper of the substance. As physicians, we want to do what’s best for our patients – but, in California, it’s tough to do that without comprehensive scientific and medical research and with the fear of federal prosecution.
The goal of our call for legalization is not to make the drug more available, but rather to create a strict regulatory system, ultimately limiting distribution and standardizing medical cannabis.
While it’s currently legal in California for a physician to recommend medical cannabis for treatments such as neuropathic pain, dosage is not well standardized nor is it regulated for purity and safety. How are we, as health care providers, supposed to accurately recommend a product to a patient when the only information we have now is that “one lollipop is equivalent to two doses?”
Our extensive medical education, combined with pharmaceutical data on other drugs, keeps us knowledgeable about the composition and strength of everything else we prescribe to our patients. Why should there be an exception with medical cannabis? Until the substance is legalized, we cannot regulate it in a way that’s safe for patient use.
As a community of physicians, we feel we’re making the most responsible recommendation for public health. As it stands now, we simply don’t know enough about medical cannabis to understand the benefits or risks that use could have for patients. There have been limited reports stating medical cannabis may be suitable for some cases of chronic pain and there have been similar reports associating use with both short- and long-term health risks.
The fact is we don’t know what the real effects are. By changing cannabis from a Schedule I drug, which the federal government states has “no accepted medical use” and allowing for better research and strict regulation, we’re watching out for the good of the public health and the safety of our patients.
Despite prohibition-related efforts, unregulated cannabis is easily accessible, often at a low cost. CMA recognizes the current structure as a failed health policy that has been unsuccessful in keeping patients safe. While we’re glad to be part of the 15 other states that have decriminalized the use of medical cannabis, it simply isn’t enough. We must create a structure that allows for serious research and controlled distribution.
The bottom line is that patient safety and good public health are the ultimate goals. Not until we’ve gathered sound scientific evidence, and created a robust regulatory structure for medical cannabis, can we achieve those goals.
California Medical Association adopts official policy to legalize marijuana
Rescheduling of drug and legalization allows for more conclusive research
The California Medical Association (CMA) has adopted official policy that recommends legalization and regulation of cannabis. The decision was based on a white paper concluding physicians should have access to better research, which is not possible under the current policy. The paper, available here, is a thoughtful study and response to an important issue, continuing CMA’s tradition of providing guidance on public health.
CMA is the largest physician group in California and the first statewide medical association to take this official position.
“CMA may be the first organization of its kind to take this position, but we won’t be the last. This was a carefully considered, deliberative decision made exclusively on medical and scientific grounds,” said James T. Hay, M.D., CMA President-Elect. “As physicians, we need to have a better understanding about the benefits and risks of medicinal cannabis so that we can provide the best care possible to our patients.”
CMA’s Board of Trustees, a representative body of physician delegations across the state, adopted the policy without objection.
The federal government currently lists cannabis as a Schedule I drug. That classification restricts the research and ability to study the substance. Part of the policy adopted by CMA emphasizes that the drug should be rescheduled in addition to being legalized.
“There simply isn’t the scientific evidence to understand the benefits and risks of medical cannabis,” said Paul Phinney, M.D., CMA Board Chair. “We undertook this issue a couple of years ago and the report presented this weekend is clear – in order for the proper studies to be done, we need to advocate for the legalization and regulation.”
The CMA Council on Scientific Affairs (CSA) developed a set of medical cannabis recommendation guidelines for physicians indicating the limited conditions for which the medical use of cannabis may be effective. Current literature is inadequate, cannabis dosage is not well standardized and side effects may not be tolerated.
CMA’s newly adopted policy also advocates for the regulation and evaluation of recreational cannabis.
“We need to regulate cannabis so that we know what we’re recommending to our patients,” Dr. Phinney said. “Currently, medical and recreational cannabis have no mandatory labeling standards of concentration or purity. First, we’ve got to legalize it so that we can properly study and regulate it.”
Physicians, who are currently only allowed to “recommend” medical cannabis, have been stuck in an uncomfortable position, since California decriminalized the drug in 2006.
“California has decriminalized marijuana, yet it’s still illegal on a federal level,” Dr. Hay said. “That puts physicians in an incredibly difficult legal position, since we’re the ones ultimately recommending the drug.”
CMA advocates for the regulation of medical cannabis to allow for wider clinical research, accountable and quality controlled production of the substance and proper public awareness. The physician group also recommends the regulation of recreational cannabis so that states may regulate this more widely used cannabis for purity and safety.
“Our physicians have looked at this issue closely and carefully over a significant period of time,” said Dustin Corcoran, CMA Chief Executive Officer. “After months of research and collaboration, they have chosen to adopt this forward thinking, medically sound policy that will only further their ability to properly treat patients.”
Selected Quotes from Endorsements and Statements of Support:
• “[A] federal policy that prohibits physicians from alleviating suffering by prescribing marijuana for seriously ill patients is misguided, heavy-handed, and inhumane.”
