By: Petra Person – Hofstra Law School – Law Student Contributor
On April 17th, 2016, Pennsylvania became the 24th state, along with the District of Columbia, to legalize a medical marijuana program. Pennsylvania Governor Tom Wolf proudly enacted the Medical Marijuana Act (Senate Bill 3) to0 provide long overdue medical relief to suffering patients.[i] Upon SB 3 taking affect, the Pennsylvania Department of Health will have six months to draft temporary regulations, including the designation of qualifying illnesses in order to register as a patient.
This state action indicates an astounding shift in societal views of the regulation and legalization of responsible cannabis use. With this enactment, over half of all Americans will now live in a state that has acknowledged the need for a medical marijuana program. This is an astounding step in the face of the federal government’s silence as to the contentious categorization of cannabis as a Schedule I substance of the Controlled Substances Act, the most restricted category reserved for substances which have “no currently accepted medical use.”[ii] Despite numerous proposals to reschedule cannabis and murmurs of FDA support of rescheduling, the requisite Congressional or Executive action to do so has yet to mount.
Despite the emerging medical marijuana industry, the medical community has faced countless hurdles in developing a robust medical marijuana market. State-regulated medical marijuana programs dangle significant structural obstacles to systematically inhibit doctors from entering the sphere. The considerable requirements placed on a physician in order to register with the state as a cannabis provider, in conjunction with certain restraints of the medical community itself, have marginalized many educated physicians from advocating for cannabis legalization and regulation. Perhaps these reasons can help illustrate why a single Illinois doctor was responsible for writing cannabis referrals for over 1/3 of the 3,300 certified Illinois patients as of June 2015, according to Illinois State’s most recent Annual Report on the medical marijuana program.[iii] The lack of doctors certified to administer cannabis referrals within the State of Illinois resulted in untenable burdens for countless qualifying patients.
It is a common argument, among advocates for states with stricter medical marijuana programs, that the risks physicians must absorb in order to offer cannabis referrals deter many health care providers from entering this space. Further, many medical conglomerates in states with medical programs forbid its doctors from certifying medical marijuana under federal law, which compounds the lack of available doctors to the detriment of the patient.[iv] This state-regulatory assault on medical marijuana results in patients driving hundreds of miles in hopes of obtaining medical relief to control their qualifying illness, such as epilepsy, because so few doctors will handle medical marijuana.
Health care providers are further dissuaded from advocating for cannabis due to uncertainty regarding their professional ethical obligation to “do no harm”. Physicians must toggle the structural obstacles presented by the federal bureaucracy with the needs of their suffering patients seeking legal cannabis relief. Health care providers are further isolated through the disjointed state-regulatory programs, as the disparities between the enacted medical marijuana programs isolate many physicians in support of regulation. This has resulted in a vacant seat in the national dialogue for the need for policy reform in this spectrum. The isolated state-by-state nature of the medical marijuana program has disengaged educated and respected physicians from confronting the fictitious scientific evidence asserted by cannabis prohibition supporters. Only recently has the medical community become empowered in unity to advocate for the effective governmental regulation of cannabis.
In 2011, the California Medical Association (CMA) made history by becoming the first doctors’ group to call for the unequivocal, full legalization of marijuana within the state of California.[v] This action was a monumental shift of the health care community, serving as an indicator of the trending view of the CMA’s more than 50,000 California physicians. Until recently, many health care providers have been skeptical to publicly voice their opposition to the war on marijuana, in fear they present to condone recreational cannabis use and violate their ethical responsibility to “do no harm.”[vi] As societal views on the medical value of marijuana have steadily become more encompassing, physicians have began to acknowledge their duty to oppose the prohibition of cannabis in the interest of public health. Many knowledgeable physicians recognize the need for social reform on this matter from anecdotal patient experience and overwhelming scientific evidence. However, until now, the medical community has remained disjointed, lacking a centralized, national platform for medical professionals to unify in their advocacy.
In response to this void within the medical community, a national group of more than 50 physicians have announced the formation of the Doctors for Cannabis Regulation (DFCR) in April 2016.[vii] The DFCR stands as the first national organization of doctors, to cooperatively influence the states and federal government to legalize and regulate the use of marijuana in the interest of public health. The aim of this organization is underscored through a broad lens examination of the public health crisis resulting from the war on cannabis. The DFCR does not advocate for the use of marijuana but opposes marijuana prohibition, by recognizing the disparate negative repercussions of the current marijuana prohibition and wide-span impact throughout society.
The DFCR is composed of respected physicians across the nation, bound together through a progressive, altruistic outlook of the catastrophic effect the war on cannabis has spurred. In one of our nation’s most disgraceful racial disparities, African Americans are 300% more likely to be arrested for marijuana possession than whites, despite similar usage rates.[viii] The prohibition has directly led to the proliferation of dangerous, synthetic cannabinoids, like K2 and Spice.[ix] The public health implications of marijuana prohibition quite clearly disparately burden low-income individuals due to inability to pay fines, inadequate access to legal counsel, and high potential lose of housing, employment and student loans. Ultimately, the medical community has began to draw attention to the role that the marijuana prohibition has in undermining public health in the face of mounting evidence in support of marijuana regulation. Marijuana prohibition has been counterproductive to the advancement of society to the extent in which state civil disobedience has prevailed. Our nation is on the cusp of social reform to remedy the civil disobedience of the various state enacted medical marijuana programs.
On April 18th, 2016, at 2:00 PM, the DFCR held an interactive teleconference to mark its formal launch, introducing the aims and intents of the organization. During the teleconference, DFCR founder and board president David L. Nathan, an associate professor at Robert Wood Johnson Medical School at Rutgers and a distinguished fellow of the American Psychiatric Association, introduced himself and clarified the need for social reform within the medical community. Nathan spoke to the ethical obligation physicians are bound to, speaking to the unique benefits of medical cannabis over strong pharmaceutical alternatives. The teleconference, available to any interested party, lasted about an hour, with multiple distinguished medical professionals fostering dialogue into the hypocrisy, far reaching repercussions on public health, and immediate need for doctor support against the opposition of marijuana regulation.
The DCFR maintains the best way to handle the risks associated with a medical program is to mitigate through open regulation.[x] This emerging physician standpoint calls for affirmative doctor support in opposition of marijuana prohibition, regardless of personal opinions of marijuana usage. Ultimately, a physician should be compelled to disregard their personal opinion on marijuana consumption, to oppose the far-reaching, evidential rationales to dismantle marijuana prohibition.
[ii] David Savage (October 16, 2012). “Medical marijuana advocates seek reclassification of drug”. Los Angeles Times. Retrieved 2012-10-27.
[vii] Supra, Note 3
[viii] The War on Marijauna in Black and White ACLU, June 2013
[ix] Fantegrossi, William E., et al. “Distinct pharmacology and metabolism of K2 synthetic cannabinoids compared to Δ9-THC: Mechanism underlying greater toxicity?” Life Sciences (97)1. February 27, 2014. pp. 45-54.
[x] Supra, Note 5