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||Posted May 23, 2010 by Derek Rosenzweig
On May 4th after the introduction of SB1350, I had the opportunity to chat with Rep. Cutler during lunch. He expressed interest in learning more, and then sent this email to me after he returned to his office:
On Tue, May 4, 2010 at 12:45 PM, Bryan Cutler wrote:
Thank you for sharing your thoughts with me today. I have cut and pasted my list of concerns below
I will not be supporting the bill for a variety of reasons.
First, there are just as many studies that show that marijuana smoking is dangerous to a persons health. It can also lead to other drug addictions and usage. There also will be logistical issues with the dispensing of the product given that our pharmacists are not currently licensed to dispense marijuana which is a class 1 narcotic. Additionally, the bill as drafted, would allow patients to grow their own plants for their own use. However, when the math is done the amount of usable product that can be taken from a plant far exceeds the amount one person can use for their own needs. The question then becomes what will happen to the extra marijuana?
Finally, there are many people who view the legalization of medical marijuana as the first step in legalizing all drugs. I have had people lobby me on this premise. I will admit that I respect their honesty, but think that it is bad public policy. It is for all of these reasons that I will not be supporting the bill.
Thank you for asking and letting me share my opinion.
Below is my reply to him.
Hello Rep. Cutler,
Thank you for taking the time on May 4th to discuss, however briefly, the passage of HB1393/SB1350. I want to apologize for taking so long to get back to you, but I've had a lot of things to deal with personally. I'm glad that you're open to learning more in order to make a more informed decision, and I recognize and understand your concerns; however, some of them are not based in fact.
You are right that there are some studies out there which show marijuana's harmful effects, but consider the fact that NIDA stands for "National Institute for Drug Abuse," not "National Institute for Finding the Helpful Benefits of Medicinal Plants." NIDA has a mission to find the harms of drugs and not their benefits. They actively bar research into marijuana's medicinal properties by refusing to fund research with the aim of finding benefits, and they have even admitted to this. The DEA is even worse, ignoring the advice of not one, but TWO of their own Judges, after years of research and hearings! Inexcusable behavior from the Federal government to continue to wage war on their own citizens and restrict access to one of the safest medicines in human history.
"Marijuana, in its natural form, is one of the safest therapeutically active substances known... It would be unreasonable, arbitrary and capricious for the DEA to continue to stand between those sufferers and the benefits of this substance... (1)"- Francis Young, DEA's Chief Administrative Law Judge, 1988
"... there is currently an inadequate supply of marijuana available for research purposes... I therefore find that the Respondent's registration to cultivate marijuana would be in the public interest." - Mary Ellen Bittner - DEA's Administrative Law Judge
Young's decision was eventually rejected by the DEA in 1990, and in January of last year, DEA Deputy Administrator Michele Leonhart set aside Judge Bittner's ruling ' stating that NIDA possesses 'adequate' quantities of cannabis to meet the needs of clinical investigators, and that the agency monopoly on the distribution of marijuana for research is compliant with America's international treaty obligations. (Notably, on January 26, 2010 President Barack Obama selected Leonhart to be the DEA's full time Director.)
That said, research continues regardless, both here in the USA in states with medical marijuana laws, and overseas where restrictions are not so... insane. The CMCR, for instance, is a result of California's dedication to the truth. In 1999, the California legislature passed and Governor Gray Davis signed SB847, which commissioned the University of California to establish a scientific research program to expand the public scientific knowledge on purported therapeutic usages of marijuana.
The Center for Medicinal Cannabis Research has initiated and compiled a good list of research (PDF) showing the medicinal properties and potential of marijuana in its whole form. "In total, the CMCR has approved fifteen clinical studies, including seven clinical trials, of which five have completed and two are in progress. The CMCR has also approved four pre-clinical studies, all of which have completed... As a result of this program of systematic research, we now have reasonable evidence that cannabis is a promising treatment in selected pain syndromes caused by injury or diseases of the nervous system, and possibly for painful muscle spasticity due to multiple sclerosis. Obviously more research will be necessary to elucidate the mechanisms of action and the full therapeutic potential of cannabinoid compounds. Meanwhile, the knowledge and new findings from the CMCR provide a strong science-based context in which policy makers and the public can discuss the place of these compounds in medical care."
More research and literature may be found on our website at http://www.pa4mmj.org/involve/get_literature . I urge you to read all of it!
