On April 17, 2016, SB 3, the Pennsylvania Medical Marijuana Act was signed into law by Gov. Tom Wolf. The law, which is a result of Pennsylvania’s compassionate medical cannabis legislation, went into effect on May 17, 2016, with the first dispensaries serving patients in April 2018.
This law marks a historic moment for use and access to cannabis in Pennsylvania for patients with “serious medical conditions." The Commonwealth of Pennsylvania is the first to approve medical marijuana for the treatment of opioid addiction. This is very much a welcome development in light of the national opioid addiction epidemic. This means Pennsylvania, along with 30 other states and the District of Columbia, have now legalized marijuana for medicinal purposes – and, the trend appears to be growing.
That is a good thing; especially, given the fact that the U.S. Government considers marijuana an illegal substance and classifies it as a Schedule 1 drug, which means it has no medicinal value and is highly addictive. Neither of those claims have been supported by scientific or medical research.
The Pennsylvania Medical Marijuana Act does not define what constitutes a “serious medical condition,” but simply lists 20 medical conditions, including multiple sclerosis, Parkinson’s disease, glaucoma, autism, sickle cell anemia, to mention just a few.
Historically, marijuana has been used for medicinal and ceremonial purposes for centuries. Interestingly enough, marijuana was legal in Pennsylvania until the 1930s, when it was proscribed partly due to hysteria caused the movie titled “Reefer Madness.” The town of Hempfield, Pennsylvania, is so named because of its robust hemp production in the early 1900s.
Marijuana is not known to have the same psychological and physiological withdrawal signs and symptoms that are associated with other classes, such as opiates and benzodiazepines.
Yet, marijuana has become very stigmatized partly due to the psychoactive effects of Delta-9 tetrahydrocannabinol (THC), its illegality under the law, hitherto, societal and communal morality standards, longstanding misunderstanding/disinformation and outright propaganda.
The paucity of scientific evidence to support its medicinal uses, a consequence of lack of research funding, has created fear among practitioners, who believe, rightfully so, that prescribing marijuana may have a negative effect on their practice and personal reputation. Because most medical providers’ expectation that prescribing cannabis would attract the scrutiny of regulatory authorities and jeopardize their medical licenses, they tend to avoid such therapies.
Because of the stigma described above, the debate about the use of marijuana for medicinal purposes has been muddied and controversial to the extent that the general society does not quite understand its benefits. And, without incontrovertible scientific evidence to support its efficacy, suspicion and discomfort among medical professionals appears to have heightened.
Clearly, a conglomeration of factors, coupled with illegality under federal law and the lack of a wider acceptance of the medicinal uses of cannabis, have contributed to the lack of research in the United States.
Unfortunately, medical school curricula are conspicuously devoid of information on marijuana (alternative therapies, including homeopathy, in general for that matter), again, partly due to its federalized illegality and lack of scientific research foundation. Consequently, doctors who want to introduce this therapy in their practice often lack knowledge in the medicinal uses of cannabis.
The United States seems to be on the way side, in terms of this therapy. Countries, such as Israel, Australia, Canada and Germany, are currently leaders in research about medicinal uses of marijuana. It is believed that Israel is by far in the lead in this area.
Current cumulative research provides ample evidence that cannabis provides effective treatment for many conditions for which current therapies are inadequate. These include some types of cancer, neurological disorders, psychiatric disorders and chronic pain, to mention a few.
The lack of evidence-based information makes it difficult for doctors to confidently “recommend” (not prescribe) precise strain and dosage information to patients. Available information is mostly anecdotal at this time. The recommendation is for individuals to start slowly and titrate upwards as tolerated.
Unfortunately, most large healthcare institutions are not permitting their providers to “prescribe” medical marijuana, partly due to concerns about possible legal actions by the federal government, dearth of evidence-based information and the aforementioned stigmatization of marijuana.
Pennsylvania needs to revisit its policy because the administration of the program seem to be shrouded under unnecessary secrecy.
For example, approved physicians are prohibited from advertising their services to certify patients for medical marijuana. Why? The directive states that patients can find approved physicians on the state’s web portal (medicalmarijuana.pa.gov), which paradoxically lists the physicians’ phone numbers, but not their locations.
Why the secrecy? If there was something nefarious about medical marijuana, why approve it in the first place? Authorities must overcome this antiquated mentality of cannabis and adopt more progressive ideas.
The qualities of cannabis and its pluripotent potentials should be advertised, not cloaked in secrecy. Research should be encouraged and funded robustly.
So far at Toftrees Family Medicine, we have successfully helped five patients discontinue the use of their addictive prescription medications. That is a good thing – especially in midst of a deadly opioid epidemic.
Our goal at TFM is to treat patients’ medical condition(s) and attempt to wean them off their addictive medications and/or at least, reduce their total medication burden. How can taking 20 or 30 or 40 different medications be good for any human being? This is phenomenon is not uncommon. Patients are generally happy with the prospects of being weaned off some of their medications.
The use of cannabis should be guided by evidence-based information (which I admit is currently scant) and not by fear and paranoia. A physician’s choice to participate in the medical marijuana program should be guided by the convictions of his or conscience, medical ethics and ethos - not by the dictates of corporations he or she may be employed by.
I end with these words of caution to patients: Find a physician who is willing to think beyond the boundaries of traditional medicine; do your own research and share that knowledge with your physician, so that you make joint decisions regarding your care. Take charge of your healthcare.
Dr. Fidelis Ejianreh practices at Toftrees Family Medicine in State College. He is one of six doctors in Centre County who certifies patients for medical marijuana. He received his medical degree from Rowan University School of Osteopathic Medicine.