Compassionate Use of Cannabis in PA

Many years ago while walking the vendor isles at an American College of Emergency Physicians Scientific Assembly, I passed a booth that was collecting signatures in support of medical use of cannabis. Knowing its extremely low toxicity, both from detailed study in undergraduate pharmacy and years of clinical medicine, I signed. They also asked if I would be willing to come forward and publicly express my opinion. I almost always answer yes to that one.

A few years later, I got a call the NJ coalition supporting compassionate use legislation and after some discussions ended up the featured physician speaker in a Video called “Marijuana is Medicine”, featuring many patients who benefited from medical use. It was featured at the Trenton Film Festival and a copy presented to each legislator in the state. Subsequently, compassionate use legislation passed.

Several years later, in 2009, I was called again, this time by Jewish Social Policy Action Network asking if I would testify for compassionate use before the House Subcommittee on Health and Human Services. I did, but in the 5 1/2 years since, nothing changed in PA.

Recently, I got another call to speak in PA. Not that I mind being called again, though it sure seems (especially considering recent polls) that very few have been willing to speak publicly.

This time was much different for me. I spoke at a press conference in the capital rotunda organized by State Representative Ed Gainey on behalf of a bipartisan coalition of legislators. They claim to have the votes to pass legislation but Rep. Matt Baker refuses to let it out of committee for a vote. I was a last minute addition to the speakers list (they wanted a physician/expert to speak), which also included TV personality Montel Williams, legislators, and a number a patients. I had no idea how the day would play out, but I prepared a statement and went to Harrisburg. I arrived to find that a local grassroots group was there in significant numbers. The group, Campaign4Compassion, is composed mostly of parents of children with resistant forms of epilepsy, but also a host of other maladies for which there is now much more than anecdotal evidence for efficacy.

I was brought to tears more than once during the press conference. A mother of a child who was having hundreds of seizures a day that just stopped with CBD. The child has now spoken her first words. A state trooper, whose child sat in the front row, testified to seeing similar results and is now faced with competing promises to protect his family and to uphold PA law. He said he will probably become a medical refugee, up-end his family, and move to CO. And Montel Williams, who has MS, told his compelling story of facing deep depression and near suicide, until he discovered cannabis could alleviate many of his symptoms.  It was just the start.

The press conference was a preview for a town hall meeting set up by local TV Station, CBS21 in Harrisburg, for that evening. (90 minutes and available on the web for those interested). The network had arranged for a local panel that included the chief of pediatric neurology who cared for many of the children I mentioned, and he left no doubt about the apparent effectiveness of CBD for many of his patients. We heard from a wife of a vet with PTSD. The VA had him on 17 different medications without improvement. Then he heard about other vets smoking pot to relieve his insomnia, night terrors, etc. It worked, but the VA drug tested him, found THC, and locked him up for 21 days. Shortly after his discharge, he killed himself.

Most emergency physicians have seen plenty of chemo and HIV patients who have benefited, but I have never been so moved by the stories, deeply personal, that were shared that day. I know how often emergency physicians see patients that have become addicted to opioids, who have legitimate pain and few alternatives. Many of these patients were there too. Some now successfully using cannabis to reduce or eliminate their opiate use.

Between the noon press conference and the Town Hall that evening, I was invited to an open house sponsored by one of the mothers of an epileptic child. Her child had a dramatic response to CBD. After hundreds of seizures daily, the child was started on CBD and has had only a few seizures in the last year. She was playing with the dog and now speaks a few words.

Yes, this time was different for me. It is time that ACEP take a formal position in support of medical cannabis use.  I will never leave the side of these patients. Legislators are still plagued with bad information. Medical organizations have been slow to speak up and their silence is used as an excuse by both physicians and legislators to not move the issue.

Opponents often point to the long discredited concept of cannabis as a gateway drug and to the risk oF rising use by teens. And no one needs to tell emergency physicians about the what drug problems are in the community.

According to the CDC, In 2008, prescription opioid pain relievers (oxycontin, hydrocodone, etc) — were responsible for over 15,000 overdose deaths — more than the combined death count attributed to cocaine and heroin. A recent study in JAMA showed that availability of medical cannabis was associated with significant reduction in opioid related deaths. There are 2 messages there : 1)We need to educate doctors and patients about proper opioid use; and 2) we need to give doctors and patients as many alternative options as possible.

A new Lancet study on adolescence use over 20 years concluded “the risk of marijuana use in states before passing medical marijuana laws did not differ significantly from the risk after medical marijuana laws were passed”.

Last year there were some opinions on the pages of ACEPnow, our College newsletter. The “opposing view” was from a Colorado emergency physician, up close to the front line, but it seemed the only issue that arose in Colorado was unintentional exposure by children, and uneducated use by tourists. I fully agree with the authors conclusions : “The medical community should be actively involved in regulations. State legislators and health care providers must remain vigilant and follow the public health effects of such laws to determine best strategies and interventions (eg, child-resistant packaging, dose limitations, education, and counseling) for public health and safety.”

However that is really not a position against medical use, but rather focuses on responsible implementation. Absolutely, by all means, learn from experience and legislate accordingly, but it’s time to legalize compassionate use without delay everywhere.

As an emergency physician, I have always prided myself in being a patient advocate. The patients and families I met this week have inspired me. I hope you will join me and let your voice be heard in support of Compassionate use.


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