Smoking is not Ideal, is not Dangerous, and is Only one of Many Ways to Administer Medicinal Cannabis
Dr. Donald Tashkin, a prominent scientist and pulmonary researcher for the US government, has been for years trying to prove that marijuana smoking causes cancer. Because he can say it better than I can, I urge you to watch these two videos of Dr. Tashkin being interviewed about the results of his study which found that even highly frequent and long term use of just cannabis does not give a higher chance of developing lung, neck or mouth cancer. The interview is 2 parts, each about 20 minutes long, and it's very fascinating hearing it straight from the researchers mouth. Part 1 -
: Part 2 -
While we can all agree that smoking a plant is not the most ideal way to get its beneficial effects, we can not ignore years of rising illicit marijuana use but not rises in statistics for lung cancer and disease. They just don't match. Ideally, patients will vaporize their medicine, or will prepare it in foods and eat it. Vaporization is the preferred method, because there is no smoke. Cannabis combusts at 240''C, but the cannabinoids are released at about 180'C. Vaporizers pass air at about 185'C over the plant material, therefore providing relief with no added risk from the smoke.
The worst dangers of actually smoking marijuana come not from the plant itself, but mold - which can kill you if you're not careful - and dangerous adulterants such as sand and PCP. Forcing patients who find relief from marijuana to continue to rely on the illicit black market is an incredibly bad public health policy. While most of the illicit marijuana out there is free of contaminants, it is not tested for them and the source of the marijuana usually remains a mystery to the end buyer. While HB1393/SB1350 would not require compassion centers to test for adulterants, I would be very happy to see that amendment introduced. Many of the dispensaries in California, Colorado, and Rhode Island use machines to verify their medicine is free from contaminants, even without it being required. It's a good public health policy.
The benefits of smoking or vaporizing (see "Vaporization as a 'Smokeless' Cannabis Delivery System", attached as 'vaporizer_epub.pdf') - which provide the exact same relief - include that it is easily titratable (meaning a patient can smoke/vape enough to feel better then stop) and very fast acting. Marinol, for example, is a pill which must be digested and which is extremely hard to control the doseage of. Marinol has also been known to have effects more detrimental than one would receive from simply smoking or vaporizing it. Even worse, Marinol is extremely expensive for patients (upwards of $1300/month) and is rarely covered by insurance. Forcing doctors to choose a less effective and more expensive medicine wastes time, money, and is bad public policy. Passing HB1393/SB1350 into law would allow doctors to make the determination themselves as to which medicine is better. Prohibition removes options, but a good program such as that described by the Compassionate Use Act will open up all the options and will include good safeguards.
Alcohol and illicit black market are gateways to harder drugs, NOT cannabis
The notion that cannabis use - especially medicinal cannabis use - leads to addiction and then harder drugs has been dis-proven over and over again. The Institute of Medicine even found that notion to be completely without merit.
At the request of the FDA the IOM issued a report in 1999 titled 'Marijuana and Medicine: Assessing the Science Base'. The IOM stated, "There is no conclusive evidence that the drug effects of marijuana are causally linked to the subsequent abuse of other illicit drugs".
The Institute of Medicine's 1999 report on marijuana explains that marijuana has been mistaken for a gateway drug in the past because:
"Patterns in progression of drug use from adolescence to adulthood are strikingly regular. Because it is the most widely used illicit drug marijuana is predictably the first illicit drug most people encounter. Not surprisingly, most users of other illicit drugs have used marijuana first. In fact, most drug users begin with alcohol and nicotine before marijuana - usually before they are of legal age."
A study in the Journal of the American Medical Association on cannabis and its possible role as a gateway drug found that, "While covariates differed between equations, early regular use of tobacco and alcohol emerged as the two factors most consistently associated with later illicit drug use and abuse/dependence."
This AMA report further states:
"Alternatively, experience with and subsequent access to cannabis use may provide individuals with access to other drugs as they come into contact with drug dealers. This argument provided a strong impetus for the Netherlands to effectively decriminalize cannabis use in an attempt to separate cannabis from the hard drug market. This strategy may have been partially successful as rates of cocaine use among those who have used cannabis are lower in the Netherlands than in the United States."
The AMA report published in Vol. 289 No. 4, January 22/29,2003 is titled 'Escalation of Drug Use in Early-Onset Cannabis Users vs Co-twin Controls.'
The World Health Organization has even joined in with its 1998 'WHO Project on Health Implications of Cannabis Use'. This report noted the effects of Prohibition when it stated that "exposure to other drugs when purchasing cannabis on the black market, increases the opportunity to use other illicit drugs."
