Almost daily, Dr. Gogi Kumar is questioned at Dayton Children’s Hospital about medical marijuana by concerned parents of children who suffer from seizures.
Kumar is not alone in the curiosity she receives from patients about Ohio’s confusing medical marijuana program that is expected to begin in September.
Doctors told this newspaper they are bombarded with questions about medical marijuana and are concerned because they don’t have all the answers. There is an information gap on questions such as how effective marijuana is for specific disorders, how the compounds affect children and how it interacts with other medications, doctors said.
Kumar, the hospital’s neurology medical director, said parents have seen examples of children who are helped by cannabis-based treatment and want that same relief for their kids.
“I’m not resistant to (recommending) medical marijuana, but I need data,” Kumar said. “Although it’s natural, marijuana is not like a vitamin. I have to be careful as to what I’m giving the patient.”
Ohio’s medical marijuana program is set to start Sept. 8, but patients who are hoping to take medical marijuana may still face another obstacle: physicians wrestling with issues of data gaps and ethical questions when it comes to recommending a substance that was approved for treating 21 disorders by a legislative vote, not the FDA.
There’s a lack of large, double-blind studies in the U.S. on the effects of medical marijuana on specific conditions. And with the studies that are out there, said Dr. Glen Solomon, it’s hard to control whether the exact strain and dosage studied is what his patient ends up taking.
With other medications, said Solomon, who practices internal medicine with Wright State Physicians, research has shown the substance to be safe and effective.
“And that let’s you sleep well at night when you’re a doctor,” he said. “Medical marijuana never went through that process. This is a substance that basically the state legislature decided is now a medicine.”
Task force
Solomon is part of a task force at Wright State University’s Boonshoft School of Medicine that wants to serve as a resource for students, residents and local doctors to learn the information that’s available about marijuana.
The task force is still early in formation; Solomon said the goal is also to create an online database of what research is available about marijuana and to provide educational programs for doctors and residents.
Tessie Pollock, spokeswoman for the State Medical Board of Ohio, said the state marijuana program “is fortunate that we had a lot of other states to look at when establishing these rules” and was able to garner best practices, what worked and what didn’t work and how those states developed education for their physicians.
The medical board hasn’t started certifying doctors yet to recommend marijuana but will do so this spring.
Physicians will also need to complete two hours of continuing medical education to get certified to recommend marijuana and those renewals.
The refusal of the U.S. DEA to move marijuana from a Schedule 1 drug — considered to have to no acceptable medical use — to a Schedule 2 drug is in part responsible for the state legislature legalizing medical marijuana, said State Rep. Steve Huffman, who is also an emergency physician.
If the DEA changed how it classified marijuana, then there could have been research and federal approval for certain disorders like with other medicines, but without that change, it’s been approved instead by state votes.
Patient demand
One of the results of research not keeping up with patient demand has been patients going out on their own to treat their symptoms with marijuana. And that can leave physicians in the dark on what is the real reason that their patients’ symptoms are improving.
Since the state approved starting a medical marijuana program, Dr. Cleanne Cass, who is a Dayton area hospice and palliative care physician, said her patients have been less likely to try to hide that they’ve been using marijuana to help with their symptoms.
“Since the state referendum, patients are more open to telling me that they are using marijuana,” she said.
Cass said she plans to attend “as many conferences as I can” to learn about medical marijuana, which is going to be a hot topic in hospice care.
Kumar said while she doesn’t encourage her patients’ parents to do things like order cannabis oil on the internet, they still do and she tells them to be honest with her what they are doing at home so she can sort out what is working and what’s not.
“I always encourage them to please tell me,” she said.
There are also recent clinical trials that provide evidence that a cannabis based medication, Epidolex, is effective in some patients with intractable epilepsy, but this medication is not yet approved by the FDA.
“We already have a drug that’s on the way to being approved by the FDA so why not wait for it because then you know exactly what you’re doing,” Kumar said.
Data shortage
With a shortage of robust studies on how marijuana could be used medically, it raises a bigger question of whether states should be allowed to approve these type of issues with a vote, said Marc Sweeney, dean of Cedarville University School of Pharmacy.
“The challenge is when you put any type of pharmacologic therapy on a ballet, unlike the FDA process, the general public is making a decision whether a quote unquote drug should be used,” Sweeney said.
A review published in 2015 in The Journal of the American Medical Association looked at all randomized controlled trials of cannabis or cannabinoids to treat medical conditions and found 79 trials involving more than 6,400 participants. Most did not achieve statistical significance. Some did though, like a study that associated marijuana with improvements in resolution of nausea and vomiting due to chemotherapy, with 47 percent of those using it finding relief versus 20 percent of the control group.
Hufffman said he would advocate for federally reclassifying marijuana to allow more U.S. research, because if federal restrictions weren’t in the way there could be more scientific information to guide these debates.
“But we’re ham-stringed by not moving it to Schedule 2 so we could have that data,” he said.
What can you get medical marijuana for?
Under Ohio law, the 21 qualifying medical conditions:
AIDS, amyotrophic lateral sclerosis, Alzheimer’s disease, cancer, chronic traumatic, encephalopathy, Crohn’s disease;
Epilepsy or another seizure disorder, fibromyalgia, glaucoma, hepatitis C, inflammatory bowel disease, multiple sclerosis, pain that is either chronic and severe or intractable, Parkinson’s disease;
Positive status for HIV, post-traumatic stress disorder, sickle cell anemia, spinal cord disease or injury, Tourette’s syndrome, traumatic brain injury, and ulcerative colitis.
Medical marijuana facts
1. It’s still illegal under federal law for doctors to prescribe marijuana. In Ohio, patients will get what is classified as a physician recommendation, which is filled at a dispensary and not a pharmacy. Physicians have to be certified by the State Medical Board of Ohio to recommend marijuana.
2. All medical marijuana patients and their caregivers have to register with the State Board of Pharmacy. The registration expires in a year, or if the patient is terminally ill, it expires after six months.
3. Ohio’s medical marijuana program is scheduled to start Sept. 8. The state already awarded licenses to grow marijuana and still needs to award licenses for dispensaries.
