Health Policy Forum: Medical marijuana has some health benefits, but there are adverse risks

By Melissa Patrick
Kentucky Health News

Research shows conclusively that medical marijuana has some health benefits, but also comes with some adverse risks that would likely be exacerbated by the increasing potency of the plants, and some think a medical marijuana law in Kentucky would be a “Trojan horse” for recreational use.

Meanwhile, teen vaping of high-potency marijuana products is increasing. And some wonder why Kentucky should follow states that have passed laws approving certain drugs when that’s the job of the U.S. Food and Drug Administration.

Those were some major messages Sept. 24 during a breakout session at the Foundation for a Healthy Kentucky’s Howard L. Bost Memorial Health Policy Forum, the theme of which was “Kentucky’s Substance Use Epidemic: A Solutions Update.”

Ed Shemelya, a 30-year veteran of the Kentucky State Police and coordinator of the federal government’s National Marijuana Initiative, said we need to be talking more about the potency of marijuana, which he said “exploded” after states began legalizing its recreational use.

The initiative works in the officially designated 33 High-Intensity Drug Trafficking Areas areas. Its duties include disrupting domestic trafficking and production of and reducing demand for, marijuana and derivative products.

Shemelya said he is seeing marijuana plants that can produce as much as 22 pounds of processed product, with more than 40 percent tetrahydrocannabinol (THC), the plant’s psychoactive product. Before recreational use was made legal in a few states, marijuana plants typically produced one to two pounds of product and were much less potent, he said.

Also of great concern are the dabbing products, which he said are showing up with THC potency as high as 80 percent. Dabbing is the catch-all phrase for marijuana concentrates that are used in e-cigarettes, like “shatter,” “budder” or “wax.”

“This is what scares me, the vaping,” he said. “The fastest growing youth segment is vaping because of the stealth component of it.”

Stealth vaping allows a person to vape in secret. Rather than exhaling the vapor, a person simply holds it in so that it has almost disappeared by the time he or she exhales.

From another point of view, a professor of public administration and policy at the University of Georgia came with a handful of research papers to support both the health and financial effectiveness of medical marijuana.

David Bradford shared findings from a 2017 National Academies of Sciences Engineering and Medicine review of more than 10,000 studies on the health effects of recreational and therapeutic use of cannabis (marijuana’s biological genus).

The review found conclusive evidence for the effectiveness of medical cannabis in treatment of chronic pain, chemotherapy-induced nausea, and spasticity associated with multiple sclerosis; and moderate evidence of its effectiveness in treating sleep disorders, Bradford said.

Bradford also shared his own research that, using data on all Medicare Part D patients between 2010 and 2013, showed that prescription drugs for conditions like anxiety, depression and chronic pain had dropped in states that had legalized medical cannabis.

“We are seeing substantial substitutions away from prescription drugs when cannabis is available,” he said. “But the big ticket item here is pain medications,” such as ibuprofen and other non-steroidal, anti-inflammatory drugs “as well as oxycodone,” an addictive painkiller.

Bradford estimated that Medicare could save $1.2 to $1.7 billion a year if every state passed a law allowing medical marijuana to be obtained from dispensaries, presuming Medicare Part D enrollees would buy their medical marijuana without any subsidies. He said other research showed a 14.4 percent decrease in Part D opioid use in states with a dispensary based law.

Bradford said an update of his study, which has been peer-reviewed but not published, found that dispensary laws are twice as effective as home-cultivation based laws in diverting people away from pain medications — in urban counties, but not rural ones. Much of Kentucky’s population is in rural areas where marijuana is raised.

He concluded, “We do think there is evidence that appropriately devised medical cannabis laws can be one tool in helping optimize policies to save lives, which is the most important thing, and on the way, you might be able to save a little bit of money too.”

Jason Hockenberry, associate professor at Emory University’s School of Public Health in Atlanta, said his research shows fewer prescriptions being written for Medicaid patients in medical-marijuana states. He added that the widely cited National Survey of Drug Use and Health has found “no translation between passing a medical marijuana law and any of the uses in other substance-use behaviors over the subsequent years.”

But “It’s not just about those health things,” he added. He showed a graph that showed how incarceration rates had dropped in four states with major marijuana reforms. Among African Americans, the rates dropped from 742.1 per 100,000 before reforms to 251.9 per 100,000 afterward. Among all other races taken together, that number dropped from 167.7 to 51.1.

Dr. Scott Teitelbaum, medical director of the Florida Recovery Center, argued that we shouldn’t be passing laws to legalize a drug because that is the responsibility of the FDA.

“I would argue vehemently, and will continue, that there are two things we don’t do with medications: smoke them or vote on them,” said Teitelbaum, a psychiatry professor at the University of Florida and chief of its Division of Addiction Medicine.

Teitelbaum acknowledged research shows marijuana’s medical benefits but said it also shows there are risks that must also be considered, including addiction, psychiatric disorders, traffic accidents, and cognitive deficits.

In addition, he said it’s important to remember that the movement to revive cannabis as a medicine is driven by many factors other than science — namely money. He concluded by asking, “Do we want to legalize it or do we want to decriminalize it? That’s a more real conversation than this Trojan horse: medicalization.”

All the speakers agreed that we need more longitudinal studies, which look at effects over time.

The topic was timely. The 2013 Kentucky Health Issues Poll found that 78 percent of Kentucky adults favored legalization of marijuana for medicinal purposes, and members of the Kentucky General Assembly are seriously considering a medical-marijuana law.

During the last legislative session, they spent three straight days in discussion of such a bill but ended up shelving it on a 14-4 committee vote, with not enough time left in the session to find a way to pass it.

And though a new bill hasn’t yet been submitted for the short session that begins Jan. 8, the Interim Joint Committee on Licensing, Occupations & Administrative Regulations has devoted two meetings to the topic this summer, presenting arguments both for and against it. Committee Co-Chair John Schickel, R-Union, said in a Sept. 14 news release that he expects some type of marijuana legislation to be introduced.

So far, 31 states and the District of Columbia have legalized medical marijuana. Nine states and the district have legalized recreational marijuana, and 17 states, including Kentucky, have legalized cannabidiol extracts with low THC.