— Dr. Jerome Kassirer, “Federal Foolishness and Marijuana,” editorial, New England Journal of Medicine, January 30, 1997
• “[The AAFP accepts the use of medical marijuana] under medical supervision and control for specific medical indications.”
— American Academy of Family Physicians, 1989, reaffirmed in 2001
• “Based on much evidence, from patients and doctors alike, on the superior effectiveness and safety of whole cannabis (marijuana) compared to other medicines for many patients — suffering from the nausea associated with chemotherapy, the wasting syndrome of AIDS, and the symptoms of other illnesses … we hereby petition the Executive Branch and the Congress to facilitate and expedite the research necessary to determine whether this substance should be licensed for medical use by seriously ill persons.”
— American Academy of Family Physicians, 1995
• “[We] recommend … allow[ing] [marijuana] prescription where medically appropriate.”
— National Association for Public Health Policy, November 15, 1998
• “Therefore be it resolved that the American Nurses Association will: — Support the right of patients to have safe access to therapeutic marijuana/cannabis under appropriate prescriber supervision.”
— American Nurses Association, resolution, 2003
• “The National Nurses Society on Addictions urges the federal government to remove marijuana from the Schedule I category immediately, and make it available for physicians to prescribe. NNSA urges the American Nurses’ Association and other health care professional organizations to support patient access to this medicine.”
— National Nurses Society on Addictions, May 1, 1995
• “[M]arijuana has an extremely wide acute margin of safety for use under medical supervision and cannot cause lethal reactions … [G]reater harm is caused by the legal consequences of its prohibition than possible risks of medicinal use.”
— American Public Health Association, Resolution #9513, “Access to Therapeutic Marijuana/Cannabis,” 1995
• “When appropriately prescribed and monitored, marijuana/cannabis can provide immeasurable benefits for the health and well-being of our patients … We support state and federal legislation not only to remove criminal penalties associated with medical marijuana, but further to exclude marijuana/cannabis from classification as a Schedule I drug.”
— American Academy of HIV Medicine, letter to New York Assemblyman Richard Gottfried, November 11, 2003
• “[The LFA] urges Congress and the President to enact legislation to reschedule marijuana to allow doctors to prescribe smokable marijuana to patients in need … [and] urges the US Public Health Service to allow limited access to medicinal marijuana by promptly reopening the Investigational New Drug compassionate access program to new applicants.”
— Lymphoma Foundation of America, January 20, 1997
• “The American Medical Student Association strongly urges the United States Government … to reschedule marijuana to Schedule II of the Controlled Substance Act, and … end the medical prohibition against marijuana.”
— American Medical Students Association, March 1993
• “[T]he use of marijuana may be appropriate when prescribed by a licensed physician solely for use in alleviating pain and nausea in patients who have been diagnosed as chronically ill with life threatening disease, when all other treatments have failed; …”
— The Medical Society of the State of New York, May 4, 2004
• “[T]here is sufficient evidence for us to support any physician-patient relationship that believes the use of marijuana will be beneficial to the patient.”
— Rhode Island Medical Society, 2004
• ” [The] CMA continue[s] to support scientifically rigorous research, including all FDA-approved Phase II and Phase III clinical trials and examine the current science concerning the therapeutic role of cannabinoid-based pharmaceuticals”
— California Medical Association, October 30, 2006
• “[The] CMA continue[s] to support the ability of physicians to discuss and make recommendations concerning the potential benefits or harm to the patient of smoked herbal cannabis consistent with state and federal law and oppose criminal prosecution of patients who possess or use smoked herbal cannabis for medical reasons upon the recommendation of a physician”
— California Medical Association, October 30, 2006
• “The SFMS takes a support position on the California Medical Marijuana Initiative [legalizing medical marijuana].”
— San Francisco Medical Society, August 1996
• “Present evidence indicates that [cannabinoids] are remarkably safe drugs, with a side-effects profile superior to many drugs used for the same indications…”
— British Medical Association, November 1997
• “[We] support pharmacy participation in the legal distribution of medical marijuana.”
— California Pharmacists Association, May 26, 1997
• “We think people who use cannabis to relieve the pain of arthritis should be able to do so.”
— Arthritis Research Campaign, October 23, 2001
• “The evidence is overwhelming that marijuana can relieve certain types of pain, nausea, vomiting and other symptoms caused by illnesses like multiple sclerosis, cancer and AIDS — or by the harsh drugs sometimes used to treat them. And it can do so with remarkable safety. Indeed, marijuana is less toxic than many of the drugs that physicians prescribe every day.”
— Former U.S. Surgeon General Joycelyn Elders, M.D., “Myths About Medical Marijuana,” Providence Journal, March 26, 2004
• “We must make sure that the casualties of the war on drugs are not suffering patients who legitimately deserve relief.”
