Policy Positions Paper: Use of Medical Marijuana in Georgia
The use of marijuana (Cannabis sativa) can be traced back more than 5000 years ago related to medical, recreational, and spiritual reasons (Bostwick, 2012). The United States Pharmacopeia has included it since 1850’s, and until the 1930’s physicians provided prescriptions for it for a number of physical complaints (Narcanon International, 2016). In 1970, the United States Congress determined it had no valid therapeutic value and categorized it as a Schedule I illegal substance. However, a number of sources have stated that marijuana has no addictive properties (Samsha, 2016). The National Institute on Drug Abuse state this is the main reason Cannabis is the most popular of illegal drugs. Many portions of contemporary culture feel “pot” use is socially acceptable and when used for medical reasons, the majority of American citizens are supportive. A poll conducted by the Gallup organization reports that 73 percent of those questioned responded that they approved of “making marijuana legally available for doctors to prescribe in order to reduce pain and suffering.” (see Graph 1) (Gallup Inc., 2013). When more than 400 doctors participated in an international survey, between 60 percent and 70 percent stated they would prescribe marijuana if a patient requested it for medical reasons (de Jong, 2005).
There remains a large vocal group of opponents to the legalization of marijuana for any reason based primarily on the stigma attached to the substance by drug dealer, criminals, and misinformation. Many people find it difficult to discuss the attributes of marijuana for medical reasons because of their impression of the stereotype of illegal drug abusers. Marijuana is called a “gateway drug” that leads to the use of more dangerous and addictive substances. The theory proposes that using soft drugs leads to advancement of harder drugs such as cocaine or heroin
Graph 1. Americans’ Views on Legalizing Marijuana (Gallup, Inc.)
(Kilmer et al., 2010). The Gateway Theory also states that association with the subculture using illegal drugs promotes more susceptibility to acceptance of harder substances. This misconception started as early as the late 1930s when the movie Reefer Madness was distributed as part of a public information campaign (IMDb, 2016); in the film, teenagers smoking the drug demonstrated psychotic behavior. The press also promoted the impression by publishing stories of marijuana users as a dangerous element in society (Bostwick, 2012). In truth, there have been no reported deaths from an overdose of marijuana (see Graph 2). The fact that marijuana continues to remain federally illegal for any use is the lack of approval by the Food and Drug Administration (FDA). The purpose of this position paper is to present the facts regarding medical benefits of the use of marijuana, economic advantages for state and federal government, and challenges in formal legalization of the drug.
Pertinent Terminology
In the course of this position paper, specific terms required clarification. When discussing
“legalization” of marijuana, this involves legally allowing the cultivation of the plant,selling of Cannabis and derivatives such as oils, and buying marijuana and derivatives (Svrakic et al., 2012). The process is the same as when tobacco and alcohol use became legal. “Decriminalization” eliminates criminal sanctions against associations with marijuana; the drug remains illegal, but if a person is holding less than a certain amount they will not be prosecuted. This is important as more states legalize marijuana possession within their borders in direct conflict with federal laws that prohibit any association with the drug.
Therapeutic Benefits of Medical Marijuana
Perhaps the most convincing argument for the federal legalization of medical marijuana is the decrease in suffering that would be afforded patient living with deadly or chronic disease. The medical community continues to debate the effectiveness of marijuana as a treatment for illnesses, but there is little doubt it offers palliative relief from pain, nausea, vomiting, and other side effects of pharmaceutical therapies and disease (see Image 1).
