Senate Bill 1182
On January 15, 2014, PA State Senators Folmer and Leach co-sponsored and introduced legislation to legalize marijuana/cannabis for medical use in Pennsylvania. Senate Bill 1182, or the Governor Raymond Shafer Compassionate Use of Medical Cannabis Act, had its first hearing in the Senate Law and Justice committee on Tuesday, January 28th. You can read my testimony here.
Clearing The Air
There has been some confusion about exactly what SB1182 does. Any claims that Senate Bill 1182 is “CBD-only” are completely unjustified. Here are the facts:
- It does not specify the manner in which cannabis is to be used by the patient. Patients and caregivers with a valid ID are protected from arrest or prosecution when in possession of up to 1oz of cannabis flowers or 3oz of cannabis concentrates (such as oil or hashish). (See definition of “Medical use”, and Sections 8.a.1 and 8.a.3.ii).
- This gives patients and physicians the freedom to determine the best administration method for the patient’s condition. This allows adult patients to smoke or vaporize cannabis flower or concentrates, while the children with Dravet’s syndrome can use “Charlotte’s Web” (a CBD-dominant strain) processed into an oil, with parental permission and written certification by their physician (Section 8.b). This particular oil contains very small amounts of THC, and is not smoked.
- The words “CBD” and “cannabidiol” only appear in their definition. “Tetrahydrocannabinol” only appears in its definition, and where it specifies restrictions on driving (Section 15.a) or for drug testing (Section 6.a.8).
- There are NO restrictions on strain (Section 14.a), and no cannabinoid ratio restrictions.
Other highlights of Senate Bill 1182 include:
- Physicians, Physicians Assistants, Registered Nurse Practitioners, Nurse Midwives, Dentists, Psychiatrists, or a professional with a license to prescribe Schedule III medications can recommend medical marijuana for a patient after performing a full medical assessment of the patient (See definition of “Medical professional” and Section 8.d).
- A medical cannabis ID card (or its equivalent) from another state is considered valid under SB1182 (see the definition of “Medical cannabis identification card”).
- Conditions that can qualify a patient for medical cannabis are many and varied, reaching the vast majority of people who could benefit. Note: the Board can also add new conditions specifically to this list. Conditions that qualify include any of the following (See the definition of “Debilitating medical condition”):
- Cancer or the treatment of cancer.
- Glaucoma or the treatment of glaucoma.
- Post-traumatic stress disorder or the treatment of post-traumatic stress disorder.
- Positive status for human immunodeficiency virus, acquired immune deficiency syndrome or the treatment of either human immunodeficiency virus or acquired immune deficiency syndrome.
- A chronic or attenuating disease or medical condition or its treatment that produces one or more of the following:
- Cachexia or wasting syndrome.
- Severe or chronic pain.
- Severe nausea.
- Seizures, including seizures characteristic of epilepsy.
- Severe and persistent muscle spasms, including spasms characteristic of multiple sclerosis or Crohn’s disease.
- Intractable pain.
- Any other medical condition or its treatment that is recognized by licensed medical authorities attending to a patient as being treatable with cannabis in a manner that is superior to treatment without cannabis.
- Section 22. removes marijuana from Schedule I of the Pennsylvania Controlled Substances Act.
- SB1182 will establish “Commercial medical cannabis farms”, where cannabis is grown (see Section 11); “Compassionate care centers” where cannabis flower and concentrates can be dispensed (see Section 10); and “Commercial medical cannabis manufacturers” which turn cannabis flower into concentrates such as oils and hashish (See Section 12).
- Commercial farms, manufacturers, and compassion centers will all be non-profit (see their definitions).
- Patients would require a cannabis farmer’s license to be able to grow their own. (See Section 11). A commercial medical cannabis farmer who has a valid medical cannabis identification card may retain up to 25% of the annual yield for personal use (Section 11.g). The rest would have to go to a dispensary or a manufacturer of concentrates.
- Patient records, including names of people with medical cannabis ID cards, are CONFIDENTIAL and are NOT subject to the PA “Right-to-know” law. Law enforcement cannot access the data, and may verify that a claim of medical use/a medical use ID card is valid (Section 9.f).
- Patients can not smoke their medicine in public places, but they can vaporize in public places (Sections 15.b and 15.c).
Administration – Board and Bureau
A new “Pennsylvania Medical Cannabis Board” will be created to implement and administrate the program (see its definition and Sections 3.a.1, 5.a, and 5.b). The Board has the authority to make additional regulations to make the program efficient, fair, and workable (See Section 5). The Board will consist of three members appointed by the Governor, and with the advice and consent of two-thirds of all the members of the Senate (Section 5.a.1). Not more than 2 of which can be from the same party as the Governor. The Board will contain an Advisory Council comprised of Secretaries from a number of currently existing PA bureaus (Section 3.b). Side note: There is no Patients Advocate position on this council, but we are working on that.
