Thursday, October 1, 2015



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.

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