Pubdate: Fri, 09 Oct 2015
Source: Atlanta Journal-Constitution (GA)
Copyright: 2015 The Atlanta Journal-Constitution
Contact:  http://www.ajc.com/
Details: http://www.mapinc.org/media/28
Author: Steven Morris
Note: Dr. Steven Morris is an Atlanta gastroenterologist.

OPED: CANNABIS LAW AN IMPORTANT FIRST STEP

Cannabis Law an Important First Step

I am a clinical gastroenterologist, practicing at Emory Midtown 
Hospital for 35 years. I am the managing member of Atlanta 
Gastroenterology Associates. We practice throughout the greater 
Atlanta area and Athens and have about 82 physicians, 30 PAs and 
nurse practitioners and 550 employees. We treat a large number of 
patients with Crohn's disease, and the work of the medical cannabis 
commission is of great importance to me and my colleagues.

There are two issues I would like to address today: Crohn's Disease 
and the role of medical cannabis as a therapeutic agent in the care 
of these patients; and the use and regulation of medical cannabis in Georgia.

Crohn's disease is a chronic illness. It affects children, 
adolescents and adults and is characterized by inflammation of the 
small and large intestine. There is no cure; it is managed by medical 
therapy and surgery when necessary. Our goal is to have patients lead 
normal lives, and that is most often the case.

Newer medications called biologics have helped us control symptoms in 
a large number of patients and improved the quality of life in many 
others. However, there are patients who have had multiple surgeries 
and failed many different medical regimens. They suffer from chronic 
pain, weight loss and an inability to eat. The pain can result in 
dependency, and even addiction, to pain-relieving medication. The 
weight loss makes these patients, who are often on medication that 
lowers their immune system, more susceptible to life-threatening infections.

Can medical cannabis help these patients? Though cannabis has benefit 
in cell lines and in vitro studies in mitigating inflammation, there 
has been no substantive medical research or controlled clinical 
trials demonstrating the ability to treat Crohn's disease and induce 
remission or prevent relapse. Further research clearly needs to be 
done in this area.

However, we know from extensive work with cancer patients that 
medical cannabis has great benefit in reducing pain, increasing 
appetite and reducing nausea. These benefits will be of great help 
caring for those with Crohn's disease who have failed medical 
therapy. If we can prevent pain medication dependency and addiction, 
we can significantly help a subset of Crohn's patients. Improving 
appetite and weight may also be beneficial in allowing other 
medicines to work and have synergistic effects.

Oregon and Colorado have passed legislation allowing both medicinal 
and recreational use of marijuana. In Bend, Ore., which has 
approximately 80,000 people, there are 19 dispensaries; in Portland, 
the number is rising into the hundreds. In Denver alone, there are 
400 dispensaries (compared with 200 Starbucks) to serve the population.

The other end of the spectrum is Minnesota, with a population of 5.5 
million people, which just enacted a very restrictive medical 
marijuana law. The legislation authorized nine medical conditions to 
be treated and allowed for two manufacturers and eight distribution 
centers. Physicians must certify a patient has one of the allowed 
conditions and, after approval by the Minnesota Department of Health, 
the patient can get the medication at one of the dispensaries.

However, Minnesota has run into problems with what I would call "docs 
in a box" for marijuana: Companies like marijuanadoctors.com have 
entered the state. They set up clinics where patients can be seen by 
a physician for a consultation fee of $250 and be certified the same 
day to receive medical marijuana. They even advertise that no medical 
records are necessary.

These clinics mark patients anxious or trying to skirt the law as 
easy prey. Already, Minnesota has had to suspend several of these ventures.

I believe the intent in Georgia is to have a highly compassionate but 
regulated structure that will allow patients who are truly candidates 
for medical cannabis to obtain it.

It should allow and encourage doctors who believe their patients 
would benefit to write the prescriptions and certify their patients. 
I think it is critical the primary or treating doctor - whether 
internist, family practitioner, pediatrician or specialist such as a 
neurologist, oncologist or gastroenterologist - be the one that 
initiates the certification and continues to care for the patient.

It certainly may require some education among physicians, but all new 
therapy does.

The medical cannabis law is an important step for patients, and it 
must be applied within the framework of the medical system. This will 
allow patients to be better cared for, and for observational and 
clinical studies that will better guide us as to future use and 
efficacy. If physicians come to believe the law is being used to turn 
quick profits without regard to patient well-being, it will taint the 
therapy and never allow it to take its place as a potentially 
important therapeutic tool.
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MAP posted-by: Jay Bergstrom