Image 1. Potential Therapeutic Uses of Medical Marijuana (Norml.org, 2015)
An evaluation of 37 controlled studies conducted between 2005 and 2009 concerning the benefits of the components of marijuana recommended the drug for varying degrees of control of chronic neuropathy and multiple sclerosis and for promoting increased desire for food in patients suffering from terminal diseases such as cancer and acquired immune deficiency syndrome (AIDS)(Hazekamp and Grotenhermen, 2010). The University of California Center for medicinal Cannabis Research reported that marijuana works as well or better than barbiturates and opiates for neuropathy pain associated with cancer, diabetes, multiple sclerosis, AIDS, spinal cord injuries and similar diseases without the dangers of addiction and increasing tolerance (Center for Medical Cannabis Research: University of California, 2010). Although the use of medical marijuana is legal only in some states, the FDA does permit medications with a base of delta-9-tetrahydrocannabinol (THC), chemicals related to the cannabinoids in marijuana, for patients suffering from nausea, vomiting, and loss of appetite (Scott, Dalgleish, and Liu, 2014). There have also been reposrt that THC controls muscle spasms and decreases pain and inflammation. Cannabidol (CBD) is another component of marijuana and is being researched for control of seizures, addiction, pain, inflammation, and some forms of mental illness.
Experiments with THC and CBD on animals have shown marijuana extracts may kill some kinds of cancer and decrease other types when used with radiation more so than when radiation is used alone, particularly cells in brain tumors (Mechoulam et al., 2007; Scott, Dalgleish, and Liu, 2014). Other research involving cannabis involves treating amyotrophic lateral sclerosis (Carter and Rosen, 2001), bipolar disorders (Ashton et al., 2005), joint stiffness and muscle spasms of multiple sclerosis (Koppel, 2014), bone fractures associated with degenerative bone diseases (Gross, 2015), and mental illness associated with anxiety such as psychosis and depression (Campos, Moreira, Gomes, Del Bel & Guimaraes, 2012). The challenges related to research for therapies involving marijuana is that it is an illegal substance and it is difficult for researchers to obtain sufficient quantities of the drug for laboratory experiments. Medical organizations such as the Institute of Medicine, the American Medical Association, and the American College of Physician are urging drug manufacturers to place pressure on the FDA to allow experimentation with marijuana treatments in order for physicians to be able to make informed decisions for prescribing (Cohen, 2012).
The following is an example of an actual case that involved a woman diagnosed with Crohn’s disease who resides in a state where it is illegal to possess medical marijuana. An inflammatory disease of the digestive system, Crohn’s disease manifests in unrelenting symptoms of influenza (Ferner, 2015). Shonda Banda had been living in Kansas with Crohn’s disease for over 10 years and found some relief through the use of cannabis oil. Her health had degenerated to the point of being considered terminal when she began to use the marijuana extract, but improved to the point where she was healthy enough to function well and resumed the responsibilities of raising her 11-year-old son. However, her son got into a confrontation with police at his school during a lecture on drug use when he stated his mother used marijuana and when Ms. Banda returned home that afternoon, her home was being searched with a warrant. Her son from removed from her home and she was charged with five felony counts of possession with intent to distribute and child endangerment (Patterson, 2015). One year later, Banda’s son is still not living at home and her charges are still pending (Associated Press, 2015). Banda is suing the courts in Kansas, stating she is being deprived of necessary medical care, that her son was never allowed access to marijuana, and her cultivation and extraction of the cannabis oil was for her own use. Before discovering the therapeutic impact of marijuana for her health, Banda was prescribed fentanyl, one of the most potent and addictive analgesics produced. Banda now faces 30 years in prison and permanent loss of the custody of her son for opting to use marijuana rather than addictive painkillers. In addition, the cost of marijuana is much less than manufactured medications.
The 1937 Marihuana [sic] Tax Act raised the cost of the drug to physicians by $1 per ounce and for other reasons to more than $100 per ounce in response to public outcry, despite objections by drug companies and the American Medical Association (Musto, 1972). In 1970, the FDA declared cannabis to be a street drug with high potential for abusive use and together with Congress, placed it in the same drug category as Quaaludes, methamphetamines, heroin, and hallucinogens (Cohen, 2010). This resulted in halting most of the research using marijuana for positive medical therapies in the United States (Hoffman and Weber, 2010). The National Institute on Drug Abuse, the FDA, and the Drug Enforcement Agency must all grant permission for a research team to conduct the study (Cohen, 2010). For this reason, most studies concerning cannabis therapy take place outside the United States; there has been adequate research in Canada to legalize medical marijuana (Ben Amar, 2006).
