The Fallacy of the Medical Marijuana Movement – A Pharmacist’s Perspective

Please note: The following article does not necessarily represent the views of the Green Party of the United States, or the Green Party of Florida. This article is published by the Green Party of Bay County, Florida to provide a different perspective on Amendment 2, and is provided by a respected professional in the health care field. The opinions expressed are those of the author.

This article is published by the Green Party of Bay County, Florida with permission and may not be published in whole or in part without the express permission of the author. Contact baygreens@outlook.com for more information.

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The premise for legalizing the use of marijuana is the belief that there is a duty to relieve suffering. Many who currently use marijuana illegally do so, they say, because it relieves suffering in ways legal medications cannot.

Dronabinol, a synthetic form of tetrahydrocannabinol (an active ingredient in marijuana), was approved by the FDA almost three decades ago. Originally, Dronabinol was approved for use in controlling nausea and vomiting in individuals being treated with chemotherapy, and it has since received approval to improve appetite for acquired immunodeficiency syndrome patients. This synthetic component, which is identical to the highly purified component of marijuana at the molecular level, has been studied and used to treat a variety of other ailments, with limited success, in populations of patients for whom other conventional therapies have had limited or no success. Epidiolex (a plant derived cannabidiol without tetrahydrocannabinol) was approved by the FDA as an “orphan drug” for intractable epilepsy in November 2013. Epidiolex is the highly purified extract touted in “Charlotte’s Webb” and is currently being legally used with the federal government’s and FDA’s approval by over 400 patients.

When prescribing Dronabinol or Epidiolex for a patient, the prescriber can do so knowing that the quality, dose, and means of administering the medication are known, and can thus be controlled, this control gives the prescriber the ability to effectively maximize the results of the prescribed medication with a minimal dosage. This is important for a couple of reasons:
1. It helps prevent intolerance which will eventually render a medication useless.
2. It helps to minimize the negative side-effects from other compounds that may be present. The prescriber can rest assured knowing that the patient is receiving only the active ingredient needed for his/her condition without the patient also ingesting the harmful compounds found in marijuana (ammonia, hydrogen cyanide, and several nitrogen-related compounds.)

Marijuana leaves, flowers and extracts have been found to contain more than 480 potentially active pharmacological compounds. Although any one of these compounds might be the most effective treatment we currently have for a particular medical condition, when the marijuana is smoked the body is unnecessarily exposed to more than 479 other compounds – each of which may interact with other medications the patient is already taking. These compounds may also produce adverse reactions that appear suddenly, or they may appear several years after ingestion.

The Food and Drug Administration’s primary mission for over 90 years has been to promote and protect the public health under the authority of the Federal Food, Drug, and Cosmetic Act and the Public Health Service Act; until there is assurance that marijuana meets the standards of the FDA, it should not be approved for medicinal purposes.

Current FDA approved medications can, and many certainly do, have drug interactions and adverse effects; however, most medications are single-entity compounds that have been studied extensively under controlled conditions, with fairly predictable results. The prescriber and pharmacist can be confident that they are providing a medication that maximizes the benefits of the medication while minimizing the risk(s) of said medication. The appropriateness of any medication prior to dispensing it to a patient is always evaluated by a pharmacist who has completed four years of rigorous in-depth study in pharmacology, and who is registered and licensed to practice pharmacy in the state of Florida. This evaluation includes a cross-check of other medications the patient is currently taking for potential interactions of over the counter and prescription medications, as well an overview of the patient’s personal history of medical conditions, allergies, sensitivities, and a general knowledge of the patient’s history of compliance with medical therapy to ensure the likelihood that the medication will be safe and effective as prescribed.

This is not done with medical marijuana. I recently had a conversation with a dispensary employee engaged in selling medicinal marijuana to a client. The employee was legally permitted by his state to sell marijuana to a client, who had asthma, based on the recommendation of a non-board certified physician to treat chest pain. The dispensary employee had explained to the patient that by smoking marijuana, the diaphragm would relax, making it easier for the asthma patient to breathe. When the dispensary employee was told the patient experienced respiratory distress immediately following the inhalation of the marijuana smoke, the employee who had sold the marijuana to the patient admitted that he had no formal education or training in medical conditions or therapies, and in fact was a high school drop out.

Many of the proponents of medical marijuana are not so much interested in marijuana as a medical treatment, but rather consider the legalization of marijuana as a medicine to be the easiest path to the decriminalization of marijuana as a recreational drug. Studies have shown that many of the people who use medical marijuana for treatment of medical conditions have exaggerated their medical complaints, did not have the reported medical condition, or were non-compliant with other medications or medical treatments for the very same condition for which they were seeking the use of medical marijuana. Many of these patients have never seen a physician who specializes in the area of medicine that could best treat their condition. According to the American Society of Addiction Medicine, the majority of recommendations used to dispense marijuana at dispensaries in one state were from doctors who were not currently board certified in the area of medicine specializing in the condition that it (medical marijuana) was being recommended for. The National Association of Drug Diversion Investigators has found that the processes used by dispensaries to verify the legitimacy of the patient, usage, and recommendation are so lax there is a greater risk of inappropriate use or diversion than if a pharmacy and pharmacist was involved in the dispensing process.

If this is true, then why are pharmacies and pharmacists not involved in the process of dispensing a drug that has been legalized by the state when pharmacies and pharmacists are also licensed by the state – and licensed specifically to dispense medications? Well, the answer comes down to money, and the cooperation of the Federal government.

Prescriptions filled in pharmacies are not subject to taxation at the rate that recommendations of medicinal marijuana are when they are filled by marijuana dispensaries, nor are all of the governmental fees that are normally associated with the process of producing and delivering the goods to the consumer imposed. This is facilitated by a good cop/ bad cop relationship between the state and federal government with regards to controlled substance regulations.

As a health care professional, I would like to see the government allow and encourage studies of the 400+ components of marijuana for various medical conditions and insure profitability to those who invest in the research if that research proves beneficial to the public. If medical marijuana went through the same regulatory channels that every other legitimate medication must go through before it is offered to the public by a physician who specializes in the area for which the marijuana is prescribed, and by a pharmacy that is licensed to legally dispense it – the same safe-guards would be assured for the patient and community that every other prescription medication offers.

As a professional in the field of medicine, I am concerned about the breach of trust that currently protects the medical community and their patients. The goal of these protections is to promote and protect the overall health of the general public from fraud, poor medical counseling by professionals, and the dispensing of incorrect information by untrained individuals – Amendment 2, as it is written, is a throwback to the old days of snake oil sold by traveling hucksters, and is ultimately bad for public health.

By Karl Metzger, DPh

For further reading:

About Amendemnt 2, Ballotpedia:  http://ballotpedia.org/Florida_Right_to_Medical_Marijuana_Initiative,_Amendment_2_%282014%29

Full text of Amendment 2:  http://ballotpedia.org/Florida_Amendment_2_%282014%29,_Full_Text_of_Constitutional_Changes