California Medical Assn. support of marijuana legalization has doctors talking

The California Medical Assn.'s recent decision to support marijuana legalization has drawn mixed opinions from physicians and others.

At the same time, legal challenges continue across the country over state medical marijuana laws. And in recent months, the federal government has threatened to shut down marijuana dispensaries for violating federal law.

"It's a new era in medicine in how people are regulating and treating medical marijuana," said Diana Protopapa, director of political affairs and education for the Colorado Medical Society.

The California association's Oct. 16 decision to recommend legalization and regulation of medicinal and recreational cannabis stemmed from a white paper that concluded physicians need better research on the drug. Under current federal policy, adequate studies on marijuana are not possible, the organization said. The association is the first state medical society to officially support marijuana legalization, said CMA President James T. Hay, MD.

"This was a carefully considered, deliberative decision made exclusively on medical and scientific grounds," he said. "As physicians, we need to have a better understanding about the benefits and risks of medicinal cannabis so that we can provide the best care possible to our patients."

Physicians have no control over the substances patients are obtaining, Dr. Hay said. In some cases, marijuana may be tainted and unsafe. Physicians are stuck in an uncomfortable position in recommending medical marijuana because the drug is illegal under federal law, he said.

"California has decriminalized the use of medical marijuana. It is legal to grow, have and recommend in limited quantities. However, any time a physician makes the decision to recommend, they are running afoul of the federal law," he said.

Paul Phinney, MD, CMA board chair, said the correct choice for the association was clear. "Currently, medical and recreational cannabis have no mandatory labeling standards of concentration or purity. First, we've got to legalize it so that we can properly study and regulate it."

The CMA policy is encouraging and coincides with recent polls on public acceptance of marijuana, said Karen O'Keefe, director of state policies for the Marijuana Policy Project, a national group that advocates marijuana legalization.

A Gallup poll released Oct. 17 shows that 50% of Americans support legalizing marijuana and 46% are opposed. The public's approval rating of marijuana has increased by 20% since 2000, according to the Gallup report.

But Colorado emergency physician Patricia VanDevander, MD, questioned whether legalizing marijuana would benefit public health. She chairs her state medical society's Medical Marijuana Task Force.

"I'm not sure just by legalizing it, we'll take care of a lot of the health issues," she said. "It may take care of the legal issues, but I'm not sure if it's in the public's best interest from a public health standpoint. I don't see a lot of support in the medical community" for legalizing the drug.

Legal challenges remain

Colorado is among 16 states that have approved medical marijuana statutes. Multiple lawsuits have ensued surrounding the state's law, including an August suit by medical marijuana patients who want the Colorado Supreme Court to overturn regulations imposed on the drug. The law also has sparked questions about monitoring the validity of medical marijuana recommendations by doctors.

Tightening restrictions on medical marijuana has caused unintended consequences for Colorado doctors, said Protopapa, of the state medical society. For example, Colorado required physicians recommending medical marijuana to have licenses in "good standing" but excluded those with licenses that had restrictions and other conditions -- a change that impacted all doctors, whether recommending medical marijuana or not. Earlier this year, the society worked with legislators to change the definition of "good standing" back to its original meaning. The state medical board now decides whether any license restrictions or other conditions affect marijuana recommendation privileges.

In Arizona, state officials, led by Gov. Jan Brewer, sued the Justice Dept. to block a law permitting the use of marijuana for medical purposes. The lawsuit asked a federal judge to clarify whether compliance with the law violates federal law. Federal attorneys in August asked a judge to throw out the suit. That case is ongoing.

The Arizona Medical Assn. has no policy on medical marijuana, although it encourages more scientific research from a medical standpoint, said association spokeswoman Sharla Hooper.

Michigan has experienced legal battles since its medical marijuana law was enacted in 2008. Federal authorities took the state to court over medical marijuana records of seven Michigan residents following a Lansing-area investigation. A judge in June ordered the state to turn over the records.

The Michigan State Medical Society supports the use of cannabinoids for medical purposes by routes other than smoking. The society also urges further research and testing on the drug.

American Medical Association policy says cannabis is a dangerous drug, and sale and possession of marijuana should not be legalized. In regard to medical use, the AMA calls for further "adequate and well-controlled studies of marijuana and related cannabinoids in patients who have serious conditions for which preclinical, anecdotal or controlled evidence suggests possible efficacy and the application of such results to the understanding and treatment of disease."

The AMA urges that marijuana's status as a federal schedule I controlled substance be reviewed with the goal of facilitating clinical research and development of cannabinoid-based medicines and alternative delivery methods. The policy stresses this should not be viewed as an endorsement of state-based medical cannabis programs, the legalization of marijuana or the contention that scientific evidence on the therapeutic use of cannabis meets the current standards for a prescription drug product.

Educating doctors

State medical societies want to be sure physicians understand state laws on the subject.

In 2009, the Colorado Medical Society created a medical marijuana task force to review proposed resolutions related to marijuana and evaluate proposed state legislation. The task force recently hosted an educational seminar for members on medical marijuana.

The law "made us stop and say, 'What kind of service should we provide for our members?' " Protopapa said. She said the move was not intended to push toward picking a side on the issue, but to provide informational resources on the law for physicians to access.

The Arizona Medical Assn. dedicated an edition of its quarterly magazine to medical marijuana this year, offering guidance to physicians on the law and how best to comply.

Dr. VanDevander, of the Colorado medical society, doubts there will be a consensus on whether medical marijuana is appropriate or should be legal.

"There will always be people on all three sides -- pro, neutral and against," she said. "You will never get all physicians all on the same page at the same time."