Pubdate: Wed, 15 Jun 2016
Source: Chicago Tribune (IL)
Copyright: 2016 Chicago Tribune Company
Author: Robert McCoppin


Terminal Illness Also Covered Under Bill for Rauner

Advocates for medical marijuana hope Illinois' plan to expand its 
program will give the industry the boost it needs to sustain itself - 
but some doctors warn that, despite changes made to protect them, 
they still have legal and medical concerns about the product.

After previously rejecting efforts to make medical marijuana 
available to more people, Gov. Bruce Rauner's office has indicated he 
will sign into law a bill to lengthen the pilot program by more than 
two years, to July 1, 2020. The legislation also adds two new 
qualifying conditions: post-traumatic stress disorder and terminal illness.

More broadly, the plan would remove the requirement that physicians 
recommend the drug for their patients, and instead only require that 
doctors certify that a patient has a qualifying condition. This 
provision is meant to address physicians' unease about recommending a 
drug that is illegal to prescribe or possess under federal law.

One person who plans to take immediate advantage of the change in the 
law is Lon Hodge, a veteran diagnosed with PTSD.

"The minute that goes through, I'll be applying," said Hodge, 62, a 
Grayslake resident who uses a service dog to help him cope with his PTSD.

Because he had bad experiences with other medications, Hodge said he 
did extensive research on the subject before trying legal marijuana 
in Colorado two years ago. He's found that with strains that contain 
less THC, the component that gets users high, and more of another 
component known as CBD, he can finally sleep through the night 
without nightmares and have productive days.

Medical marijuana business owners welcomed the planned expansion as a 
potential lifesaver for the industry. Joseph Friedman, owner of PDI 
Medical dispensary in Buffalo Grove, expected the changes to help 
broaden the patient population.

"It's a breath of fresh air and a sense of relief for the industry," 
he said. "It's going to help a lot of people who really need the help."

After a sluggish start, the medical marijuana program in Illinois has 
been growing slowly but steadily. The state has about 7,000 
authorized patients, and that number, while still significantly lower 
than initial projections, has almost doubled since medical marijuana 
went on sale in November. Sales have risen to more than $2 million a 
month at 37 dispensaries statewide.

Jim Champion, a military veteran and member of the state's Medical 
Cannabis Advisory Board, said the changes in the law would help not 
only veterans with PTSD but others who suffer from the condition, 
including victims of abuse, assaults and accidents. He welcomed the 
change even though the future of the board is uncertain because the 
new law would have the governor reconstitute the 16member panel.

PTSD affects about 3.5 percent of the population, according to the 
National Institutes of Health, which would amount to about 450,000 
people in Illinois alone. One-third of the cases are diagnosed as 
severe, and only half of those diagnosed are receiving treatment. 
It's more likely to affect women than men, and members of the 
military are at higher risk.

To qualify for medical marijuana in Illinois, a patient must have a 
doctor certify that he or she is likely to benefit from using 
marijuana to treat one of about 40 specific qualifying conditions, 
including cancer, severe fibromyalgia and spinal cord injuries.

At least five other states list PTSD as a qualifying condition for 
medical marijuana, according to a Washington, D.C.-based lobbying 
group, the Marijuana Policy Project. In New Mexico, half of all 
medical marijuana patients use it to treat PTSD. At least three 
states also permit the drug for treating terminal illness, while 
several other states don't limit the use of medical marijuana to 
certain conditions but leave it up to doctors' discretion.

Yet numerous medical groups remain opposed to the use of marijuana as 
medicine. The American Medical Association has called the drug 
"dangerous" and stated that its sale should not be legalized, while 
calling for more research on its effects.

The use of marijuana to treat PTSD, in particular, is opposed by the 
American Psychiatric Association, the Illinois Psychiatric Society 
and the U.S. Department of Veterans Affairs. Each of those groups 
said there is no credible scientific evidence that marijuana is an 
effective treatment for PTSD, and that research suggests it can 
actually be harmful to people with PTSD by increasing their anxiety.

Among veterans using the VA health system, cannabis use disorder has 
been the most common form of substance abuse since 2009, affecting 
almost 1 out of 4 veterans, the VA has reported.

The results of research into the effects of marijuana on PTSD have 
been mixed. Yale University researchers analyzed 46 studies on the 
subject and found that, while many studies cited a reduction in PTSD 
symptoms, the lack of large, controlled trials rendered the findings 

Dr. Joshua Straus, codirector of outpatient behavioral medicine at 
North-Shore University Health-System in Evanston, said other studies 
hadn't shown the benefit. Among his own patients, he has often seen 
regular use of marijuana increase anxiety.

While conventional PTSD treatments involving medications such as 
Zoloft and cognitive behavioral therapy help many patients, Straus 
said, others receive fewer benefits or suffer intolerable side 
effects. So while marijuana has been shown to be effective treating 
pain, he believes more research is needed on its use for PTSD.

The chief barrier to research remains the U.S. Drug Enforcement 
Administration's classification of cannabis as a Schedule I substance 
- - the same as heroin - meaning it has no accepted medical use and a 
high risk of abuse.

Earlier this year, however, the DEA authorized what sponsors say is 
the first randomized, controlled trial of whole plant medical 
marijuana as a treatment for PTSD. The $2 million study, funded by 
the state of Colorado, will test the effects of varying ratios of THC 
and CBD on veterans.

Partly because of limited research, many doctors in Illinois remain 
cautious or skeptical about using marijuana for any condition.

Dr. Asokumar Buvanendran, a professor who practices anesthesiology 
and pain medicine at Rush University Medical Center, said one concern 
is interaction of marijuana with other medications, particularly 
opioids, which he said have not been sufficiently studied.

His other concern is about how doctors can track medical marijuana 
use. The proposed change in the law would add medical marijuana to 
the state's prescription drug monitoring program, so doctors would 
know which patients are using it, and to make sure patients don't 
seek multiple referrals by different doctors.

To get more doctors to participate, Buvanendran said, marijuana would 
need to be reclassified at the federal level, or at minimum the DEA, 
which licenses doctors to prescribe drugs, would need to provide 
assurances that it will not penalize doctors who prescribe marijuana.

In addition, the proposed change from doctors recommending marijuana 
to merely certifying a qualifying illness may help assure doctors 
that they won't be held liable if something goes wrong with a patient 
using marijuana, said Dr. Charles Bush-Joseph, an orthopedist and 
professor at Rush and a team physician for the Chicago White Sox and Bulls.

Bush-Joseph is also a consultant for state-certified medical 
marijuana grower Cresco Labs and helped design the company's program 
to educate doctors about medical marijuana.

"I believe there is benefit to it," he said. "Physicians are trying 
to educate themselves. Now that the standard (for certifying 
patients) is a little lower, I think more doctors will be willing to 
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MAP posted-by: Jay Bergstrom