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PAMED PERSPECTIVE
By Karen A. Rizzo, MD, PAMED President
Who is the Pennsylvania Medical Society (PAMED), and why aren’t they in favor of medical marijuana as some have said?Those are questions that have been asked, but not directly to PAMED until recently when Latrisha Bentch reached out and was kind enough to offer our organization this guest blogger opportunity that you are now reading. Until that offer, most involved in this issue relied on political-speak to define our organization and our position.
Let’s start off with the easier of the two questions: who is PAMED?
PAMED is a statewide association consisting of 17,000 members and growing. The organization consists of medical and osteopathic physicians, medical residents, and medical students. We are the largest physician-led organization headquartered in Harrisburg that is committed to the good health of all Pennsylvania residents and engaged in the advancement of the practice of medicine.
Some Pennsylvania-specific issues that we’ve addressed in recent years to improve the health of all Pennsylvanians are ones that you may have seen in the news. They include the fight against prescription drug abuse, smoke-free environments, EpiPens in schools, and health insurance access. And, yes, we do work on issues that impact the business side of practicing medicine such as credentialing and truth in advertising.
PAMED is an organization that follows a democratic process to develop positions on issues. Physician members have the opportunity via various channels to raise meaningful debate on issues from the grassroots up. These debates have the ability to ultimately develop the organization’s policy on many different issues. At the end of the debate, positions developed come from the majority who participate.
This process is much like voting for president of the United States. Those who participate have a say in the matter. Those who don’t participate, but disagree with the outcome, really should participate.
And that brings me to the issue of medical marijuana. This is not a new issue for us. It’s an issue that comes up periodically. We’ve heard from members. We’ve read the studies. And, we’ve talked to researchers conducting studies.
PAMED supports reclassifying marijuana at the federal level to make it easier for research. PAMED supports research. And PAMED supports a thorough process of research that leads to final FDA-approved medications.
Because of this, we do want physicians to consider using medicines like Marinol that was FDA-approved as Schedule I drug for both appetite stimulation (1992) and for nausea (1985); and later moved to Schedule III in 1999. Marinol contains synthetic versions of chemicals naturally found in marijuana. Another FDA-approved medication with cannabis-related properties is Cesamet. This was reapproved by the FDA in 2006 for treatment of nausea and vomiting in patients undergoing cancer treatment.
Our hope is that other medications currently being researched will meet FDA approval soon and made available to those who suffer.
In forming our position, what we’ve been told by researchers is exactly what was reported in a national investigation by investigative journalism fellows with the News21 project from the University of Arizona. In their recently released report titled America’s Weed Rush, the journalism teams at News21 were told by researchers in both Philadelphia and Utah who are studying Epidiolex and its impact on children with epilepsy that there’s a “need to conduct further studies before they would consider Epidiolex a valid treatment option.”
Regarding trials that America’s Weed Rush reported, GW Pharmaceuticals, the manufacturers of Epidiolex, said parents “will have a consistent pharmaceutical medicine they can trust once Epidiolex gains FDA approval.”
America’s Weed Rush also reported “But until that happens, many medical experts urge parents to wait.”
Why wait? To avoid skewed results … better and more accurate testing ... and ultimately more trustworthy medications.
Consider what’s happening in Colorado in terms of having trustworthy medications. This was recently reported to Pennsylvania legislators by the American Epilepsy Society (AES). In Colorado, products are not regulated for purity or uniformity like they do when they meet FDA approval. A study by a team from Children’s Hospital Colorado found that artisanal “high CBD” oils resulted in no significant reduction in seizures in the majority of patients. Additionally, according to AES, seizures worsened with the use of cannabis in 20 percent of cases reviewed and in some patients there were significant adverse events.
These are real cases and stories that are not being told.
The fact is families and children going to Colorado are receiving unregulated, highly variable artisanal preparations of cannabis oil being prescribed, in most cases, by physicians with no training in pediatrics, neurology, or epilepsy. Because these products are unregulated, there is no way to tell if these dangerous adverse reactions are due to CBD or because of contaminants found in artisanal preparations.
Meanwhile, desperation has led to disappointment for many families after they’ve spent large sums of money while chasing hope through a poorly designed, legislatively-built medical cannabis industry.
PAMED understands the struggle families face and we are sympathetic to parents involved with Campaign for Compassion. We applaud each of them for their courage to step up through the legislative process, to raise awareness of this issue, and to fight for their loved one’s cause.
We also wish they would agree with PAMED that the right system to build is one that both patients and their physicians could trust.
Unfortunately, PAMED can’t support SB3 or any similar bill. There are many problems with the approach offered by such bills that would not help in creating medications you and your physicians can trust. This has been the Colorado experience. Such bills do not take into consideration how to create medical-grade cannabis or advance research while protecting it from being skewed.
We must find a careful balance to help current children with epilepsy, while also helping children yet to be born who will also someday be diagnosed with epilepsy. This applies to all medical conditions of patients of all ages.
