Certainly, the compromise legislation for Utah’s Prop 2 initiative to legalize Medical Marijuana is better than the legislature repealing the initiative in their next session.
For consistency’s sake, however, if the compromise was offered because of inherent weaknesses the opponents to Prop 2 expressed fear over, then weaknesses in the compromise must be discussed and revisions must be made.
Some of the critical media coverage on Utah’s Prop 2 legislative compromise has focused on the involvement of the state’s predominant religion (The Church of Jesus Christ of Latter-Day Saints). From my standpoint, the biggest culprit is Big Pharma.
In fact, when viewing the incredible inconsistencies in the approach to regulating Marijuana—which has no history of overdose resulting in serious health conditions, or death—one can conclude that Big Pharma used the cover of the Church’s opposition to get their roadblocks in place.
To properly understand the blatant discrepancies, an understanding of current prescription and distribution practices of pharmaceuticals is required.
Direct-To-Consumer Advertising
According to a bulletin from the World Health Organization published in August of 2009 (Volume 87, Number 8) direct-to-consumer advertising is justly under fire for problems it injects into health care.
Big Pharma claims that direct-to-consumer advertising informs patients potentially suffering from disease and raises their awareness of treatment options. But critics of the practice, and there are many, have their doubts. “The truth is direct-to-consumer advertising is used to drive choice rather than inform it,” says Dr. Dee Mangin, associate professor at the Christchurch School of Medicine and Health Sciences, Christchurch, New Zealand, pointing out that the ‘driving’ is typically in the direction of expensive brand-name drugs.
Consumers then go to their doctors and the pressure to prescribe begins. Surveys carried out in New Zealand and in the USA show that when a patient asks for a specific drug by name they receive it more often than not. “In an era of shared decision-making, it’s much more likely that general practitioners will just do what the patient asks,” says Mangin. It goes beyond that, of course, because doctors are also being enticed by pharmaceutical companies to prescribe their drugs.
In other words, in the world of prescription pharmaceuticals, training has less influence than the marketing from pharmaceutical manufacturers looking to maximize profits.
Off-Label Prescribing
A study in 2017 by Consumer Reports showed many doctors sometimes prescribe a drug off-label — for a different indication, population or age group than those for which it’s FDA-approved. Research published in 2006 suggests that 20 percent of prescriptions are off-label.
Off-label prescribing is legal, so doctors are able to justify it to “help” patients who haven’t responded to drugs that are FDA-approved for their condition. Sometimes when there are no FDA-approved drugs, doctors may also be tempted to prescribe an off-label drug when features of two conditions are similar. It must be emphasized there is no official training for this.
Combining These Two Practices
One example of using these two poorly regulated practices is in prescribing Finasteride (known as Propecia or Proscar). Finasteride prevents the conversion of testosterone to dihydrotestosterone (DHT) in the body. DHT is involved in the development of benign prostatic hyperplasia (BPH). Finasteride is also used to treat male pattern hair loss in men.
It was discovered that Finasteride 5mg, the 5mg dosage was ideal for treating benign prostatic hyperplasia. However, for hair issues the Finasteride 5mg dosage was deemed too much, while 1mg was sufficient for treating male pattern baldness.
The dosage difference works out fine, but when you attempt to make your computation 5 pills of Finasteride 1mg is more expensive than 1 pill Finasteride 5mg. Some Finasteride 1mg users have wised up and simply buy Finasteride 5mg in the treatment of their hair loss issue. They buy Finasteride 5mg and use a pill cutter to divide the 5mg dose into four equal pieces. This leaves them with four 1.25mg pill of Finasteride. They simply take the cut pill and use it for treating their baldness issue. This works out pretty well, provided you have a pill cutter.
But when you consider the table below that details side effects, would a physician wisely prescribe a 5mg dosage for someone looking to cure male pattern baldness? Probably not. The easy thing then is for the patient to express frustration over frequent trips to the bathroom during the night disrupting his sleep and “self-prescribe” 5mg of Finasteride.
Marijuana Prescription and Distribution Inconsistencies
If avoiding the risk to health from a new drug were paramount in our health care, there would be few, if any, pharmaceutical products distributed to patients.
The listed side effects for new and existing drugs is extensive—usually requiring ¾ of the time in any direct-to-consumer advertising. Yet patients with no more expertise than what is offered in a 60 second commercial are allowed to self-prescribe their medication to a physician.
Additionally, controls on opioids have proven so significantly ineffective that over 115 people die each day from overdose—40% of those are following legal prescription practices!
Even Tylenol, an over-the-counter drug, has a worse overdose history than Cannabis. Dr. Hausknecht, a New York neurologist and pain management specialist, describes Tylenol as being “by far the most dangerous drug ever made.”
According to Dr. Hausknecht, “acetaminophen-associated overdoses account for about 50,000 emergency room visits and 25,000 hospitalizations yearly. Acetaminophen is the nation’s leading cause of acute liver failure. Analysis of national mortality files shows about 450 deaths occur each year from acetaminophen-associated overdoses; 100 of these are unintentional.”
