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.
You’re right on target here brother!
It would be one thing if the Initiative were legalizing or decriminalizing pot- that would be straightforward. But it’s not right that they’re tricking the voters and using the back door by calling this a medical marijuana law.
In states that have gone before us and allowed Medical Marijuana the average percentage of the population that uses the medicine is 1.9%. So if your Assumptions are correct maybe half of the people given licenses will be using it recreationally.
Less than 1% of the population, and that’s a problem you’re worried about?! Half of the US population or more have tried Marijuana and despite the hundreds of billions of dollars spent to villainize and criminalize the cannabis plant 15-20% Americans use it on a regular basis! Millions and millions more than the 1% you’re tirading about!
Your argument is technically valid and some people will find loopholes if they are available. That will mean that people who want to use pot will be able to(just like now), and my question is: how in the World is that worse than them getting the plant from someone who grew it in Mexico for the Criminal Cartels?
Does hundreds of thousands of dollars every year being directed to the State of Arizona instead of Murderous Criminals keep you up at night?
Do you really think keeping a Safe and Natural medicine out of the hands of those who Truly Need it is more important than making sure none of the proceeds go towards our local communities and Bankrupt State?
I suppose if I was the Chief cook at a restaurant and they wanted to add some new stuff to the menu I wouldn’t be too excited about it either. I mean the restaurant might make enough money to keep the doors open, but it’s a lot more work for me and I’m not going to get a raise am I?!
Yup I’d definitely be selfish and protest the change even if it was better for everyone but me.
Thanks.. Andy-my primary objective is to make sure that the voters take a close look and realize that by opening the qualifying conditions to pain management they’re opening the Initiative benefits to recreational users. The blog post is also meant to make folks aware that Marinol is an option in cases when THC may benefit a patient. Finally-at the end of the post, I’m encouraging voters to examine the Initiative for themselves and make up their own mind.
Mr. Humble,
You state in your blog that you have had several teams comb over the initiative and could you post the findings of your team in regards to Prop 203? Is there a report that was filed and if so where can readers of your blog find the report(s)?
Thank you.
Michelle-Our team didn’t prepare a written report-so we don’t have anything like that available. But, if the measure passes in November, ADHS will provide infomration on the website.
Medical cannabis is truly a really effective medication for plenty of folks, it does not matter what some people think. I know family who have been aided with medical marihauna.
This issue is always a fighting issue between the two camps. Part of the issue is the government is still fighting the war on drugs, while at the same time others in the medical establishment realize the definite benefits of medical marijuana.
Mr Humble,
Regardless of what your personal opinion is, I hope that your department will cooperate with the citizens of Arizona if proposition 203 is passed.I hope that you perform your duties to the best of your ability, and encourage other employees to do the same. To recommend that patients use synthetic THC, versus natural THC seems to me a really uninformed statement. What is your real problem with natural THC? It saddens me that you are already setting the state of AZ up for failure, and that you do not see the benefits for patients, your department, and the state of AZ. The information is out there for you to read, please educate yourself and your department. I will be happy to pass information to you that supports THC from medical professionals, groups, research, etc.
Thanks… Of course, we will do our very best to carry out the Initiative in an efficient and effective way if it’s passed by the voters.
I have my medical team researching information on the topic including the most recent IOM report. One of my concerns about natural THC is that dosage cannot be measured and controlled (as it can be with the Marinol capsule), the variation in potency depending on source, the delivery through smoke (i.e. the combustion by-products), and the fact that I can’t find clinical trials that demonstrate it’s safety and efficacy (there are with Marinol).
But, please rest assured that our team will do a good job executing the Initiative if it passes.
