Pubdate: Mon, 01 Aug 2016
Source: Burlington Free Press (VT)
Copyright: 2016 Burlington Free Press
Author: Cory Dawson


A chorus of doctors, social workers and academics have criticized a 
state marijuana study completed this legislative session.

An assessment of the public health risks if Vermont were to legalize 
marijuana was released mid-January by the Department of Health. The 
84-page report offered policy recommendations, a summary and 
conclusions drawn from available research.

The marijuana bill died in the House this spring.

Some studies that the health department used are unreliable or placed 
out of context, researchers said. Two doctors from University of 
Vermont Medical Center, a Johns Hopkins Medical School doctor and a 
social worker all wrote to lawmakers pointing out issues they saw.

The scope of the health department's assessment seemed to only focus 
on negative impacts, and didn't put the legalization discussion in 
the context of Vermont's opiate crisis, they noted.

The scope, to Kalev Freeman, a molecular biologist and emergency room 
doctor at UVM Medical Center, as well as the medical director at a 
local marijuana dispensary, was too negative and too narrow.

"They missed it," Freeman said. "The HIA was isolated. When they take 
that narrow approach they miss the likely impact on public health 
which I think would probably be positive."

When officials from the health department presented their study, they 
warned that there was much still to learn about cannabis.

Shayla Livingston, facilitator of the report and a public health 
analyst at the Department of Health, said that this health impact 
assessment was tricky because when they were writing the health 
impact assessment the bill they needed to assess didn't exist yet.

"We had to do it before there were a lot of specifics in the bill," 
Livingston said. "That was kind of a curveball."

Often, it's hard for American researchers to study cannabis due to 
marijuana's status as a schedule one drug, putting it in a danger 
category alongside heroin, LSD and cocaine.

The assessment wasn't supposed to cover medical marijuana, or 
decriminalization because both are already law - a health impact 
assessment isn't meant to study the effects of an existing law, 
Livingston said, a point that was hard to let go of for some of the 
people working on the assessment.

"It was hard for some of them to not include parts about medical 
marijuana and decriminalization, because much of the science is 
firmer," Livingston said.

Criticism began moments after health department officials presented 
their assessment to the senate health and welfare committee.

Malik Burnett, a doctor from Johns Hopkins Medical School who 
submitted testimony, phoned into the committee room after health 
department officials presented the assessment. Burnett initially 
praised the work of the department, but noted that a relevant study 
was omitted.

"The Department of Health's report discusses an increased odds of 
crashing with increasing blood THC levels," Burnett wrote. "A more 
recent study conducted by the National Highway Traffic Safety 
Administration (NHTSA) published in February 2015, refutes this assertion."

The NHTSA study, which looked at over 3,000 crashes in the Virginia 
Beach area, found that when it comes to determining who is more 
likely to crash, age, gender, ethnicity and alcohol use were much 
more reliable indicators than cannabis.

In another example, the health department relied on a 2013 study to 
write that cannabis-related car accidents tripled from 1999 to 2013.

That study is most likely too small to generalize the findings to 
Vermont, noted UVM undergraduates working in the school's legislative 
research service. As well, the authors of the 2013 study note they 
can only check for drug use, not impairment.

In other words, long after the effects have worn off, traces of 
cannabis can be found in a person up to one week after they use the drug.

However, those findings didn't factor into the health department's 
recommendation around using marijuana and driving. The 2013 study was 
included as a section on the background of research into marijuana 
and driving, Livingston said.

"We quote one thing from the Brady and Li study, that is it," 
Livingston said, referring to the assessment's limited inclusion of 
the refuted cannabis-related accident study.

The health department's assessment ultimately recommended to 
lawmakers that they make a legal limit for THC intoxication while 
driving, like alcohol, build a reliable THC testing infrastructure 
for drivers and promote a public education strategy.

Who guided the assessment?

To figure out what the health impact assessment was going to cover, 
school guidance counselors, academics, three medical doctors and at 
least 12 state employees - 25 people in all - met over the course of 
six months and developed a framework for the assessment.

"There are other large reports, from the state department, from RAND, 
from the WHO," Livingston said. "This study has basically the 
findings as every other report."

The health department's assessment was never intended to be a 
document that advocated one side or another, Livingston said. Rather, 
it was an objective look at the impacts, per its name. When selecting 
people to guide the assessment, everyone involved with the project 
was asked to leave their personal biases at the door.

"We said 'if that's not a process you can participate in, we're going 
to ask you not participate,'" she said. Nobody from the original 
group took that invitation, she said.

"No, it wasn't a group of completely detached individuals," 
Livingston said. "It is about the people who are working with people 
who could be affected."

For doctors, cannabis-based medicine could be key

For Freeman, understanding the public health impact of cannabis-based 
medicine is deeply important and the state's health impact assessment 
fell short.

Doctors have long been searching for a mid-way drug to alleviate 
chronic pain, he said. And their options are limited - for mild pain, 
forms of over-the-counter anti-inflammatory drugs like ibuprofen or 
acetaminophen are commonly used.

For much more serious situations, think before surgery or in the case 
of trauma, opioids like hydrocodone and morphine are definitely 
appropriate, Freeman said.

"If you break your leg, and your bone is sticking out of the skin, 
thank goodness we can give you morphine. That's what it's for," he 
said. "But for chronic pain, opioids don't work. Because they're 
habit forming."

New research points to cannabis-based medicines as a replacement for 
opioids, Freeman said. A meta-analysis, or an analysis of many 
studies, including reliable randomized studies, published in the 
Journal of the American Medical Association found that cannabis-based 
medicine could be a viable alternative to treat chronic pain.

"This should be looked at by the Department of Health as part of the 
solution to the opioid epidemic," Freeman said.

Opiates present a problem that deeply frustrates medical 
professionals, Freeman said.

"How do we as a society and as health care professionals treat 
people's pain and suffering, stop them from being addicted to the 
very substances we use to treat them?" Freeman said. "There has to be 
something else out there."
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