Arizona may add more uses for medical marijuana
By PAUL DAVENPORT businessweek.com
Arizona is considering requests to expand its fledgling medical marijuana program to allow use of the drug for an array of conditions, including post-traumatic stress syndrome and migraines, beyond those allowed under the law approved by voters two years ago.
The Department of Health Services, which is required under the 2010 law to consider requests to expand coverage, holds a public hearing Friday on the first batch of requests.
Besides PTSD and migraines, the requests for covered conditions include depression and general anxiety disorder. The law already permits medical marijuana use for such medical reasons as cancer, glaucoma, AIDS, chronic pain, muscle spasms and hepatitis C.
Even as the state considers expanding the program, it is still implementing a key part of the law.
Friday is the deadline to submit applications to operate medical marijuana dispensaries. Up to 126 dispensaries will be permitted statewide, but only one per designated area. Those typically are either rural towns or parts of metropolitan areas.
The process of awarding licenses to dispensaries that will sell marijuana to users was delayed by Gov. Jan Brewer's reluctance to implement that part of the law.
The state has awarded medical marijuana user cards to more than 28,000 people. Chronic pain is the most common medical condition, though users can have more than one. Most of the users also got permission to grow marijuana until there is a dispensary in their area.
Arizona is among 17 states that have enacted laws allowing medical marijuana use, according to the National Conference of State Legislatures.
States' programs vary, and some already cover the additional medical conditions being considered by Arizona. For example, New Mexico allows medical marijuana use for PTSD, while California's covered "serious medical conditions" include migraines. Meanwhile, Colorado's decade-old program has denied petitions to add more than a dozen conditions, including PTSD, hepatitis C and depression.
Marijuana is still illegal under federal law, but the Veterans Affairs Department in 2011 issued guidelines that permit patients treated at VA hospitals and clinics to use medical marijuana in states where it is legal. The guidelines don't allow VA doctors to prescribe medical marijuana.
Consideration of possible expansion of Arizona's medical marijuana program follows efforts by the state to crack down on early abuses.
State medical regulatory boards already have disciplined doctors for failing to adequately consider patients' needs and conditions before recommending medical marijuana.
The state Medical Board in February reprimanded one physician who wrote certifications for 483 patients without making required checks of a controlled-substance database.
The Naturopathic Physicians Medical Board suspended another doctor's license for failing to adequately examine patients and document their conditions before certifying them for medical marijuana.
In advance of Friday's hearing, Health Services Director Will Humble said he is most interested in peer-reviewed scientific studies, not personal testimony.
"To me, it's really about presenting good science," Humble said. "To me, that's the compelling information that we need."
Humble's department has contracted with the University of Arizona to identify research relevant to the requests for expanded coverage. "I'm not aware of very much published literature to support adding those," he said.
Humble said he feels a need to be cautious about adding conditions because he doesn't want patients to forego traditional medical treatment to opt for questionable benefits from marijuana.
And he said Arizona's law doesn't allow the agency to remove a condition once it's listed, so it would be troubling if scientifically reliable information later surfaces that undermines the value of approving medical marijuana for a particular condition.
Brewer last year balked at allowing dispensaries, saying she feared state employees could face federal criminal prosecution. She later acquiesced after a judge ruled the state had no discretion on implementation of the dispensary portion of the law.
The state already had received about 200 dispensary applications through close-of-business Wednesday, and Humble said he expected many more before Friday's deadline.
The Case for Treating PTSD in Veterans With Medical Marijuana
By Martin Mulcahey theatlantic.com
Studies have already shown the benefits of marijuana for those suffering from PTSD, but can our government agencies be convinced?
Researchers are one bureaucratic hurdle away from gaining approval for the first clinical examination on the benefits of marijuana for veterans suffering from post-traumatic stress disorder (PTSD). The Multidisciplinary Association for Psychedelic Studies (MAPS), working under the auspices of the University of Arizona College of Medicine, are preparing a three-month study of combat veterans who served in Iraq and Afghanistan. The plan is contingent upon final approval by a Department of Health and Human Services (HHS) scientific review panel, which is likely to ratify the proposal after the project leader, Dr. Sue Sisley, alleviated the Food and Drug Administration's concerns over safety precautions. Social and political intrigue surrounding this research is far reaching, attracting opposing factions who must cede biases for the greater good and well-being of servicemen and servicewomen.
The University-controlled study Sisley advocates calls for a triple-blind and placebo-controlled environment. A meticulously prepared proposal recommends a sample base of 50 veterans, whose PTSD symptoms have not improved under current standard medical practices. All participants must agree to abstain from marijuana use for 30 days prior to participation. In two ensuing 60-day periods, the veterans are asked to either smoke or vaporize a maximum of 1.8 grams of marijuana a day (the equivalent of two marijuana cigarettes). The test group will be furnished a weekly supply of various strains of marijuana, with THC levels ranging from 0 percent to 12 percent. Sisley's study objectives are twofold. "With this research, we can actually figure out which symptoms it might help with, and what an optimal dosing strategy might look like." She is also mindful of public opinion regarding medical marijuana. "If we get a chance to do this, we're not taking liberties. This is a carefully controlled, rigorous scientific study. We're not sitting around trying to get these vets high."