These statistics cannot be used to justify laxness in prescribing and distributing Medical Marijuana. Likewise fear from existing, and unsuccessful, controls over pain management medications should not be used to impose excessive restrictions on a drug that has been used widely—if illegally—with few of the complications shown with pharmaceutical products.
Comparing Marijuana To Opioids and Recreational Alcohol
The two most common results of over consumption of alcohol (a recreational drug) are liver disease and impaired driving accidents. According to NHTSA 10,497 people died in alcohol-impaired crashes in 2016—and this statistic does not take into account homicides involving violence after excessive drinking.
Deaths from liver disease have risen sharply in the U.S., and doctors say the biggest factor is drinking —especially among young adults.
According to Dr. Elliot Tapper and Dr. Neehar Parikh “From 1999 to 2016 in the U.S., annual deaths from cirrhosis increased by 65 percent, to 34,174, while annual deaths from hepatocellular carcinoma (liver cancer) doubled to 11,073.”
Dr. Haripriya Maddur, liver specialist at Northwestern Memorial Hospital in Chicago, says drinking too much alcohol can cause liver cancer, as well as liver cirrhosis, and those two factors seem to be driving the rise in deaths among younger adults.
Considering the severity of the impacts from alcohol, it seems that if a background check is required for obtaining a Marijuana prescription, then a background check for DUI and liver disease should be required to obtain a “drinking card.”
Similarly, a background check should be required with an accompanying card for anyone being prescribed an opioid. With over 115 deaths per day from opioid abuse, this seems the least that should be done—especially if it is required for a medical substance with no known overdose deaths.
I am not opposed to a background check on Medical Marijuana. I am opposed to more stringent measures applied to it than applied to products (including recreational alcohol) with a longer and bloodier history of death and dismemberment.
If now is the time to apply such measures to Marijuana, it is more than past time to apply it to products such as opioids and alcohol.
Utah officials either don’t care, or don’t understand, that a primary driver for Prop 2 has been citizens frustrated and grieving over the loss of friends and loved ones to an opioid epidemic that is growing exponentially.
Applying more stringent measures to Medical Marijuana not only fails to address the need for compassionate solutions to those battling pain and illness, but also fails to prevent further loss of life through safer alternatives, or more effective controls, for opioid distribution and use.
Why have opponents changed the discussion from the devastation of opioids to “beware of the deadly weed” that has no history of overdose deaths?
Inconsistency In “Labeling”
A frequent criticism from opponents of Prop 2 is the lack of FDA approval or standards in the prescribing and distributing of Medical Marijuana.
As previously discussed, even FDA standards are frequently violated with off-label prescribing performed by some physicians. While considered legal, it is also considered a problem.
Yet with the compromise legislation proposed to replace Prop 2, there is an even lower standard applied by using undefined qualifications. This should concern both sides of the debate.
Consider for instance if the Utah medical establishment was populated by physicians and pharmacists who see no harm in legalizing recreational Marijuana. Would anyone consider qualifying conditions described as “rare conditions, under certain conditions,” or “pain lasting longer than two weeks, under certain conditions” as acceptable safeguards in the hands of “hippy doctors?”
For those seeking relief from excruciating pain of Rheumatoid Arthritis or Osteoarthritis it is frightening to consider that the decision of whether their condition will be defined as “rare” qualifying “under certain conditions.”
I have close and dear friends who battle daily with the severe pain of Fibromyalgia because the side effects of pharmaceuticals interfere significantly in their work. When traveling in states where Cannabis is legal, they have used Marijuana as treatment and received pain free days with no downside. They aren’t at all comfortable with the definitions not explicitly including their condition.
I’m also aware of those who suffer severe anxiety yet must avoid Xanex and other anti-anxiety medications, because of suicidal tendencies when on it. They suffer no such issues when using Medical Marijuana. Yet anxiety is not even hinted at in the compromise legislation. With a growing endemic of suicides, this seems both harsh and foolish.
This compromise of Prop 2 has been touted as compassionate care for Utah patients (and who can doubt the intent with a designated “Compassionate Use Board” as part of the provision). All sarcasm aside, it appears this legislation was too rushed to even appropriately consider all of the serious conditions that should be included by name, before throwing general definitions in.
There is absolute justification in expressed concerns that “certain conditions” are in danger of being interpreted by the prescribing doctor according to his/her bias—including whether S/he can make money prescribing a pharmaceutical. This does not protect those who vehemently oppose the side effects of pharmaceuticals and prefer the results of Cannabis if the doctor disagrees that their “condition” qualifies.
For those who understand the current environment for prescribing and dispensing pharmaceuticals, there is clearly no effort to provide either similar patient preferences or patient safety. Where there is a glaring inconsistency in applying standards there is a clear intent to withhold the benefits.
