Doctors testifying about the opioid epidemic on Capitol Hill on Tuesday made clear that marijuana has medical potential as an alternative pain treatment option and that federal prohibition is inhibiting cannabis research.
The Senate Health, Education, Labor and Pensions Committee held a hearing to discuss how to manage the nation’s opioid crisis, and medical marijuana was a point of particular interest raised by several lawmakers.
Sen. Lamar Alexander (R-TN), who chairs the panel, asked Dr. Andrew Coop of the Maryland School of Pharmacy what he considered “the most promising, non-addictive painkiller treatments or medicines that are coming down the road.”
“The drugs that are coming—I mentioned cannabinoids,” Coop said. “I know that’s a controversial topic, but this is great—”
The senator cut in to ask why it was controversial and Coop said it was because cannabis remains federally illegal. He clarified for Alexander that he was referring to “medical marijuana” when he brought up cannabinoids.
“Medical marijuana, yes,” Coop said. “I think that has great potential.”
Sen. Mitt Romney (R-UT) later said that while he didn’t have time during his allotted five minutes to ask about marijuana, he wanted Coop to “instruct us as to the path forward on cannabis research.”
The next senator to bring up cannabis was Sen. Jacky Rosen (D-NV). She said her state’s medical marijuana program “has reduced the prescriptions for high-potency painkillers” and asked Coop whether cannabis could serve as “a non-addictive approach or alternative to chronic pain—just another tool in the toolbox.”
“I, first of all, think it has great potential to be another tool in the toolbox,” he said. However, “I don’t think there’s ever going to be a one-size-fits-all magic bullet because pain is different in different people.”
“In terms of how to move the research forward in medical marijuana, one of the issues has been because of the usual legal status in the United States, research has been limited,” he said. “There’s no consistency between the different types of marijuana, the studies done. We need good, consistent, well-designed clinical studies with good, consistent material so that we can fully assess the impact, and don’t get me wrong, also the potential drawbacks.”
David Mangone, director of government affairs for the advocacy group Americans for Safe Access, said in a press release that it was “great to see witnesses and senators alike discuss the potential of medical cannabis as a tool in combating the opioid crisis,” but that “we need real action from from our lawmakers to change federal laws.”
Sen. Doug Jones (D-AL) was the last to raise marijuana at the hearing. He emphasized that while lawmakers sometimes approach their questioning in hearings with an agenda in mind, “this is not one of those” situations. He wanted to hear from the three other witnesses who hadn’t testified on the topic.
Cindy Steinberg, national director of policy and advocate at the U.S. Pain Foundation, said “cannabis has helped a number of people living with pain” and that it’s “another option” in the toolbox for pain patients. She stressed that marijuana’s legal status make it hard to standardize cannabis treatment.
“Doctors need to be the one prescribing it, but they don’t know what they’re doing with it,” she said. “They’re not trained with it either. Without having a really good research base, we’re just flying blind.”
So what’s preventing that research, Jones asked?
“The fact that it’s not legal,” Steinberg said.
While Mayo Clinic physician Halena Gazelka said she wasn’t convinced that cannabis isn’t addictive, she agreed that “the impediment has been that it’s a Schedule I substance and it’s not permissibly prescribed by providers.”
“But I do think that there may be some significant areas where this may be very useful,” she said. “I have some palliative medicine patients using it for nausea, appetite, pain, and I think it can be helpful.”
Finally, Anuradha Rao-Patel, a physician representing the health insurance company Blue Cross Blue Shield of North Carolina, said “the limitations such as the fact that it is illegal in some states as well as on a federal level makes research [on marijuana] difficult.”
“From a physician’s standpoint, I think there is some potential to the utility of medical marijuana for the treatment of chronic pain,” she said. “I’ll say, putting on my other hat as an insurer, that we obviously only cover procedures and drugs that are [Food and Drug Administration]-approved, so we would obviously need some clinical evidence and support to be able to cover these kinds of medications.”
Don Murphy, director of federal policies at the Marijuana Policy Project, told Marijuana Moment that the “questions from senators proved there is a need for a hearing devoted exclusively to cannabis as an alternative to opioids.”
“Of course, such a hearing may expose a truth some of them don’t want to hear,” he said.
Photo courtesy of Philip Steffan.
California Governor Signs Marijuana Tax Fairness Bill But Vetoes Cannabis In Hospitals
California Gov. Gavin Newsom (D) announced on Saturday that he signed several marijuana-related bills into law—including one that will let legal businesses take advantage of more tax deductions—but also vetoed another measure that would have allowed some patients to use medical cannabis in health care facilities.
Under a section of current federal law known as 280E, marijuana growers, processors and sellers are unable to deduct expenses from their taxes that businesses in any other sector would be able to write off. Until now, California policy simply mirrored the federal approach.
(Marijuana Moment’s editor provides some content to Forbes via a temporary exclusive publishing license arrangement.)
Photo courtesy of Carlos Gracia.
Former FDA Head Floats Federal Marijuana Regulation ‘Compromise’ To Address Vaping Issue
Former Food and Drug Administration (FDA) Commissioner Scott Gottlieb seems to propose changing the scheduling status of marijuana under federal law as a “compromise” to provide limited regulations and promote research.
In an op-ed published in The Wall Street Journal on Friday, Gottlieb said the recent spike in vaping-related lung injuries involving contaminated THC cartridges demonstrates the need for federal regulations.