If anecdotal evidence were the standard, acceptance of marijuana's calming properties among psychologically scarred soldiers would be a topic relegated to the past. Statistical evidence to support that hypothesis could be petitioned from the state of New Mexico, where medical marijuana is legally prescribed for PTSD. The state's number one diagnosis for a medical marijuana license, a noteworthy 27 percent of the total, lists PTSD as the qualifying criteria for issuance. That statistic comes as no surprise to Sisley, but she stresses circumstantial evidence is not enough to sway the wide range of government agencies she deals with. "We really believe science should supersede politics," she said. "This illness needs to be treated in a multidisciplinary way. Drugs like Zoloft and Paxil have proven entirely inadequate."
"If we get a chance to do this, we're not taking liberties. This is a carefully controlled, rigorous scientific study. We're not sitting around trying to get these vets high."
In neighboring Colorado, the state's legislature failed to pass a proposal mirroring New Mexico's. It effectively forbade Colorado's large veteran population from citing PTSD on medical marijuana applications. Brian Vicente, of the Sensible Colorado organization, became an advocate for veterans after the legislative rejection. Vicente has watched the government fight itself over this issue. "The federal government is, in some ways, divided," Vicente said. "Agencies like the Veterans Administration have taken some fairly decent stances of medical marijuana." Quickly, he adds a qualifier: "But, then you have the DEA [Drug Enforcement Administration] and NIDA [the National Institute on Drug Abuse] and organizations like them blocking research that other parts of the government are authorizing. It's another example of the federal government being schizophrenic and flat-out wrong on marijuana as medicine." This is a frustrating scenario Sisley has encountered first-hand. "I can't help but think they simply don't want to move forward," she said. "Maybe they figure if they stall long enough, we'll give up and go away."
As arguments among American government agencies continue, other nations are taking the lead generating medical arguments that advance Sisley's theory. A study at Israel's University of Haifa showed that marijuana administered to rats within 24 hours of suffering psychological trauma effectively blocked the development of post-traumatic stress disorder. Dr. Irit Akirav's study even concludes there is a time-frame that has to be taken into consideration. "There is a critical window of time after trauma, during which synthetic marijuana can help prevent symptoms similar to PTSD in rats," Akirav stated at the time. "It does not erase the experience, but can help prevent the development of PTSD symptoms." In Germany, Switzerland, and Spain there are currently programs, some government funded, utilizing MDMA (from which the "ecstasy" drug is derived) as a possible inhibitor of PTSD symptoms.
A governmental lack of decisiveness has created unintended consequences and casualties in the medical field. One is Dr. Phil Leveque, a World War II veteran who had his medical license revoked based on the large number of medical marijuana permits he issued for PTSD in Oregon. Leveque estimates he signed 1,000 permits for PTSD, and said he did so with a clear conscience. "Whether they were World War II, Korea, Vietnam or vets from the current conflicts, 100 percent of my patients said it was better than any drug they were prescribed for PTSD," he said. Sixteen states and the District of Columbia currently have laws permitting marijuana for medical use. However, Veterans Affairs physicians are expressly prohibited from recommending patients for enrollment in any state's medical marijuana program. This, again, highlights contradictions at different levels of government agencies.
Veterans Affairs data disclosed that from 2002 to 2009 one million troops left active duty in Iraq or Afghanistan and became eligible for VA care. That's a number that will rise annually, revealing a need for effective treatment of PTSD that cannot be overstated. PTSD remains an enormous consideration with combat troops still serving in Afghanistan, where an estimated six to 11 percent are currently suffering symptoms of PTSD. Statistics among Iraq War veterans are more disturbing, with between 12 to 20 percent of returning vets suffering PTSD-related anxieties. Those are government statistics, and some non-governmental studies suggest that as many as one in every five military personnel returning from Iraq and Afghanistan could suffer various forms of PTSD. Veteran Affairs recognizes these facts, and to its credit funds unconventional studies of PTSD, employing therapy dogs and yoga.
Sisley has found an ally in Rick Doblin, executive director of the leading psychedelic studies group. Doblin has the unenviable job of lobbying Congress under the umbrella of the non-profit MAPS. The pair share a common frustration dealing with the multitude of government agencies, some of whose interests are diametrically opposed. Doblin addresses apprehensions from the administrative standpoint: "We're asking for marijuana from an agency [National Institute on Drug Abuse] designed to prevent people from using marijuana. There's something fundamental that just doesn't work here," he said. Sisley's concerns revolve around medical studies in the field, which often fail to gain approval because of political motives instead of science. "The doctors I know think this war on marijuana is awful, and they're tired of being in the middle of it," she said. "They just want to do real research, or read real research, and not operate around all of these agendas."
Veterans endure a framework of care for PTSD that has not changed since 1980, when PTSD was added to American Psychiatric Association's dictionary of maladies. Federal agencies are clearly confused, unable to reconcile the illegality of marijuana with the benefits it could have on the lives of soldiers and their extended families. These issues are not being addressed in an open forum; instead, they remain hidden behind committee doors or special panels of anonymous voices with unknown prejudices. Medical marijuana remains one of the nation's biggest political hot potatoes, and when combined with our veterans' health creates a unique conundrum for politicians. Disturbingly, the people caught in this crossfire of self-interest are veterans who risked their lives for the system that may be stifling their medical options now.