Mr. Humble,
I would just like to point out a few key facts since your knowledge of Marijuana’s effects on the mind and body is limited. First off THC is the most active ingredient, not the only ingredient found in marijuana that contributes to its unique affect. Isolating that ingredient gives a much different result, just like the resulting highs are different from strain to strain because of the different chemical make-up. Sativa’s give a more mental high and are great for depression and eating disorders. Indica’s are more of a sedative and are very effective at alleviating pain at the brains neuroreceptors, causing no harm to the body(liver) like conventional types of medication(Oxy=Percocet=Heroin). And frankly sir, when the FDA approves these kinds of drugs that are more addictive than heroin I don’t really care what they have to say about marijuana. Marinol is just another way to sell a pill and is not natural. The body processes things found naturally the best, it’s just the way it works. MARIJUANA doesn’t have to be smoked at all to be consumed! It can be vaporized(highly recommended), or broken down into foods and drinks(most effective)and even be concentrated into an oil for consumption. In any case if a patient does choose to smoke they should have the right as it is the fastest way to induce the chemicals. Burning it also combines the hundreds of different chemicals together creating new chemicals and an otherwise new affect. I do understand the smoke is still carcinogenic and not good for you. If you really studied a little you might stumble upon some research showing how chemicals found ONLY in marijuana can inhibit cancerous cell growth and tumor growth. How it can stop the nervous system from misfiring and stop degeneration from Multiple Sclerosis,which my mother in law has, with very limited usage so the patient feels no lethargic affects. The research is there please enlighten yourself. Any medicine that’s abused is bad, that doesn’t make the medicine itself bad…
Mr Humble-
I do not agree with your concerns and believe that if you and your team research the issue in earnest you will find your perspective to be changed drastically, however I do commend you for handling the opposing veiwpoints here on your blog with humility and respect, and for being responsive and accessible in the first place.
Please keep an open mind as you review the extensive scientific studies that have been done over the past decade, in spite of the DEA’s best efforts to stifle honest medical research.
Come on guys…please leave some good related remarks about the write-up….it would be helpfull and greatly valued by all of us
The argument here I’m assuming is that the prop 203 initiative of 2010 may be misleading to the public. Let me tell everyone in here that the passing of this prop. in addition with social acceptance, is one step closer to the intelligent evolving of our species. I’ll explain. Lets review some facts about something that is clinically safer than “Acetaminophen”. As I’m typing, I notice that the word “Cannabis” isn’t even in my spell check! “Marijuana” was originally made illegal because of racially motivated lynch mobs. In 1937 “Cannabis” (a friendlier word)
was made federally illegal in the United states. There is recorded federal court testimony of a farmer in the south claiming that “Marijuana made white women seek relationships with Negros.” That was verbatim by the way. Other reasons suggested that Marijuana turned Mexican migrant workers into “super humans” and compelled them to commit various crimes like rape and murder. There was also controversy that Marijuana could wipe out the cotton industry which was the majority crop at the time that compared to Hemp and Marijuana. Unfortunately all of the beneficial facts were concealed or ignored by select controlling political parties at the time who had all the power and support. There was no CNN or Fox news “keepin ’em honest”. Marijuana and “Hemp” is more sustainable than cotton and paper trees. Hemp fibers are typically harvested from male cannabis plants. Anyone here who knows English History can recall Sigmund Freud admitting to his cocaine addiction. Through the turn of the 20th century humans learned that cocaine can cause sudden death if abused, which is why there will never be a Cocaine legalization initiative. We now know Cocaine is easier to manufacture than Methamphetamine, yet Meth is the number one drug influence for crime in this country. Many people personally appear in commercials and on billboards describing their horrible past because of their use of Meth. This Marijuana initiative confuses people because the way this prop. is written is so that Doctors can have relief for prescribing something that the FDA does not recognize as a viable treatment for disease and pain, yet Will Humble has no problem acknowledging synthetic THC (dronobinol) has FDA merit. This initiative battles intelligence against stubborn politics. If the FDA can approve THOUSANDS of prescription drugs over decades, then you would think they would have had time review an acceptable method of ingesting Cannabis which Science is proving our previous leaders to be buffoons. There is concise and accurate data suggesting Marijuana to be safer than all current pain pills. Most pain pills must pass through your liver, which creates toxins and cirrhosis. Mr. Humble is putting up a “smoke screen” by suggesting that the passing of this initiative will incite recreational use. He is trying to create apartheid by presuming that there will be people who abuse Cannabis like those who abuse opiates, benzodiazepines, or other legal drugs. I think people with his similar views are dreading the immediate access people will have to Cannabis. If people wanted to smoke opium, all they have to do is grow papaver somniferum (12% morphine) which is unlikely to be recognized by police helicopters. If non-THC producing Hemp is illegal, then why aren’t all poppy plants illegal? Its all politics my friends.