There is absolutely no doubt the gateway is not marijuana. It is the distribution system. Two decades of false government propaganda has some people mistakenly still believing marijuana is the gateway to drugs. The gateway to drugs is Prohibition and alcohol. I also highly recommend reading the testimony of Edward Pane, President and CEO of an alcohol and drug addiction treatment and education facility from Hazelton, PA, among other expertise and experience. His testimony is attached for your convenience.
Logistical Issues are Non-Issues
Pharmacists are not allowed to dispense Schedule 1 drugs, that is correct; however, in the 5 other states with medical marijuana dispensaries the only logistical issues come from communities not setting up their own regulations. Los Angeles has over a thousand dispensaries operating because they didn't think ahead and force an application process. They ended up closing down a significant number of them after they finally passed regulations. Encouraging municipalities to regulate where and when dispensaries can be at should be enough of a safeguard against too little or too many dispensaries operating in a particular area.
The Department of Health will have full jurisdiction over allowing growing permits for cultivators who specifically want to grow product to be sold at a compassion center/dispensary, as well as the authority to license such dispensaries which will have the ability to grow the medicine on premises as well as receive it from previously mentioned cultivators. It's already built into our bills. The system is very similar to other states, except that we will have the added benefit of knowing exactly who the medicine is coming from, and will know exactly what is in it. Prohibited marijuana will NEVER have this level of regulation and control, and is against the public interest. This system of distribution is very much in the public interest.
Patients Must Have Option to Grow Their Own
Dispensaries are a wonderful convenience and a necessary option for patients, but even more important is the ability for a patient to grow their own medicine. Dispensary-sold marijuana prices will likely still be in the price range of marijuana sold on the black market, though the price on average will lower a large amount. This is consistent with other states. It will still be expensive for patients to rely on a dispensary or compassion center all the time. Growing marijuana for oneself is very very cheap to do, regardless of method, especially when compared to purchasing it from a shop all the time. As I mentioned when we spoke in person, the current limits in HB1393 and SB1350 are simply not enough. The system of specifying an arbitrary number of plants is not optimal and creates confusion, and allowing patients to possess only one ounce of usable material at a time is wholly insufficient, as you mention in your concerns.
According to NIDA/NIH, a yearly average dose of medical marijuana is 5.6 - 7.23 POUNDS. That equates to roughly 7.47 - 9.64 ounces per month. Clearly, one ounce of usable material is not going to work, when a single plant can harvest well over a pound in certain situations.
The confusion arising in the system of 'number of plants' comes in a few varieties. While growing marijuana is easy, growing consistent quality marijuana does take some knowledge and technology. First and foremost is environment. Will the patient grow their medicine indoors or outdoors? Each situation has its advantages and disadvantages. Outdoor gardens can produce up to two (2) pounds per plant, depending on the skill of the grower and the strain of the medicine being grown, but can only be harvested ONCE per year. Outdoor gardens are also subject to weather conditions and pests which can affect yield. Indoor gardens can be harvested up to 4 times per year (depends on the flowering time of the strains being grown), but typically produce 1/4th of the amount of an outdoor grow. The "6 plant limit" does not specify whether those plants are mother plants (which never get flowered - they act as a base from which cuttings - or clones - are taken), clones (which are cuttings from a mother plant that are grown out to full harvest), vegetating plants (which are growing but are not yet in the phase of development where they produce THC or buds), or flowering (in the process of making the actual medicine).
So 6 plants being grown outdoors, all flowering, could produce roughly 12 pounds all at the end of a single harvest. 6 plants being grown indoors would typically never all be flowering - many would be in other phases of development. An indoor grower might only get 4 - 8 ounces per harvest from one or two flowering plants, which would get them roughly 16 - 32 ounces (or 1 - 2 pounds) per year. Clearly a better system is needed.
Law enforcement, patients, and caregivers need a simpler system for determining whether or not a garden is within guidelines. Chris Conrad's Canopy Size Predicts Yield (PDF - page 8) system is the preferred method. Canopy size is determined by area, and area is a very easy thing to measure. All that law enforcement, patients, and caregivers would need is a tape measure. The federal field data presented in Conrad's report show that, on average, each square foot of mature, female outdoor canopy yields less than a half-ounce of dried and manicured bud, consistent with growers? reports and gardens that have been seized by police as evidence. All other things being equal, a large garden will always yield more than a small one, no matter how many plants it contains. This is true for skilled and unskilled gardener alike. Restricting canopy will therefore limit any garden?s total bud yield, no matter which growing technique is used or how many plants make up the combined canopy cover. Most patients can meet their medical need with 100 square feet of garden canopy. Given that indoor gardens tend to be 1/4th the size of outdoor gardens, and can be harvested up to 4 times per year, having a 100 square foot garden in either environment will yield roughly the same amount over the course of a year. The patient will then be able to determine how to use it - by making edible preparations or hashish (which normally require more usable material than smoked/vaporized), or by simply smoking/vaporizing the dried and cured buds.
