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Medical Marijuana

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Victoria Martino

on 27 October 2013

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Transcript of Medical Marijuana

The Issue
Prop. 420:
Compassionate Cannabis Care Act in Pennsylvania
Used for medicinal purposes for thousands of years dating back to 2737 b.c. where marijuana was used to treat gout, rheumatism and poor memory
Methods of Use:
Oromucosal Spray
Marinol (INN:Dronabinol)
Cesamet (Nabilone)
Butter or cooking oil
Exempt from Sanctions
The proprietor of a dispensary who has obtained mandatory registration and has been approved by the bureau will not be subject to arrest, prosecution or other criminal, civil or administrative sanctions under state or local law for :
lab testing
Medical Cannabis
Drew Kaneps, Victoria Martino, Jack Matsen, Megan Michaels, Marie Roantree, Alison Tyrell
medical marijuana is currently illegal in Pennsylvania
Drug Scheduling
Dependent upon:
the drug's acceptable medical use
the potential for abuse or dependency
Changing to Schedule II Drug
rejected by the DEA because "there was no scientific evidence showing that marijuana was better than other approved drugs for any specific medical condition"
Ethical Issues
physician- patient relationship
informed consent
access palliative treatment to relieve pain and suffering
comes from the leaves and flowering tops of hemp plants, Cannabis sativa and Cannabis indica
Delta-9-Tetrahydrocannabinol (THC)
principle psychoactive constituent
cannabinoid-1 receptors (CNS)
cannabinoid-2 receptors (immune system)
Cannabidiol (CBD)
major constituent of medical cannabis
non-psychoactive component
"The DEA will not reschedule marijuana without an official determination of safety and efficacy from the Food and Drug Administration"
Problems arise because the FDA requires controlled double blinded clinical trials for rescheduling

Major issues:
lack of a patentable product
clinical trials must be funded by grant money from the National Institutes of Health
Smoked Marijuana
schedule III prescription drug
faster absorption
higher peak THC levels in plasma
psychopharmacological effects peak at 30-60 minutes
can self-titrate
plant compounds may provide additional benefits
cost effective
difficult to determine effective dosage (4-6%)
immunosuppression in animals and in vitro but no clinical experience has shown this in humans
tachycardia (dose related)
potential for toxic compounds in marijuana smoke
Principle of Double Effect
more effective than conventional therapies
helps combat the effects of traditional treatments leading to cures
potential toxins with marijuana smoke
viewed as a "gateway drug"
suggests that illegal drug use is condoned
can be used:
as treatment
to alleviate symptoms of accepted treatments
Theological Foundation
Pharmacologically active substances
Burden vs Benefit
Palliative care
Ordinary vs. Extraordinary Means
Government Ruling
Clinton Administration:
(1.) Has no scientific proof in terms of safety and efficacy
(2.) Gateway drug
(3.) Sends the wrong message to the public
Public Opinion
Patient vs. The Pennsylvania State Government
Right to be informed of all viable options
Issue of informed consent if currently illegal within state of residence

Benefits outweigh harms
Visible through principle of double effect
Individuals with debilitating medical conditions
Improved quality of life
Medicinal cannabis may be more beneficial to the patient than other treatments

Medical marijuana may be less of a burden than other treatments with debilitating side effects

Everyone has the right to effective treatment
Just allocation of resources
PA State Government
Considered to have no medical value
Preventing drug dependence to an illegal substance

Laws are in place to promote safety amongst all citizens
Prevent the condoning of drug use and crime (Schedule 1)
1840-1900: used for inflamed skin, and venereal disease
1851: Cannabis was listed in U.S. Pharmacopoeia
1970: Federal Controlled Substance Act
1950s: Boggs Act (1952) and the Narcotics Control Act (1956)
1937: Marihuana Tax Act
Ethical Defense
Forms of Marijuana Used Medically
18 states and Washington D.C.
currently allow medical marijuana
1996: California, Proposition 215 (56%)
Gallup numbers
48% favor "adult use" legislation

64% think the federal government should honor state medical marijuana laws
Fortune Magazine April 8, 2013
1894: Indian Hemp Drug Commission report
1976: Compassionate Investigational New Drug Program
1992: CINDP shut down
1944: LaGuardi Commission
Allow Dispensaries
State regulated but Free Market Industry
No Self-Cultivation
6% State Sales Tax + Additional County Taxes (max 2%) + cannabis tax (2.5%)
max of 12 sprays a day
$162 (Per 10ml bottle = 90 sprays (11.3 days))
varies by patient

no Smoke

one strain
not as effective as smoke or vapor
filters through liver
high price
during chemotherapy
1mg capsule $13.99, 0.5 mg capsule $3.49
significantly reduced nausea, vomiting and increased food intake 5 days following chemotherapy
no smoking
no serious side effects
high price
2 times per day (2.5 mg, 5mg, 10mg)
$110-$130 (30 capsules 2.5mg)
lower peak levels of THC compared to smoking cannabis
psychopharmacological effects peak at 2 hours - slow absorption
no smoke
difficult to use for patients with nausea
receive 10-20% of THC from pill
side effects
filters through liver
must register with the bureau
registration last 2 years
can reapply for renewal of existing mandatory registration 90 days before expiration date
operating a facility without appropriate registration can result in $25,000 fine
dispensary must provide record of sale
cities and counties can impose an additional tax but it cannot exceed 2%
separate supplemental sales tax of 2.5%
% of revenue collected should be deposited into Medical Marijuana Fund
Compassionate Cannabis Dispensaries
Franklin & Marshall
2010: 81% of Pennsylvanians support making medical Cannabis Legal