I would also like to respond to Mr. Humble’s paragraph about natural THC dosages. He suggests that there is no way to measure or control dosages of natural THC. This is incredibly inaccurate. There is indeed a way to measure THC in a mammals body. The technology does exist every time we take a drug panel test. The cutoff in traditional drug tests (the cheap ones) measure a cutoff level of 50 nanograms or less is negative in the results. The fact that we can measure the presence is not limited to the facts that either THC does or does not exist in the body. We have the technology to measure ZERO to hundreds of nanograms of THC in ones body. The fact that this paragraph mentions “Unnatural THC” vs. synthetic THC” is irony in itself.
I agree with the above comment. It sounds like we keep hearing cop outs and excuses from the ADHS, particularly Will Humble who seems to speak openly for the whole department. Mr. Humble it’s clear you need to do a little more research about some of the specifics you mention. There have been plenty of cases where THC metabolites were measured in nanograms during “DUI” blood tests. If your wonder drug “Marinol” has any resemblance to the natural version of THC, then it would be impossible to overdose on the synthetic too. But wait…If there’s no way to overdose on Marinol, then why would you need to have a dosage recommendation? Why would you ever need to measure the presence of the drug? You cant overdose on the natural version. The dosage is simply a mathematical equation as with the synthetic. Most Marijuana Doctors are Board Certified and are much better at explaining the correct intake process than you are. Unless the proposition specifically says “People will be able to use Marijuana for relaxation even if they have no ailments” then it sounds like you are already undermining Doctors and people that meet the prescribing requirements. You are being presumptuous! If a doctor recommends Medical Marijuana instead of Naprosyn, Vicodin, and Tylenol, or maybe even Ambien or Zanax, and requires his patients to use a vaporizer, then who are you to call that patient a recreational user?
Dear Mr Humble,
I understand your concerns about recreational marijuana use if this bill passes. I am a family practice Medical Dr. in Phoenix, Az. The pain medications I have prescribed can be safe if used properly. However some patients can develop a high tolerance and dependency which results in the need to “ween” patients off narcotic pain medications. Some patients even need additional medication to deal with the withdrawal symptoms of these dependencies. Before any Doctor can prescribe medication for pain, they must trust their patient not to abuse any controlled substance, and not to use their medication for recreational purposes.
Mr Humble,
Will qualified Arizona residents all have equal opportunity when applying for a dispensary license if the majority votes yes on the medical marijuana initiative?
We will follow the law and the administrative code that we develop during the first 120 days.
Thank you for the comments and research information that we have recieved since my initial post on this important subject. Our research teams in public health and substance abuse have been reviewing the infomation that we have been recieving. Our medical team led by Dr. Nelson (the Department’s Chief Medical Officer) will continue to review research to refine our position on this subject.
Also, I want to assure everybody that if the Initiative passes, the department will implement the law effectively and efficiently.
will
Hello, I am confused…is Marinol available for MD, PA, NP to prescribe that are primary care physicians. My mom was prescribed this in California and now in AZ her nurse practitioner told her it’s illegal????
Hello Archie,
Unfortunately, ADHS does not cover this scope. Please redirect your question to the Medical Board: http://www.azmd.gov/ or Board of Nursing: https://www.azbn.gov/
Thank you.