This is the system that I and Pennsylvanians for Medical Marijuana want introduced as an amendment to these bills. I believe this system should satisfy your concerns about patients producing more cannabis than they'd actually be able to possess.
Full Legalization is Inevitable, but is not the Current Issue
I won't mince words, I individually fully support the repeal of prohibition and the institution of a regulated market for marijuana - for all responsible adults over 18 years of age - and so should you. There are so many reasons for taking that position, that it would take another email much longer than this one to fully go into. However, that particular debate is not what this is about, and for you to use the fact that some of us do eventually want full legalization as an excuse to deny patients the rights of a fully regulated market for an extremely effective medicine that they're forced to get from the black market, is without merit and is frankly an untenable position. Marijuana legalization as a debate is taking place in a number of states and on the Federal level, and therefore eventually the PA legislature will eventually have to deal with it. If we pass the Compassionate Use Act now, then when that debate does take place, you will be able to debate the merits and concerns of that policy without having to worry that our laws are forcing doctors and patients into a bad situation. The two issues are intertwined but we as a movement are trying to separate them so that they can be dealt with on their own terms without politicizing and without equivocation. The legalization of hemp for industrial purposes is the 3rd part of this triangle, and that's another issue entirely.
I realize this is a very long email and I thank you for reading it in its entirety, as well as all the research I've provided. I work on this of medical marijuana specifically so that patients are taken off of the battlefield while the debate for full legalization takes place. My father, who suffers from a condition known as Reflex Sympathetic Dystrophy (aka Complex Regional Pain Syndrome), has been prescribed more narcotics for his condition, and has undergone more experimental treatments (with side effects FAR WORSE than using medical marijuana) than you'd care to know about (but which I will list here because you NEED TO KNOW).
- 4/02 and 5/02, physical therapy;
- 6/02 and 7/02, cervical epidurals;
- 12/02, acupuncture;
- 1/03, nerve root injection. 4/03, carpal tunnel injection;
- 7/22/03, 7/29/03, sympathetic nerve block;
- 8/03, stellate ganglion block;
- 10/03, quantitative sensory testing;
- 11/03 inpatient stay intrapleural catheter with bupivacaine - 3 days;
- 2/04, IV with lidocaine in hickman catheter - 4 days;
- 5/05, inpatient stay 4 days, IV with ketamine. (very bad experience!) All other procedures did not help at all!
- 5/06, psychological help and biofeedback.
At many points during his treatment, it was at times impossible for him to hold a conversation with me or my family without these horrible pharmaceuticals affecting his memory, speech, and ability to stay awake. His history of prescribed medicines includes the following:
- Pamelor 10mg, did not help;
- Neurontin 300mg, made him spaced out;
- Percodan 5/325, then Percocet 5/325, made him tired and constipated and only helped a little;
- Paxil 10mg, didn't help;
- Fentanyl patch, didn't work, caused allergic reaction;
- Oxycontin 10mg larger dose caused reaction;
- Ultram 50 mg no help;
- Pamelor 10mg and neurontin 300 mg at same time, really made him spaced out;
- Colace for constipation;
- MS Contin (morphine) 15mg, larger dose caused reaction;
- Zanaflex 4mg, made him very tired;
- Lexapro for depression, didn't help;
- Oxycodone 5mg - am still on, this one helps with pain some, causes constipation;
- Valium 5mg. and miralax for constipation, still on;
- Wellbutrin and Zoloft for depression didn't help;
- Lyrica 50 mg made him tired;
- MS Contin (morphine) 15mg then switched to Opana 40mg
There is no cure for this condition. Marijuana can help him, and you have no right - none whatsoever! - to tell him he can't use it to ease his suffering. If you'd been there when he underwent a KETAMINE drip, or was lying their screaming in pain because his medicines don't do a damn thing, you would not be patting yourself on the back for continuing to support Prohibition.
I hope you will not only support HB1393 and SB1350, but that you will join on as a co-sponsor and actively work to help pass this bill to show that you are serious about protecting the public health and interest of your constituents and for people like my father, who have no other alternative.
- Derek Rosenzweig
1.) US Department of Justice, Drug Enforcement Agency, "In the Matter of Marijuana Rescheduling Petition," [Docket #86-22] (September 6, 1988), p. 57.