— Scott Fishman, president of the American Academy of Pain Medicine, February 2006
• “It [medical marijuana] should be an option for patients who have it recommended by knowledgeable physicians.”
— Dr. Jesse L. Steinfeld, former U.S. Surgeon General, July 2003
• “Whitman-Walker Clinic supports the valid use of marijuana, under a physician’s supervision, to help alleviate AIDS wasting syndrome and nausea associated with treatment regimes.”
— Whitman-Walker Clinic, April 1998
• “[I]t cannot seriously be contested that there exists a small but significant class of individuals who suffer from painful chronic, degenerative, and terminal conditions, for whom marijuana provides uniquely effective relief.”
— HIV Medicine Association of the Infectious Diseases Society of America; American Medical Students Association; Lymphoma Foundation of America; Dr. Barbara Roberts; and Irvin Rosenfeld, Amicus Curiae brief filed in the U.S. Supreme Court (in the case of Gonzales v. Raich), October 2004
• “Marijuana, in its natural form, is one of the safest therapeutically active substances known … The evidence in this record clearly shows that marijuana has been accepted as capable of relieving the distress of great numbers of very ill people, and doing so with safety under medical supervision. It would be unreasonable, arbitrary and capricious for DEA to continue to stand between those sufferers and the benefits of this substance.”
— Francis L. Young, DEA Chief Administrative Law Judge, 1988
• “[The American Bar Association] recognizes that persons who suffer from serious illnesses for which marijuana has a medically recognized therapeutic value have a right to be treated with marijuana under the supervision of a physician.”
— American Bar Association, May 4, 1998
• “I consider the most important recommendation made by the IOM (Institute of Medicine) panel [to be] that physicians be able to prescribe marijuana to individual patients with debilitating or terminal conditions … I believe such compassionate use is justified.”
— Andrew Weil, M.D., July 1999
• “Cannabinoids and THC also have strong pain-killing powers, which is one reason medical marijuana should be readily available to people with cancer and other debilitating diseases.”
— Dean Edell, M.D., March 2, 2000
• “I’m an oncologist as well as an AIDS doctor, and I don’t think that a drug that creates euphoria in patients with terminal diseases is having an adverse effect.”
— Dr. Donald Abrams, 2005
• “Cannabis will one day be seen as a wonder drug, as was penicillin in the 1940s. Like penicillin, herbal marijuana is remarkably nontoxic, has a wide range of therapeutic applications and would be quite inexpensive if it were legal.”
— Dr. Lester Grinspoon, professor of psychiatry at Harvard Medical School, Los Angeles Times, May 5, 2006
• “In states where patients are permitted to use marijuana medicinally for serious and/or chronic illnesses and a patient’s physician has recommended its use in accordance with that state law and that state’s medical practice standards, the patient should not be subject to federal criminal penalties for such medical use.”
— HIV Medicine Association, October 30, 2006
• “Well-designed and scientifically rigorous research, including all FDA-approved Phase II and Phase III clinical trials that lead to investigation into the potential therapeutic role and commercial licensure of prescription marijuana should be encouraged, and that production facilities that meet all regulatory requirements should be licensed by the DEA to produce pharmaceutical-grade marijuana for use exclusively in federally approved research.”
— HIV Medicine Association, October 30, 2006
• “Not everybody needs marijuana for medical illness. But for those who really do, it’s very helpful. As more and more states are taking medical marijuana — New Mexico just did it the other day — eventually it will just be overwhelming. And it will happen. But I’m shocked that it’s taken this long.”
— Dr. Thomas Ungerleider, Professor Emeritus of Psychiatry at UCLA and member of President Nixon’s National Commission on Marijuana and Drug Abuse, “3rd Degree,” interview, LA City Beat, March 29, 2007
• The United Methodist Church’s Board of Church and Society has said, “Licensed medical doctors should not be punished for recommending the medical use of marijuana to seriously ill people, and seriously ill people should not be subject to sanctions for using marijuana if the patient’s physician has told the patient that such use is likely to be beneficial.”
• The Presbyterian Church supports “the use of cannabis sativa or marijuana for legitimate medical purposes as recommended by a physician.”
• The Episcopal Church urges “the adoption by Congress and all states of statutes providing that the use of marijuana be permitted when deemed medically appropriate by duly licensed medical practitioners.”
• The United Church of Christ has stated, “We believe that seriously ill people should not be subject to arrest and imprisonment for using medical marijuana with their doctors’ approval.”
• The Unitarian Universalist Association issued a resolution in support of ending “the practice of punishing an individual for obtaining, possessing, or using an otherwise illegal substance to treat a medical condition.”
• The Union of Reform Judiasm passed a resolution to “advocate for the necessary changes in local, state and federal law to permit the medicinal use of marijuana and ensure its accessibility for that purpose.”
• The American Bar Association (ABA) “recognizes that persons who suffer from serious illnesses for which marijuana has a medically recognized therapeutic marijuana under the supervision of a physician.”