Thursday, February 17, 2016, was the first evening session of the Ohio House of Representatives’ Medical Marijuana Task Force (“Task Force”), which heard a full complement of testimony, all in support of legalizing medical cannabis. The Task Force, chaired by State Representative, and physician, Dr. Steve Huffman (R-Tipp City) in the absence of Rep. Kirk Schuring (R-Canton), announced it was by mere coincidence that all ten witnesses would offer proponent testimony and that no witnesses had scheduled to come forward against medical cannabis. With three Task Force meetings in the books, it is safe to say that while the lack of opposition testimony is certainly not intentional on the part of the Task Force, it is certainly not a mere coincidence in the face of mounting evidence substantiating the medicinal value of cannabis and its beneficial uses to Ohio patients in need. After carefully scrutinizing over 3.5 hours of testimony, as well as subsequent, individual discussions with Task Force members and witnesses alike, the following represents the most salient points and analysis from the medical testimony offered at the third Task Force meeting.
Two well-respected medical doctors came forward to offer their proponent testimony. Dr. Matt Noyes, M.D., an orthopedic surgeon from northeast Ohio, testified in support of the many medical uses for cannabis in post-operative care. Dr. Noyes attested to the many patients who do not want to take narcotics in recovery from the surgical procedures he regularly performs, as well as the corresponding benefits, and reduced morbidity, of cannabis treatments. Support for this course of treatment comes both from cannabis’s medicinal value in reducing symptoms resulting from acute pain, as well as its anti-tumoral and anti-inflammatory properties. Dr. Noyes called for a robust regulatory scheme beyond what was historically utilized in California, and stated that the major universities and medical institutions Ohio is renowned for should be allowed to excel in the medical research that would surely uncover additional medicinal benefits of herbal cannabis and its chemical compounds. The regulatory questions continued to pile up from the Task Force members as Larry Moliterno (Ohio Alliance of Recovery Providers), Dr. Brian Santin, Jimmy Gould (Responsible Ohio), Matt Lutz (Muskingum County Sheriff), and Lora Miller (Ohio Council of Retail Merchants) all asked Dr. Noyes specific policy questions that the doctor could not fully address. While Dr. Noyes could fully opine on the medicinal value of cannabis, he readily admitted his lack of expertise as to the appropriate regulatory response.
Yet, Dr. Sue Sisley, M.D., an acclaimed Arizona physician practicing for 20 years in internal medicine and psychiatry, possessed the requisite firsthand experience to address the full range of medical and regulatory questions. Dr. Sisley’s comprehensive expert testimony was grounded in her experience as principal investigator for the only FDA-approved controlled trial studying whole-plant inhalation therapy for combat veterans with chronic, treatment resistant Post Traumatic Stress Disorder (“PTSD”). Dr. Sisley is the foremost national expert in medical cannabis, having worked with legislatures in Nevada, Maryland, Arizona, Washington, Hawaii, Utah, Minnesota, New York, Vermont, and Washington D.C. in considering not only the medicinal benefits of cannabis, but the best regulatory solutions serving patients in need.
Dr. Sisley presented voluminous amounts of testimonial and documentary evidence submitted into the Task Force record. Her overwhelming medical expertise in the area, and the persuasiveness of the scientific evidence she provided, allowed the Task Force members to fluidly move the conversation toward Dr. Sisley’s credentialed, personal experience with state regulatory responses to legalized medical cannabis. Dr. Sisley answered one of the Task Force’s most burning questions, by pointing out that Arizona’s success since 2010 in regulating cannabis has limited its use to medicinal purposes and not allowed it to veer into recreational use. Dr. Sisley also pointed out that Arizona’s law was passed by general election through a ballot initiative, which decreases the legislative ability to revise the law, and resulted in challenges such as a lack of laboratory testing requirements. On the other hand, states like Maryland have passed, through their general assemblies, superior laws that have far more robust regulatory schemes including elements such as access to whole-plant materials, self-titration, lab testing, and packaging standards.
The regulatory questions soon dominated the conversation, as Rep. Huffman was particularly interested in how proactive legislation could positively impact further scientific studies. Rep. Huffman himself pointed out the successful trials in Europe and the fact that current research has moved beyond Phase I clinical trials focusing on safety, and into the more advanced Phase II trials focusing more on the range of beneficial uses. Dr. Sisley concurred and detailed how the current federal position is inhibiting the FDA-approved studies and it would be at least three more years before peer-reviewed studies would be published.
Former Ohio Attorney General Betty Montgomery inquired as to the best regulatory approach to cultivation, processing, and distribution, to which Dr. Sisley has intimate, practical knowledge based on the extensive reach of her practice in Arizona. She recommended the vertically integrated licensing system utilized in Arizona which effectively manages, through extensive regulation, over 60 grow-sites, 90 dispensaries, over 500 “caregivers” (who are designated by patients to help assist in the administration of the medical cannabis), and home growing for patients who qualify.
Mr. Gould inquired as to which states have the best and worst medical cannabis laws. Dr. Sisley is uniquely positioned to answer the question due to her involvement in the legislative process of the states in question, responding that Minnesota and Utah have particularly ineffective laws because the regulatory schemes inhibit patient access to cannabis treatment. Therefore, Minnesota only has approximately 1000 patients with access to the medicine, and the black market continues to thrive. Furthermore, Utah patients have virtually no effective means of access and as a result simply cross the border to Colorado to obtain cannabis for medicinal use. What’s more, Utah’s ineffective legislative response continues to keep the state at or near the top of the highest rate of opiate overdoses in the nation.
One of the Task Force members then pressed Dr. Sisley on the large percentage of patients who use medical cannabis for chronic pain, asserting that those patients are abusing the system for recreational purposes. Dr. Sisley acknowledged that while that may be the case in isolated circumstances, just as it is in other treatment modalities, confirmed studies have shown that in the 23 states that allow medicinal cannabis, opiate overdose rates are down 25%. Furthermore, there is not a single documented case of medical or recreational cannabis overdose. As in every intersection between medical care and regulatory oversight, physician integrity must be relied upon as the first defense. Furthermore, in the medical cannabis states which have robust regulatory schemes, there is no evidence that state medical boards and patient advocate groups are not effectively responding to the challenges presented.
Finally, Dr. Santin asked a particularly poignant question of Dr. Sisley (paraphrased here): removing the social stigma of cannabis and its propaganda reflected in the history over the last century, what is your medical opinion as to its proper schedule classification? Dr. Sisley, in step with every physician who has testified before the Task Force (as well as comments made by physician and Task Force member Rep. Huffman), opined that the current classification of cannabis as a Schedule I drug with no medicinal value is “absurd.” Dr. Sisley pointed out that it is the Drug Enforcement Agency (“DEA”) and not doctors who decide that classification. With the medical side-effects so benign, even with the inhalation of plant-based treatments as recognized by the FDA allowance of the current trials administered by Dr. Sisley, and addiction levels no higher than that of caffeine, the current federal schedule is neither supported by hard science nor sound policy.
The proponent medical testimony, yet to be refuted before the Task Force, has now framed the discourse not by how valuable medical cannabis is in treating a whole range of illnesses, but by how best to regulate its use. The perspectives on a robust regulatory scheme that are emerging paint an optimistic picture for those Ohio patients in need. Similarly, the optimism for the emerging markets in support of the industry, and its regulatory framework, are just as well-founded.