(Up from 2006 poll 76% approval)
Not FDA approved: currently Phase III clinical trial in US
schedule II controlled substance
Bureau of Medical Marijuana Enforcement
Medical Marijuana Regulation, Control and Taxation Act of 2012 currently in CA
within the Department of Consumer Affairs
Dispensary concept adapted from:
Our Medical Cannabis Business Environment
Compassionate Cannabis Patients
Senate Bill No. 17
Patients criteria adopted from:
How to Qualify:
1. must be a resident of Pennsylvania for longer than 30 days
18 to obtain
under 18 requires approval of state certified caregiver
2. Possess medical records that indicate the diagnosis of a qualifying condition
3. Obtain written documentation from a physician licensed in the state of Pennsylvania that you are a qualifying patient.
4. Apply and receive a Compassionate Cannabis Card
We welcome visitors.
1890: Hemp is replaced by cotton as a major cash crop
1998: Alaska becomes 2nd state to legalize Medical Marijuana
21 years of age
All Dispensaries must be state licensed and State-run patient registry
Bona fide physician-patient relationship must be established prior to purchase of Medical Cannabis
Patients may legally possess up to 6oz.
Patients cannot possess more than 6oz at a time
Possession is solely meant to treat or alleviate patients medical condition
Each patient must obtain and carry a physicians recommendation in writing
Patients must not break rules similar to those laid out in Delaware's §4904A
Law and Medical Cannabis
Patient's Stipulations:
Eligible Ailments:
Cancer, HIV/AIDS, ALS, Crohn's disease, agitation of Alzheimer's Disease
A chronic or debilitating disease or condition that produces one or more of the following:
severe debilitating pain
has not responded to previously prescribed mediation or surgical procedures for more than 3 months
from other treatments that produce serious side effects
severe nausea
severe and persistent muscle spasms
Role of Pennsylvania Department of Public Health
- establish a voluntary registration
- Identification card system
When considering the situation of medical cannabis, the patients right's of autonomy, beneficence, nonmaleficence and justice trump the Pennsylvania State Government's rights of nonmaleficence and justice.
Imago Dei
Respect autonomy
It is a social sin to prohibit physicians from recommending cannabis as a viable option.
Just distribution of healthcare resources
Common good
We need one another in order to reach self-actualization
Responsible use of technology
Resurrection/ Destiny
The Legal Aspect of Informed Consent
"[M]arijuana is an illegal drug; no one should ever use illegal drugs; therefore, no one should ever use marijuana for any reason"
Government's Logic
Questionable Logic
challenged by medical researchers, physicians, patients, and the government's own findings
(1.) "the benefits of smoking marijuana were limited by the toxic effects of the smoke, but nonetheless recommended that the drug be given under close supervision to patients who do not respond to other therapies"
(2.) "there was no evidence that giving the drug to sick people would increase illicit drug use in the general population"
(3.) "Marijuana is not a "gateway drug" that prompts patients to use harder drugs such as heroine and cocaine"
The White House Commission Committee consisting of 11 independent researchers concluded:
1st Amendment
Physicians are protected
9th Circuit
Conant v. Walters
14th Amendment
"State cannot deny any individuals the right to exercise a reasonable choice in the method of treatment of ills"
1958: 5th circuit court
10th Amendment

Prevents the federal
government from mandating
state enforcement

The federal government can only attempt to stop state action, it cannot force a state to act.
Obama initiated
informal ease on legitimate medical marijuana patients, cultivators, and distributors
Federal Enforcement Capabilities
"The Ethics of Medical Marijuana: Government Restrictions vs. Medical Necessity"
"The Ethics of Medical Marijuana: Government Restrictions vs. Medical Necessity"
"The Ethics of Medical Marijuana: Government Restrictions vs. Medical Necessity"
State law is merely an obstacle to the federal law, all individuals involved with medicinal cannabis no matter if it is therapeutic or commercial are still subject to federal prosecution
Defense of States Role
- Identification cards are a mere mechanism to help Pennsylvania law enforcement officers identify legitimate medicinal cannabis users
Dispensary criteria adopted from:
"The nurses told me it wasn’t a bad idea. However, the doctors discouraged it. Also, I’ve seen it on TV being used for"
"I would try my anti-nausea medicine and the pain killers I was prescribed. A good portion of the time after taking them I was still in so much pain. Until I smoked and was able to relax and calm down."
"It truly is the reason why I was able to deal with cancer so well. When the drugs I was prescribed failed it was the only way for me to get past certain days."
"Sure I was hesitant at first, but when I truly needed it I did not hesitate for a second because I was in so much pain."
What alternative medications or treatments did you try before you tried medical marijuana?
What were your personal thoughts on using medical marijuana?
How was medical marijuana brought up as an option?
Were you hesitant at first to try it/afraid you would get caught since it wasn't legal?
"Two months, I started using it halfway through my chemo treatment, because the built up effect of chemo took its toll and days at a time were just waking up with the spins."
How long did you use it for?
"Medical Marijuana Policy in the United States." HOPES, 15 May 2012.
Full transcript