In America, 24 states have passed laws allowing medical marijuana with Florida, Louisiana, and South Carolina with pending legislation (ProCon.org, 2016). This places federal legislation ruling possession of marijuana for any reason is illegal in conflict with states that allow it. This is another strong influence for federal legalization, assuming it would have to occur almost simultaneously with a ruling from the FDA that the drug is relatively harmless and actually a benefit for medical practices. The current law in George concerning medical marijuana is for the use of marijuana oil only (Georgia Cannibis.org, 2016). In order for medical marijuana to be available from a physician’s prescription for ingestion, smoking, or inhaler, legislation would need to be introduced and passed through committee process. If this is successful, the state house would need to pass the bill to the Georgia’s governor for approval. At the time of signing, the law would go into effect. In the process of introduction and committee and House approval, policy specifications would need to be discussed and possibility amended; the specifications concerning patient qualifications and other details vary from state to state. Currently, the law in Georgia concerning medical marijuana oil does not allow legal production or sale, but does decriminalize possession by registered qualified patients of no more than 20 fluid ounces of oil with less than 5 percent THC and an equal amount of CBD. Governor Nathan Deal signed Haleigh’s Hope Act in April 2015 to allow study programs in universities in Georgia for the use of marijuana for pediatric seizure disorders.
As the use of medical marijuana becomes more accepted, the attitude of police departments has also undergone change. President Barack Obama announced that he thinks resources for law enforcement are better spent in other areas than making and prosecuting marijuana possessions (Ncsl.org, 2015). Statistics released by the American Civil Liberties Union (ACLU) report more than 50 percent of the total number of arrests for drug possession was for cannabis. There were 8.2 million people arrested for marijuana possession between 2001 and 2010 and 88 percent of these individuals were not charged with intention to distribute the drug (ACLU, 2015). The results of this activity was to misdirect police officers and court attorneys from more productive reduction of violent crime and millions of American had their lives negatively impacted with criminal records, lost income, and jobs for a crime that in 26 states has been deemed not illegal. Every year, the estimated cost of this activity on the part of the government is $10 billion (Gettman, 2007).
Barriers to Federal Legalization of Medical Marijuana
In America, the FDA is given the right of supervision of manufacturing and approval of all drugs used medically and recreationally. There is a strict process based on intense research in an effort to avoid harm by drugs to humans (FDA.gov., 2015). The problem with the FDA granting approval for marijuana for medical use is that the drug is illegal and it is illegal based on the classification of the FDA. One of the components of the approval process is research proving safety of the drug for human use in studies conducted in the United States, but research cannot be conducted on the scale needed for FDA approval due to the illegality of the drug.
Conclusion
Polls have shown that most of the people in the United States support patient use of marijuana for relief of various medical conditions. Almost 50 percent of the territories and states in the country have approved medical marijuana and two states have approved recreational use. To address the remaining number of undecided citizens, physicians, politicians, and researchers, it is necessary for the approval of high-quality, long-term, large-scale trials. Based on the results of the studies, the responsible agencies can reliably approve the use of medical cannabinoids and effective public information campaigns can be launched to promote legal and social acceptance.
The overlapping of state and federal laws concerning possession and use of medical marijuana confounds the issue and prompts unnecessary suffering and expense for all entities concerned. Great strides have been made toward legalizing medical marijuana, but in order for progress to continue, states such as Georgia need to recognize the needs of their residents and pass needed legislation for full access of patients to all forms of the drug. After consideration of the facts surrounding the legalization of medical marijuana, federal government and FDA approval is inevitable and Georgia would do well to take the steps needed to support patients within the borders of the states as quickly as possible.
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