The following op-ed was written by Paul R. Phinney, M.D., California Medical Association (CMA) president-elect, and Luther F. Cobb, M.D., CMA speaker of the house, and was featured in The Sacramento Bee on November 1, 2011.
Recently, the CMA, representing more than 35,000 physicians, the largest statewide physician organization in America, boldly decided to adopt a different, more pragmatic approach to the polarizing issue of marijuana decriminalization. The decision – the result of a carefully considered process, painstakingly researched and debated for more than one year – is centered on one concern above all others: patient safety.
To be clear: this was a purely medical decision.
Our individual members come from every corner of California and represent every possible political philosophy and partisan leaning. But the one thing we all share is a common commitment to putting patients first. By that standard, we believe that the present system of medical cannabis is flawed, contradictory and dangerously detached from scientific evidence and that a new approach to legalization, regulation, research and enforcement is needed to protect physicians and patients alike.
Under current law, medical cannabis has been decriminalized in California, but is still illegal on a federal level. This puts physicians in an untenable, impractical position as the ultimate gatekeeper of the substance. As physicians, we want to do what's best for our patients – but, in California, it's tough to do that without comprehensive scientific and medical research and with the fear of federal prosecution.
The goal of our call for legalization is not to make the drug more available, but rather to create a strict regulatory system, ultimately limiting distribution and standardizing medical cannabis.
While it's currently legal in California for a physician to recommend medical cannabis for treatments such as neuropathic pain, dosage is not well standardized nor is it regulated for purity and safety. How are we, as health care providers, supposed to accurately recommend a product to a patient when the only information we have now is that "one lollipop is equivalent to two doses?"
Our extensive medical education, combined with pharmaceutical data on other drugs, keeps us knowledgeable about the composition and strength of everything else we prescribe to our patients. Why should there be an exception with medical cannabis? Until the substance is legalized, we cannot regulate it in a way that's safe for patient use.
As a community of physicians, we feel we're making the most responsible recommendation for public health. As it stands now, we simply don't know enough about medical cannabis to understand the benefits or risks that use could have for patients. There have been limited reports stating medical cannabis may be suitable for some cases of chronic pain and there have been similar reports associating use with both short- and long-term health risks.
The fact is we don't know what the real effects are. By changing cannabis from a Schedule I drug, which the federal government states has "no accepted medical use" and allowing for better research and strict regulation, we're watching out for the good of the public health and the safety of our patients.
Despite prohibition-related efforts, unregulated cannabis is easily accessible, often at a low cost. CMA recognizes the current structure as a failed health policy that has been unsuccessful in keeping patients safe. While we're glad to be part of the 15 other states that have decriminalized the use of medical cannabis, it simply isn't enough. We must create a structure that allows for serious research and controlled distribution.
The bottom line is that patient safety and good public health are the ultimate goals. Not until we've gathered sound scientific evidence, and created a robust regulatory structure for medical cannabis, can we achieve those goals.