Jacob Bell
New Member
The California Medical Association (CMA) has adopted an official policy calling for the legalization and regulation of cannabis, which, it says, will facilitate wider clinical research on the drug.
"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, MD, president of the CMA, in a release.
"As physicians, we need to have a better understanding about the benefits and risks of medicinal cannabis so we can provide the best care possible to our patients."
The CMA notes that clinicians in California, where cannabis is decriminalized, are often in a catch-22 situation. Under the decriminalization rules, they can only "recommend" the substance for medical purposes, but there are no processes in place to address this.
"We need to regulate cannabis so we know what we're recommending to our patients," Paul Phinney, MD, president-elect of the CMA, told Medscape Medical News.
"Plus, because it's still illegal on a federal level, physicians are left in an incredibly difficult legal position."
The CMA's recommendations were published online October 14 in a white paper on the association's Web site.
Confusing System
The term "legalization" allows for the cultivation, sale, and use of a substance. Decriminalization can consist of a range of activities, including reducing penalties for related offenses. At this time, 16 states and the District of Columbia have decriminalized medical cannabis.
However, cannabis is also currently listed as a schedule I drug by the federal government, along with heroin, LSD, and peyote. This means "it has no accepted medical use and a high potential for abuse," according to the white paper.
It is also illegal under the federal Controlled Substance Act to knowingly or intentionally possess any schedule I drug.
In 2010, the CMA House of Delegates ordered the formation of a committee to recommend a policy on this substance.
The Legalization and Taxation of Marijuana Technical Advisory Committee, which prepared the white paper, "found that the public movement toward legalization of medical cannabis has inappropriately placed physicians in the role of gatekeeper for public access to this botanical. Effective regulation is possible only if cannabis is rescheduled at the federal level."
In the meantime, Dr. Phinney said that the CMA is recommending that clinicians be allowed to continue recommending cannabis for patients, but that it should be done according to guidelines developed by the CMA's Council on Scientific Affairs.
Regulating Recreational Cannabis
In addition to rescheduling medical cannabis, the committee also recommends regulating recreational cannabis "in a manner similar to alcohol and tobacco."
Earlier this year, California Health and Safety Code 11357 was implemented. The code reclassifies the possession of up to 1 ounce of nonmedical marijuana from a criminal misdemeanor to a civil infraction.
"There are currently no mandatory labeling standards of concentration or purity for cannabis. It is widely available in the community, yet it is completely unregulated," said Dr. Phinney.
"Declassifying it from a schedule I substance would allow the creation of a robust regulatory structure. Back during prohibition, we tried to make alcohol totally illegal, but I think we're a lot better off now with it regulated the way it is."
Cannabis' current classification also limits research on its potential risks and benefits.
"Unfortunately for California physicians, the popular justification for decriminalization actions has been a declaration of the medical efficacy of cannabis when, in reality, current data have shown that the medical indications...are very limited," the committee notes.
Call for a National Coalition
The white paper also points out that although cannabis may be effective in treating nausea, pain, and anorexia, dosage is not "well standardized," and its adverse effects are not well studied.
"We don't really know very much about which kinds of patients, and at what ages, should be treated, and at what doses. So we're sort of prescribing blind," said Dr. Phinney.
"You can do research on a schedule I substance, but the number of hoops you have to go through and the expense involved make it really prohibitive."
The CMA is calling for a national coalition made up of state medical associations and medical specialty societies to build support for the federal rescheduling of cannabis.
"National advocacy is essential to promoting the adoption of consistent, effective regulations at the federal level. Without a national solution, a patchwork of state-by-state decriminalization efforts will persist, thus exposing physicians and members of the public to liability and federal criminal sanctions."
Dr. Phinney said he hopes this is an issue that will be taken up by the American Medical Association.
"Perhaps CMA taking this bold but definite step in this direction will encourage other states that are thinking in these terms to adopt similar policies. And if it is adopted at the national level, I think we may get some impetus toward reconsideration of the schedule I status, which would open a lot of doors," he said.
"I hope people realize doctors don't want rampant drug use in the community. Doctors want people to be healthy. And we, at the CMA, believe these recommendations help move an issue that's been stuck in a prohibition mindset to something that's thought about a little differently."
