A Medical Marijuana Update

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On April 13, 2016, the Pennsylvania House of Representatives agreed to changes made by the Senate on Senate Bill 3 (the medical marijuana bill), making Pennsylvania one of 24 states enacting laws legalizing medical marijuana.

This does not mean that medical marijuana is now available. It will take approximately 18 months for the entire medical marijuana program to be implemented. People who are eligible to obtain medical marijuana include those individuals diagnosed with one of 17 serious medical conditions. These include cancer; HIV or AIDS; ALS; Parkinson’s disease; multiple sclerosis; damage to the nervous tissue of the spinal cord with intractable spasticity; epilepsy; inflammatory bowel disease; neuropathies; Huntington’s disease; Crohn’s disease; PTSD; intractable seizures; glaucoma; sickle cell anemia; severe and chronic organ intractable pain in which conventional therapeutic intervention and opiate therapy is contraindicated or ineffective; and, autism.

But is legalization the right approach? Cannabis is the most commonly use illicit drug in the world, with estimates that it is used by 162 million adults worldwide. Cannabis use is particularly common among young people. Many people experiment with cannabis or use casually, while a small proportion become heavy or dependent users. Cannabis is derived from the Indian hemp plant, cannabis sativa. The active ingredient is Delta-tetrahydrocannabinol (THC), which produces the desired psychological effects of cannabis smoking. Cannabidiol is another component of the plant, which may have effects opposite to THC. Many of the new preparations of cannabis possibly have more deleterious mental effects because they contain a greater proportion of THC than cannabidiol.

There are 400 known chemicals in marijuana. Sixty to eighty of those are unique to the marijuana plant and are called cannabinoids. Marijuana and tobacco smoke contain many of the same chemical constituents, including many carcinogenic chemicals. The smoke contents of marijuana and tobacco reveal much the same gas phase and particulate phase constituents. Of these components 33 are cancer-causing chemicals.

Proponents of the legalization of medical marijuana refer to dozens of studies that have been conducted around the world demonstrating marijuana’s benefit in treating various disorders. There are a total of 61 peer-reviewed studies between 1990 and 2014. Only 27 of the studies were double blinded, and only 17 were double blinded with positive results. Of these 17 studies, many were very short-term, involved a small number of participants, are not Phase 3, and used terms like “might” or “may” to describe the results.

Currently, the bill does not require insurance companies to cover medical marijuana. Also currently physicians are not required to certify any individual who seeks to obtain medical marijuana. It should also be remembered that, except for Marinol and Cesamet marijuana is not a medicine that has been scientifically tested or FDA-approved to prescribe to patients.  The Pennsylvania Medical Society does not and has not ever endorsed the legalization of medical marijuana until peer reviewed scientific studies demonstrate benefit greater than risk. Until such evidence, exists coverage for medical marijuana should also not be a component of any compensation package offered by employers.

Dr. Gentile, a specialist in Addiction Medicine, is an expert physician at Tucker IME. For more information on Dr. Gentile, his CV, and the services that he and our other medical experts can provide, please visit our website at www.tuckerime.com..

By Anthony Gentile, M.D.