While he expressed frustration over the “federal government’s decade-long refusal to challenge state laws legalizing pot,” he also recognized that enforcing prohibition in legal states isn’t politically practical and floated a “feasible compromise” that would “require Congress to take marijuana out of the existing paradigm for drug scheduling, especially if Congress wants to allow carefully regulated access for uses that fall outside FDA-approved drug indications.”
That language leaves room for interpretation, but he goes on to say that the “ship has probably sailed on legalization for recreational use” and that “regulation of the potency of THC compounds, the forms they take, how they’re manufactured, and who can make purchases ought to be possible.”
Gottlieb stopped short of explicitly backing descheduling, which would represent a formal end to federal prohibition. Still, his recommendation that the government control aspects of legal marijuana markets like THC potency is a more concrete position than he’s taken in recent weeks, where he’s repeatedly bemoaned the lack of regulations and the gap between state and federal cannabis laws as contributing to vaping issues without endorsing a specific policy to correct it.
It’s clear in the editorial that the former commissioner feels Congress has missed its opportunity to prevent the proliferation of state-legal cannabis programs. And he criticized the Obama administration for issuing guidance that offered states some assurances that the Justice Department wouldn’t interfere in their markets, as well as congressional riders barring the department from using its funds to enforce prohibition against medical cannabis patients and providers following state laws.
My Op Ed in today’s @WSJopinion – The tragic vape injuries involving THC demand that we consider a federal reckoning when it comes to the dangerous conflict between state and federal pot laws that leave federal regulators on sidelines https://t.co/HGptTfx8Db
— Scott Gottlieb, MD (@ScottGottliebMD) October 11, 2019
“The result is an impasse,” he wrote. “Federal agencies exert little oversight, and regulation is left to a patchwork of inadequate state agencies. The weak state bodies sanction the adoption of unsafe practices such as vaping concentrates, while allowing an illegal market in cannabis to flourish.”
One area where FDA might be able to exercise its regulatory authority in this grey space would involve oversight of vaping hardware. Because the agency is able to regulate the “components and parts” of vapes for tobacco use—and because companies generally market those products as being intended for the use of vaporizing herbs and concentrates generally—it could be argued that FDA has jurisdiction over regulating the devices. However, that would still prove challenging “without clear laws and firm political support,” Gottlieb said.
My Op Ed in @WSJopinion – The conflict between federal and state law when it comes to marijuana has created a dangerous gap in oversight. It's about time we consider a new federal paradigm when it comes to regulation of cannabis and its active ingredients https://t.co/QifVa5Dbfq
— Scott Gottlieb, MD (@ScottGottliebMD) October 13, 2019
“THC is currently illegal under federal law,” he said. “Right now there’s no middle ground allowing federal agencies to scrutinize these compounds for their manufacturing, marketing and safety.”
Again, it’s not exactly clear what kind of federal regulation Gottlieb is proposing to Congress. He spends part of his op-ed noting the difficulties scientists face in obtaining high quality cannabis for research purposes—an issue that policymakers have indicated rescheduling could resolve—but he also said the government should ensure that any reform move is “backed up with oversight and vigorous enforcement to keep a black market from continuing to flourish and causing these lung injuries.”
That’s led some to assume he’s talking about descheduling and providing for broad regulations, as regulating the market is largely viewed as a primary means of disrupting the illicit market and enforcing safety standards for marijuana products. But the continued ambiguity of his position raises questions about whether he’s actually proposing Congress should go that far.
“The protracted hand-wringing over federal cannabis policy must stop,” he said. “The tragic spate of fatalities related to vaping of pot concentrates means the time has come for Congress and the White House to stop blowing smoke and clear the air.”
Mexican Senate Committees Will Introduce Marijuana Legalization Bill Next Week
Mexican Senate committees will introduce an updated proposal to legalize marijuana for adult use within days.
During a meeting on Thursday, members of the Health, Justice, Public Security and Legislative Studies Committees announced that they would remain in permanent session as they go through various legalization bills that lawmakers have already filed and present a comprehensive new piece of legislation on Thursday.
Sen. Miguel Ángel Navarro Quintero of the ruling MORENA party, who is a cosponsor of one existing reform bill, said the development “is a positive step to regulate—it is definitely a positive step,” according to TV Aztecha.
The primary focus of the committees will be on legislation introduced by Interior Secretary Olga Sánchez Cordero last year, senators said. However, there are about a dozen other legalization bills on the table, including one to have the federal government control the marijuana market, and they said provisions of each proposal would be taken into consideration.
The panels will also look at public input and expert testimony—including a panel led by a former White House drug czar—that were gathered as part of a weeks-long series of cannabis events that the Senate organized.
“It is a backbone that we are taking into account,” Sen. Julio Menchaca of the MORENA party said of Sánchez Cordero’s bill, which the cabinet member filed while previously serving as a senator, adding that “each of the initiatives that different senators have presented are also very important.”
Quintero said “if we are committing an open parliament, all opinions must be taken into account, because if not, we would be simulating a process.”
If the committees are successful in advancing the legislation, that would put the chamber one key step closer to meeting a deadline imposed by the Supreme Court last year. After ruling that the country’s ban on possession and cultivation of cannabis by adults is unconstitutional, it gave lawmakers until the end of October to change federal drug policy.
The leader of the MORENA party in the Senate, Sen. Ricardo Monreal, said earlier this month that the chamber was on track to vote on a legalization bill ahead of that deadline.
Separately, the chairman of the Senate’s Agriculture Committee, Sen. José Narro Céspedes, said on Thursday that legalization will be an economic boon for farmers and must be implemented in a way that disrupts the illicit market.
Photo courtesy of Mike Latimer.