Masquerading as Medicine?
"I would emphasize there are significant medical and psychiatric risks associated with medical marijuana," John Renner, MD, a professor of psychiatry at Boston University School of Medicine in Massachusetts, who also runs the Addiction Psychiatry Residency at the Boston Veterans Administration, told Medscape Medical News.
"Right now, many people are concerned with the expanded use of marijuana masquerading as medicine. I'm also concerned that a push to legalize it will be misinterpreted to mean it's perfectly harmless. And that is not true."
Dr. Renner, who is also the chair of the American Psychiatric Association's (APA's) Council on Addiction, said the APA's official position statement on medical marijuana has not changed since it was first adopted in 2009.
"We reviewed it again recently and thought it was fine the way it is. Basically, the APA's position is that individuals who are ill should get medications that are helpful to them. But we are concerned that those medications are safe, and that there is adequate research to demonstrate how effective they are," said Dr. Renner.
"Our primary concern is that medical marijuana is not an approved [US Food and Drug Administration] drug. And I think everyone is very concerned about smoking marijuana, in terms of its pulmonary effects. It's just not a safe way to deliver medication."
He added there are also concerns with the decriminalization process that currently exist in several states.
"In a sense, it's really bypassed the national evaluation system, and we certainly think that's a mistake. Beyond that, I personally would agree with the physicians in California that their medical marijuana system that's been set up is a serious problem."
Dr. Renner stressed that the APA has in no way endorsed the legalization of cannabis.
"Speaking just for myself, I think we need to look for better ways to safely regulate this drug. But I don't think medical marijuana is the answer."
He noted that although the US Food and Drug Administration's current regulatory system has some bureaucratic problems, and can be cumbersome and expensive, "there are still plenty of good reasons" that it is there.
"I think the whole notion where states can individually go out and approve any chemical and say it's okay for use, bypassing all the usual science and safety regulatory procedures, is really a disastrous precedent."
News Hawk- Jacob Ebel 420 MAGAZINE
Source: medscape.com
Author: Deborah Brauser
Contact: Contact Us
Copyright: WebMD LLC.
Website: California Physicians Call For The Legalization Of Cannabis
"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, MD, president of the CMA, in a release.
"As physicians, we need to have a better understanding about the benefits and risks of medicinal cannabis so we can provide the best care possible to our patients."
The CMA notes that clinicians in California, where cannabis is decriminalized, are often in a catch-22 situation. Under the decriminalization rules, they can only "recommend" the substance for medical purposes, but there are no processes in place to address this.
"We need to regulate cannabis so we know what we're recommending to our patients," Paul Phinney, MD, president-elect of the CMA, told Medscape Medical News.
"Plus, because it's still illegal on a federal level, physicians are left in an incredibly difficult legal position."
The CMA's recommendations were published online October 14 in a white paper on the association's Web site.
Confusing System
The term "legalization" allows for the cultivation, sale, and use of a substance. Decriminalization can consist of a range of activities, including reducing penalties for related offenses. At this time, 16 states and the District of Columbia have decriminalized medical cannabis.
However, cannabis is also currently listed as a schedule I drug by the federal government, along with heroin, LSD, and peyote. This means "it has no accepted medical use and a high potential for abuse," according to the white paper.
It is also illegal under the federal Controlled Substance Act to knowingly or intentionally possess any schedule I drug.
In 2010, the CMA House of Delegates ordered the formation of a committee to recommend a policy on this substance.
The Legalization and Taxation of Marijuana Technical Advisory Committee, which prepared the white paper, "found that the public movement toward legalization of medical cannabis has inappropriately placed physicians in the role of gatekeeper for public access to this botanical. Effective regulation is possible only if cannabis is rescheduled at the federal level."
In the meantime, Dr. Phinney said that the CMA is recommending that clinicians be allowed to continue recommending cannabis for patients, but that it should be done according to guidelines developed by the CMA's Council on Scientific Affairs.
Regulating Recreational Cannabis
In addition to rescheduling medical cannabis, the committee also recommends regulating recreational cannabis "in a manner similar to alcohol and tobacco."
