As I’ve mentioned in previous posts, an Initiative called the Arizona Medical Marijuana Act will be on the Ballot this November.  We organized several teams (behavioral health, substance abuse, public health, licensure, rules, IT, and administrative council etc.) to examine the Initiative over the last few weeks.  You can read a news article this week that highlights some of my concerns about the Initiative.

Here’s some background:

The active ingredient in marijuana that’s cited for its medicinal value is called Tetrahydrocannabinol (or THC).  A synthetic version of THC called dronabinol is available by prescription (tradename Marinol®).   Marinol (dronabinol) is approved by the FDA for the treatment of anorexia in AIDS patients and for nausea and vomiting in folks undergoing chemo. It’s a Schedule III medicine, which means that doctors can prescribe it off label (e.g. for things other than nausea, vomiting, and chemotherapy) and it can be refilled.  It’s generally considered to be non-narcotic and to have a low risk of dependence.

But, the Initiative would allow people to apply for and get marijuana registration cards (from us) that allows them to buy & use marijuana itself for therapeutic purposes. The basic problem is that the FDA doesn’t recognize the smoking of marijuana as a treatment for any medical condition.

The medical conditions that qualify for a medical marijuana registration card in the Voter Initiative include “a chronic or debilitating disease or medical condition or its treatment that produces severe or chronic pain.” Smoking marijuana isn’t part of any conventional, licensed or approved medical management of pain; it hasn’t been tested by the FDA for its safety or effectiveness for pain management.  However, numerous FDA-approved medications are available that have been clinically proven to be safe and effective for pain relief and management and new strategies like acupuncture and biofeedback are showing more promise all the time.  And remember, if a doctor thought that THC might be helpful for a patient’s pain management, they could always prescribe dronabinol.

Many states that have implemented medical marijuana laws found most applicants cite “severe or chronic pain” as part of their qualifying medical condition.  Severe or chronic pain was a factor for more than 88% of all medical marijuana cardholders in Montana.  In Colorado, 91% of applicants qualified because of chronic pain (the majority of them were under 45 years old)- and only 3% of the cardholders qualified because of HIV or the symptoms from chemotherapy (areas where there’s evidence that marijuana can be helpful).

The bottom line is that the Initiative would allow people to apply for and receive registration cards so they can purchase and use marijuana even though the FDA doesn’t recognize smoking marijuana as a treatment for any medical condition.  The majority of cardholders in Arizona will likely qualify because of severe or chronic pain, which has dozens of approved safe and effective treatment alternatives.  It also leaves the door open for recreational users to claim they have pain issues in order to get a card to avoid getting in trouble in case they get caught with marijuana (for their recreational use).  And remember, doctors can always prescribe dronabinol for their patients when they think THC may be helpful to their patient.

Dr. Nelson and I co-wrote a statement along these lines that will be in the upcoming voter guide.  Our letter represents our opinions.  Every voter should examine the proposal for themselves and make their own decision about how to vote.