Pubdate: Tue, 08 Jul 2014
Source: Wall Street Journal (US)
Copyright: 2014 Dow Jones & Company, Inc.
Contact:  http://www.wsj.com/
Details: http://www.mapinc.org/media/487
Author: Steven Patierno
Note: Dr. Patierno is a professor at the Duke University School of 
Medicine and deputy director of the Duke Cancer Institute. He is also 
chairman of the medical advisory board of PalliaTech, Inc., a New 
York phytomedical technology company.

NEW YORK DOES MEDICAL MARIJUANA RIGHT

The State's Ban on Smoking and Mandating of Individual Metered Dosing 
Is Smart Policy.

The use of marijuana as a medicine is remarkably uncontroversial at 
the bedside of a cancer patient or a child suffering from convulsions 
who might be helped. As this consensus has grown into broad public 
acceptance, many state legislatures have leapfrogged federal 
prohibition and the Federal Drug Administration process to allow 
medical use of cannabis. But they have usually failed to translate 
compassion into safe, effective health care. Until recently, when New 
York got it right.

The Compassionate Care Act, passed by the New York State Legislature 
last month and signed into law by Gov. Andrew Cuomo on July 5, 
introduces simple yet profound reforms by banning marijuana smoking 
and mandating individual dosing of medical cannabis in all other 
forms, such as capsules and vaporization. By treating medical 
marijuana like other medicines, New York shifted the debate into the 
mainstream of modern medicine and set a much-needed national standard of care.

New York's ban on smoking, the most common method of taking cannabis, 
has drawn headlines and criticism from some medical-marijuana 
advocates. But as public policy, the ban is good science and an act 
of common sense. Cannabis has four times the tar of tobacco, and 
similar carcinogenic and respiratory risks. There is also the risk of 
secondhand smoke to caregivers and loved ones. State health-care 
systems should not be in the business of sanctioning smoking of 
anything, for any reason.

Politicians and supporters celebrate after New York Governor Andrew 
Cuomo, center, signed a ceremonial bill to establish a medical 
marijuana program in New York on Monday. Associated Press Less noted 
but arguably of greater significance is New York's mandating of 
individual metered dosing-i.e., requiring the standardization of 
fixed-dose levels and safety monitoring for both the actual dose and 
purity. Metered dosing is the standard of care in modern medicine, 
allowing doctors to prescribe precise amounts based on the patient's 
response, and reducing the chance of adverse drug interactions. 
Without metered dosing, doctors are reduced to having their patients 
"buy and try" cannabis and hoping for the best.

Given the impossibility of allowing smoking in a clinical setting, 
the liability inherent in uncontrollable dosing, and a reluctance to 
send patients to what still seems to many like a "headshop" to pick 
up medicine, relatively few doctors currently recommend cannabis. 
Individual metered dosing will give physicians the tool they need to 
add cannabis to their treatment arsenal.

Metered doses can also be produced to medical standards-something 
that is missing and has caused many problems in other state 
medical-cannabis programs. Like any raw plant, cannabis may contain 
molds, fungi, bacteria, insect matter, growth enhancers, pesticides 
and other contaminants that are dangerous to patients, and the 
potencies of cannabinoid medicines vary widely. Cannabis produced in 
metered doses is easily tested for contaminants, and the potency of 
all active ingredients, for instance, and sterilized for 
safety-essential public-health safeguards.

The dosing requirement delivers other benefits, too. Individually 
packaged doses of cannabis in bar-coded, medical-grade packaging are 
easily tracked using standard inventory controls. Currently, most 
medical marijuana is distributed in a bulk form that is 
indistinguishable from the street drug, presenting a serious risk of 
diversion. Moving to a medical supply-chain model makes sense from a 
business, public safety, regulatory and law-enforcement point of view.

New York's proposal also addresses the Drug Enforcement 
Administration position that state medical-marijuana programs don't 
meet the standards of modern medicine because they lack "standardized 
composition or dosage."

Finally, dose standardization is the key to improving the quality of 
care for patients in the future. Without it, we have not been able to 
gather sufficient reliable clinical data on the effectiveness of 
medical marijuana. After almost two decades since California became 
the first state to legalize medical cannabis, we still have 
relatively few scientifically meaningful findings.

As the Compassionate Care Act is rolled out over the next 18 months, 
the New York health-care system will begin to benefit from a growing 
trove of medical data that can be used eventually to advance the 
science and clinical practice of cannabinoid medicine everywhere.

Meanwhile, the introduction of smokeless cannabis in dosage form will 
immediately ease human pain and suffering and help to move medical 
marijuana from the underground economy to the mainstream of the 
nation's health-care system.
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MAP posted-by: Jay Bergstrom