And that’s why PAMED, through a democratic process involving physician members throughout the state, has taken a position similar to many other medical and healthcare organizations throughout the country.
CAMPAIGN for COMPASSION PERSPECTIVE
By Lolly Bentch Myers, Campaign4Compassion
We agree with the Pennsylvania Medical Society’s (PAMED) call for marijuana to be rescheduled by the federal government. However, Campaign4Compassion, an overwhelming majority of doctors across the country, 23 states, and the people of Pennsylvania do not think that patients should have to wait for the federal government to change their classification in order to use this plant medicinally.Campaign4Compassion (C4C) is a grassroots advocacy group that was started by mothers of sick children and other patients to advocate for the compassionate use of medical cannabis. Our goals are to educate residents and lawmakers in Pennsylvania and to pass comprehensive, compassionate medical cannabis legislation so that all patients with qualifying conditions have access to medication without fear of criminal prosecution.
Several national medical associations including the American Nurses Association, the American Public Health Association, the American Academy of HIV Medicine, the Leukemia & Lymphoma Society, the Epilepsy Foundation of America, and many others support the compassionate use of medical marijuana. A recent poll from the New England Journal of Medicine found that 76% of doctors would recommend medical marijuana to their patients, with 96% support from Pennsylvania doctors who participated in the poll. The Pennsylvania Medical Society claims to represent Pennsylvania doctors, but according to their own numbers only 37% of doctors in the state are current members of the group.
While PAMED expresses their opposition to SB 3 and any similar legislation, they never provide a specific problem with the content of the bill. As Dr. Bruce Nicholson, Chief, Division of Pain Management, Lehigh Valley Health Network and member of PAMED has stated:
“The intent of this legislation is to control and ensure that there is acceptable dosing of THC & Cannibidiol for both the therapeutic use in the patient population as well as further studies of medical cannabis regarding specific conditions. It is my opinion that the current position of PAMED is not one of constructive dialogue further identifying the potential benefits of medical cannabis."
Like many other opponents of medical marijuana legislation, PAMED stakes their position on the need for more research and FDA approval. Since 1976, there has been a congressional mandate placed on the National Institute on Drug Abuse (NIDA) to study drugs only as substances of harm. Since NIDA owns the only researchable source of cannabis in the United States, research has been slanted to find only the negative effects of these drugs. However, in other countries where laws are different, researchers have found that cannabis can be used safely within the confines of a medical program.
Even within the United States, despite the restrictions on research, over a dozen recent small-scale Phase 2 trials support marijuana’s medical efficacy. Studies like these and research from other countries was sufficient evidence for 23 states and the District of Columbia to enact sensible medical marijuana legislation. Lawmakers, residents, and doctors in those states decided patients should not have to wait for this bureaucratic process to be changed.
To support their claims that medical marijuana has harmed patients with epilepsy, PAMED sites the Chapman study presented to the American Epilepsy Society (AES). Out of 75 patients using medical cannabis, 57% reported improvement in seizure control with 33% reporting more than a 50% reduction in seizures. In a patient population that has only a 1% response rate to the 22 other FDA-approved antiepileptic medications, this efficacy rate is impressive. PAMED also indicates that medical marijuana was responsible for the 20% who experienced an increase in seizures. However, they fail to mention pharmaceutical anticonvulsants can also cause an increase in seizures in some patients.
We would like to mention that although PAMED focused on pediatric epilepsy, many seriously ill Pennsylvanians could benefit from access to medical marijuana. Chronic pain, nausea, lupus, spasms related to multiple sclerosis, and Crohn's disease all have strong evidence supporting the efficacy of medical marijuana, including, in several cases, small-scale double-blind placebo-controlled trials.
We would also like to make it very clear that as parents and potential patients we know there is no guarantee that any treatment will be effective. We are only asking for access to another option by our trusted medical professionals and the patients that they treat. The diseases that we face are debilitating, life-altering and often times life threatening. We do not have time on our side.
PAMED asks us, “Why not wait”?
To ask patients and their loved ones to wait years for the federal government to reschedule marijuana, for research to advance, for our legislature to act, is cruel.
Why not wait?
We should not have to wait one more minute. The people we love are suffering, and there is a safe, effective treatment that could help. Every day we wait means more pills, more hospital stays, more seizures, more pain, more tears.Now is the time to move forward on this critically important legislation.
Recently, Campaign4Compassion joined a bipartisan group of lawmakers, potential patients and caregivers inside the Pennsylvania State Capitol to demand that lawmakers stop waiting and take action. We urged movement for patients suffering today, the ones that have passed waiting and for future generations not yet diagnosed with disease. We would have loved to have had the support of PAMED.
We respectfully request that the Pennsylvania Medical Society reconsider their position. We implore them to remember that at the end of the day, we simply don’t want to bury our loved ones knowing that there is a medicine that could have facilitated healing and a better quality of life.
Why would anyone want to stand in the way of that?
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