Earlier this year, California Health and Safety Code 11357 was implemented. The code reclassifies the possession of up to 1 ounce of nonmedical marijuana from a criminal misdemeanor to a civil infraction.
"There are currently no mandatory labeling standards of concentration or purity for cannabis. It is widely available in the community, yet it is completely unregulated," said Dr. Phinney.
"Declassifying it from a schedule I substance would allow the creation of a robust regulatory structure. Back during prohibition, we tried to make alcohol totally illegal, but I think we're a lot better off now with it regulated the way it is."
Cannabis' current classification also limits research on its potential risks and benefits.
"Unfortunately for California physicians, the popular justification for decriminalization actions has been a declaration of the medical efficacy of cannabis when, in reality, current data have shown that the medical indications...are very limited," the committee notes.
Call for a National Coalition
The white paper also points out that although cannabis may be effective in treating nausea, pain, and anorexia, dosage is not "well standardized," and its adverse effects are not well studied.
"We don't really know very much about which kinds of patients, and at what ages, should be treated, and at what doses. So we're sort of prescribing blind," said Dr. Phinney.
"You can do research on a schedule I substance, but the number of hoops you have to go through and the expense involved make it really prohibitive."
The CMA is calling for a national coalition made up of state medical associations and medical specialty societies to build support for the federal rescheduling of cannabis.
"National advocacy is essential to promoting the adoption of consistent, effective regulations at the federal level. Without a national solution, a patchwork of state-by-state decriminalization efforts will persist, thus exposing physicians and members of the public to liability and federal criminal sanctions."
Dr. Phinney said he hopes this is an issue that will be taken up by the American Medical Association.
"Perhaps CMA taking this bold but definite step in this direction will encourage other states that are thinking in these terms to adopt similar policies. And if it is adopted at the national level, I think we may get some impetus toward reconsideration of the schedule I status, which would open a lot of doors," he said.
"I hope people realize doctors don't want rampant drug use in the community. Doctors want people to be healthy. And we, at the CMA, believe these recommendations help move an issue that's been stuck in a prohibition mindset to something that's thought about a little differently."
Masquerading as Medicine?
"I would emphasize there are significant medical and psychiatric risks associated with medical marijuana," John Renner, MD, a professor of psychiatry at Boston University School of Medicine in Massachusetts, who also runs the Addiction Psychiatry Residency at the Boston Veterans Administration, told Medscape Medical News.
"Right now, many people are concerned with the expanded use of marijuana masquerading as medicine. I'm also concerned that a push to legalize it will be misinterpreted to mean it's perfectly harmless. And that is not true."
Dr. Renner, who is also the chair of the American Psychiatric Association's (APA's) Council on Addiction, said the APA's official position statement on medical marijuana has not changed since it was first adopted in 2009.
"We reviewed it again recently and thought it was fine the way it is. Basically, the APA's position is that individuals who are ill should get medications that are helpful to them. But we are concerned that those medications are safe, and that there is adequate research to demonstrate how effective they are," said Dr. Renner.
"Our primary concern is that medical marijuana is not an approved [US Food and Drug Administration] drug. And I think everyone is very concerned about smoking marijuana, in terms of its pulmonary effects. It's just not a safe way to deliver medication."
He added there are also concerns with the decriminalization process that currently exist in several states.
"In a sense, it's really bypassed the national evaluation system, and we certainly think that's a mistake. Beyond that, I personally would agree with the physicians in California that their medical marijuana system that's been set up is a serious problem."
Dr. Renner stressed that the APA has in no way endorsed the legalization of cannabis.
"Speaking just for myself, I think we need to look for better ways to safely regulate this drug. But I don't think medical marijuana is the answer."
He noted that although the US Food and Drug Administration's current regulatory system has some bureaucratic problems, and can be cumbersome and expensive, "there are still plenty of good reasons" that it is there.
"I think the whole notion where states can individually go out and approve any chemical and say it's okay for use, bypassing all the usual science and safety regulatory procedures, is really a disastrous precedent."
News Hawk- Jacob Ebel 420 MAGAZINE
Source: medscape.com
Author: Deborah Brauser
Contact: Contact Us
Copyright: WebMD LLC.
Website: California Physicians Call For The Legalization Of Cannabis
