Pubdate: Fri, 18 Mar 2016
Source: York Dispatch, The (PA)
Copyright: 2016 York Newspapers, Inc.
Contact:  http://www.yorkdispatch.com/
Details: http://www.mapinc.org/media/1940
Author: Katherine Ranzenberger

DOCTORS STILL WARY OF RISKS OF MEDICAL MARIJUANA

Patients in Pennsylvania who may benefit from medical marijuana are 
one step closer to getting the help they need after the Pennsylvania 
House of Representatives passed a bill Wednesday.

However, medical professionals in York County are still wary of 
taking the leap of prescribing medicinal cannabis to patients without 
knowing the benefits and risks it.

"There is a fair amount of research out there already, but it's 
patchwork studies and studies done overseas," said Dr. D. Scott 
McCracken, a member of the York County Medical Society. "We'd prefer 
to see long-term research before we prescribe it. We want to make 
sure it's used in a safe and effective way."

McCracken compared the research out there to the 1990s and the start 
of opioid prescriptions. Opiates were marketed for chronic pain, he 
said, but the tests out there were based on three-to six-month trials.

Doctors were prescribing opioids such as oxycodone and morphine to 
patients for chronic pain, McCracken said. This has ultimately led to 
the opioid abuse epidemic in Pennsylvania and to heroin abuse, as well.

"If you look at a yearlong trial, there's almost no benefit of opioid 
prescriptions for chronic pain," he said. "We're being more cautious 
this time around. That's the nightmare for marijuana use. We need to 
find the long-term harms and benefits. We're talking five, 10 or 15 
years out. That's the data we're missing."

Ava's story:

Michelle Vermeulen's 4-year-old daughter Ava started suffering from 
epilepsy at 4 weeks old. The York Township family tried multiple 
medications to treat the seizures and found a medication that worked 
for a while.

"Her form of epilepsy does not respond well to medication," Vermeulen 
said. "The biggest side effect of the medications is that it causes 
permanent vision loss, causing a kind of tunnel vision. It's irreversible."

After about six months, though, the seizures came back. Then 
7-month-old Ava had a hemispherectomy, removing the right side of her 
brain. Vermeulen said you'd never know because she's walking and 
talking like other kids.

"The seizures went away for about three years, but they came back 
again," she said. "We went back to medication. She's on Onfi, a 
benzine medication like Valium and Xanax, but she's still having seizures."

Vermeulen has talked with her daughter's doctors about medical 
cannabis to help with her seizures. Vermeulen is a pharmacist and is 
worried about the stress the side effects of the current medication 
can have on her daughter.

"It's hard enough that she's already missing half her brain," she 
said. "We've done surgery. We've done medication. We've done the Keto 
diet," referring to the ketogenic diet, which focuses on high-fat, 
low-carb foods and has helped control seizures in some people.

"We know medical marijuana isn't a miracle drug, but it's hard to 
ignore the success stories," Vermeulen said.

As a pharmacist, Vermeulen said she can understand how doctors can be 
wary of a similar situation to the opioid epidemic. However, she said 
opiates don't treat the underlying condition of people who use them.

"I do agree we need more information and research," she said, "but I 
do know the options we have now are affecting kids' brains."

Jackson's story: Cara Salemme, whose 9-year-old son Jackson has a 
rare form of epilepsy resistant to most drug treatments, has been 
advocating for medical marijuana for years in Pennsylvania. She said 
it is "ludicrous to compare opioids to medical marijuana."

"The addiction factor just isn't there," Salemme said. "Research is 
great. We want research. But we need to get these people something 
that can help their symptoms now."

The North Codorus Township mother said she has thought about moving 
her family to another state, like Colorado, where medical marijuana 
is legal. However, she wants to stay in Pennsylvania to work with her 
son's doctors to get access to the medication that could help more 
than just her son.

"We have resources in Pennsylvania that will help with the research," 
Salemme said. "This would just give those doctors that are out of 
options another one."

Studies: There have been studies in recent news touting the benefits 
of tetrahydrocannabinol, or THC, the active ingredient in marijuana. 
One study published by the Journal of the American Medical 
Association found states with medical cannabis laws had nearly 25 
percent fewer opioid overdoses than states without those laws.

Even emergency room doctors such as Dr. Tom Kehrl said they have seen 
other legal substances like alcohol do more damage than marijuana. 
Kehrl said that on Friday he treated seven patients in a row with 
alcohol-related injuries.

However, he and others are worried about the longer term effects it can have.

"We don't know the dosing or the potential side effects," Kehrl said. 
"We can all recount failed new drugs, procedures and modality. It's a 
tricky balance. We want to be doing the bests for our patients."

Salemme said she expects it to take 18 to 24 months before the 
program is fully up and running. She said there have been similar 
timelines in other states that have legalized medical marijuana.

"Our work isn't done," she said. "If it has to go back to the House 
again, that'll be a problem."
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MAP posted-by: Jay Bergstrom