I am going to put myself on the line and talk about Utah’s Prop 2. This is our proposition for medical marijuana to be available through dispensaries by March 2020. There are many conditions written in about growing, where dispensaries can be and what provisions are in place for patients who do not have a dispensary within a reasonable distance.

 

I am opposed to prop 2 and after spending some time over the last day being told that I lack empathy and don’t care about others more than I care about my own moral superiority, I have decided to write out my thoughts. You may not agree with me but I hope you can see that I am not taking this stance simply because I think pot is bad and I want to keep it from people in pain.

 

During the summer I had a conversation with someone about my opposition to dispensaries.

(I understand all of the safe guards written into the legislation but I, personally, do not like the idea of a pain medication being distributed by anyone other than a pharmacist. Throughout my early days of working in a hospital and now as a mom, I have seen that there are many drugs that interact negatively one with another. I am not here to debate the fault in our current state of medicine. It is what it is and that is not my focus. The reason that pharmacists go through years of training is so that they are aware of proper dosing and potential harms in dual dosing. A dispensary will not have the same oversight into these matters. It will be a one and done type of situation. While the doctor prescribing should be aware of any complications, this does not always occur and having a pharmacist assist in this process becomes a double check for each and every patient to make sure that the treatment given is, indeed, the best course. Those are my feelings.)

Through the summer conversation it was brought to my attention that marijuana was not able to be distributed through pharmacies because of the way they were classified through the FDA and DEA. I was not aware of this and actually changed my position to believe that if there were federal regulations blocking access to something that could help, it became incumbent on us, as compassionate human beings, to accept the failings of the system and push the proposition forward.

 

That, once again, changed last month. There is a drug called Epidiolex that has been undergoing testing for quite a while. Many believe that it is a synthetic form of marijuana but this is not actually true. It is a rendering of cannabidiol while removing the tetrahydrocannabinol (the psychoactive agent of marijuana). After all of the testing concluded that the medicine could be effective for treatment of seizure disorders, it was approved by the FDA. However, until it was rescheduled from a level 1 drug (highest restriction) to a level 5 drug (lowest restriction and able to be distributed through pharmacies) insurance companies were not willing to look at coverage. Rescheduling came this last month. While I recognize that this is not access to the full plant for everyone in pain, I think it is the first significant movement we have ever seen on this issue and opens a door for much more movement. I believe that this holds enough merit to forestall passing proposition 2 and bringing dispensaries into the state of Utah.

 

 

 

Now, onto the concerns that I hear expressed by those in favor of the Proposition 2.

  • Marijuana is not any more dangerous than alcohol. Why are we putting such strong restrictions on it?
    • As a psychiatrist my husband treats schizophrenic teenagers every month who had their disease triggered by marijuana. Schizophrenia jumps from a 3-4 % likelihood to a 7-8% likelihood among marijuana users. That might be antidotal but I believe there is legitimate harm that can come from marijuana use and I do not see that getting better with this proposition. We used to use marijuana as medicine… like 100 years ago when we used cocaine as a pick me up and heroin as a cough suppressant. The public pretending that the real negative side effects aren’t there does no one any favors.

 

  • The new drug is not marijuana. Why not just legalize the natural plant?
    • I am going to use my husbands words to answer this.  The idea that medical usefulness of cannabis has been ‘proven’ in thousands of cases is not completely accurate. There are dozens of strong case studies and thousands of people who post online that they like how they feel when they take it, and one small scale placebo trial in kids with intractable seizures, and those should lead to large scale clinical trials but we don’t have them yet. The gold standard in medical research is placebo trials. Case studies are great, but especially when you have a drug that is a known psychoactive compound how do you control with a placebo? If we are really talking JUST about medical use then why bypass the safeguards we put in place over a hundred years ago that protect society from harmful substances? Let clinicians and doctors do trials and figure out the safest and best way to use the drug, including isolating the different psychoactive compounds and giving them separately so you’re not getting extra drug that you don’t need.”

 

  • The drug that is approved cost about $32K – $34K/year. Why should we expect patients to pay this cost instead of accessing the plant that is much cheaper.
    • The cost of the drug is so high because of a few reasons.
  1. It is new. The company that spent money on creating the drug, research and fighting the legal battle to get it approved need to recoup their cost.
  2. There is federal oversights required with this drug that require added cost being passed on to the user. You may have issue with this (I get it) but it is the give and take of having the security that I discussed at the beginning of this post.
  3. Insurance does not currently cover the drug but with the rescheduling, they will. While that does not mean that the cost of the medicine will immediately come down, it does mean that the out of pocket cost to the patient will come down.

You may take issue with all of those points but I believe we have to give this drug time (perhaps the same amout of time that we have given to getting the proposition into place) to make any comparrisions of price.

 

 

There are personal reasons that people are voting for or against this proposition. I hope we can move past the superficial attacks like

Stoners just want to get high legally.”

or

Your moral superiority is keeping you from compassion.”

 

I have not made this decision rashly and I have made it to the best of my ability.