Pubdate: Fri, 30 Jan 2015
Source: Atlanta Journal-Constitution (GA)
Copyright: 2015 The Atlanta Journal-Constitution
Contact:  http://www.ajc.com/
Details: http://www.mapinc.org/media/28
Author: Jessica D. Gabel

POLITICS MIXING WITH MEDICINE

Medical marijuana is an oft-debated and polarizing subject. It
inspires images of everything from a drive-thru dispensary on a sunny
California beach to an ailing cancer patient desperately seeking a
reprieve from the effects of chemotherapy.

For my own part, I have no dog in the fight. To me, the real question
is simple "what does the science tell us?" As with most pharmacy-grade
medicines, we should be looking to studies, clinical trials, and
research to objectively assess the benefits of treatment against the
possible harmful effects.

More than a dozen states now legalize the medical use of marijuana,
and a few (most notably Colorado) permit recreational uses without a
prescription. Some states narrow the list of conditions that qualify
for a marijuana prescription while others are far more liberal
defining the boundaries of medical use.

Many of these laws came to be through ballot measures sent to voters
or through the state legislative process. This is an extremely
unconventional method of making assessments about medicine.
Pharmaceuticals are generally approved for medical use through
scientific research, development and clinical trials.

Imagine if drugs as common as Prozac or Adderall or even Oxycontin
became available only through a political process. We would condemn
such practices as frustrating the advancement of medicine and technology.

A bill is now pending that would decriminalize medical marijuana in
Georgia, but it comes with two unavoidable and politically-motivated
obstacles: (1) no one in Georgia can legally grow it; and (2) federal
law still views marijuana as an illegal substance. The practical
effect is that patients must leave Georgia to obtain medical marijuana
and the movement of marijuana across state lines is a technical
violation of federal law.

To be clear, the chances of a federal prosecution for possession of
medical marijuana are slight, but the risk cannot be utterly ignored.
In the past, the Supreme Court has told us that medical necessity is
not a defense to federal drug charges related to medical marijuana. In
another case, the Supreme Court concluded that federal law trumps
state law even when cultivation and possession of medical marijuana
does not cross state lines.

This means that someone can be charged with federal crimes even if he
or she is obeying state regulations, and by leaving a gaping hole in
the Georgia legislation, that is the risk that exists. It is, perhaps,
the price of doing business.

Of course, at the federal level, Congress possesses the power to
reclassify marijuana, but by listing marijuana as a "Schedule I" drug,
the federal government disavows any medical benefit from marijuana.
This decision is political and not scientifically defensible. Even the
Georgia Legislature noted that the medicinal purposes of marijuana
have been known for thousands of years. But as it stands, medical
marijuana policy is the fragmented byproduct of political negotiation
rather than sound science and medicine.

There are many issues when it comes to crafting an appropriate medical
marijuana policy. It seems to me that the easiest ones - like access
for the patients who need it and the economics of decriminalizing it -
are the ones bogged down the most by politics.

Unfortunately, this prevents us from reaching the more difficult
issues: who gets to use medical marijuana (qualifying conditions,
patient age, responsiveness to conventional treatments), efficacy
studies, and long-term consequences. We cannot seriously approach
evidence-based medicine in the case of marijuana unless we can move
past the territorial puffery.

Professor Jessica D. Gabel teaches forensic medicine at Georgia State
University College of Law.
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