A new “Bureau of Medical Cannabis Control Enforcement” is created within the Pennsylvania State Police, to enforce the act and regulations (its definition and Section 3.a.2). The Board will have an Investigation Unit (Section 5.d) to implement and monitor compliance with the regulations and law specified in the bill, but will have no powers to actually arrest anyone (see Section 5.d.4) The Bureau will have the authority to arrest people who are in violation of the program or its violations.
A new “Bureau of Consumer Relations” will also be set up to handle complaints and suggestions (Section 3.c). They will set up a state-wide system for investigating all complaints and suggestions and implementing improvements. For more information, please read the entire bill itself.
Schedule I Placement – Unscientific, Non-compassionate, Fraudulent
During their testimony, the PA Medical Society refused to outright endorse the bill. They want “more research,” and urged the Federal government to remove marijuana from its Schedule I placement in the Controlled Substances Act. This is something President Obama can do on his own. He can direct the FDA or HHS to do it. Congress can pass legislation to do it.
The Commonwealth of Pennsylvania also has its own version of the Controlled Substances Act. The PA CSA is just about identical to the Federal version. Both classify marijuana as a Schedule I substance. Placement in Schedule I is dependent on a substance meeting all three of the following criteria:
- a high potential for abuse; AND
- no currently accepted medical use in the United States; AND
- a lack of accepted safety for use under medical supervision
Marijuana does not meet any of these criteria. There is ample evidence of currently accepted medical use in the USA, especially the fact that 21 states plus Washington DC have passed state laws allowing it. The Institute of Medicine’s “Marijuana as Medicine” report in 1999 came to the conclusion that “except for the harms associated with smoking, the adverse effects of marijuana use are within the range of effects tolerated for other medications,” and that “the short-term immunosuppressive effects are not well established but, if they exist, are not likely great enough to preclude a legitimate medical use.” The report concluded:
“Scientific data indicate the potential therapeutic value of cannabinoid drugs, primarily THC, for pain relief, control of nausea and vomiting, and appetite stimulation; smoked marijuana, however, is a crude THC delivery system… …Because of the health risks associated with smoking, smoked marijuana should generally not be recommended for long-term medical use. Nonetheless, for certain patients, such as the terminally ill or those with debilitating symptoms, the long-term risks are not of great concern. Further, despite the legal, social, and health problems associated with smoking marijuana, it is widely used by certain patient groups.”
Center for Medicinal Cannabis Research
California established, as part of their medical marijuana program, a Center for Medicinal Cannabis Research. Since 2000, the CMCR has worked to “…conduct high quality scientific studies intended to ascertain the general medical safety and efficacy of cannabis and cannabis products and examine alternative forms of cannabis administration.” Their February 2010 report examined the results of seven clinical studies published, or submitted for publication. These topics included:
- Cannabis for Treatment of HIV-Related Peripheral Neuropathy
- Vaporization as a Smokeless Cannabis Delivery System
- Short-Term Effects of Cannabis Therapy on Spasticity in MS
- Placebo-controlled, Double Blind Trial of Medicinal Cannabis in Painful HIV
- Analgesic Efficacy of Smoked Cannabis
- Double Blind, Placebo Controlled Trial of Smoked Marijuana on Neuropathic Pain
The CMCR report summarized:
“By design CMCR clinical studies focused on conditions identified by the Institute of Medicine for which cannabis might have potential therapeutic effects, based on current scientific knowledge (Institute of Medicine, 1999). To date, four CMCR-funded studies have demonstrated that cannabis has analgesic effects in pain conditions secondary to injury (e.g. spinal cord injury) or disease (e.g. HIV disease, HIV drug therapy) of the nervous system. This result is particularly important because three of these CMCR studies utilized cannabis as an add-on treatment for patients who were not receiving adequate benefit from a wide range of standard pain-relieving medications. This suggests that cannabis may provide a treatment option for those individuals who do not respond or respond inadequately to currently available therapies. The efficacy of cannabis in treatment-refractory patients also may suggest a novel mechanism of action not fully exploited by current therapies. In addition to nerve pain, CMCR has also supported a study on muscle spasticity in Multiple Sclerosis (MS). Such spasticity can be painful and disabling, and some patients do not benefit optimally from existing treatments. The results of the CMCR study suggest that cannabis reduces MS spasticity, at least in the short term, beyond the benefit available from usual medical care.”
“As a result of this program of systematic research, we now have reasonable evidence that cannabis is a promising treatment in selected pain syndromes caused by injury or diseases of the nervous system, and possibly for painful muscle spasticity due to multiple sclerosis. Obviously more research will be necessary to elucidate the mechanisms of action and the full therapeutic potential of cannabinoid compounds. Meanwhile, the knowledge and new findings from the CMCR provide a strong science-based context in which policy makers and the public can discuss the place of these compounds in medical care.”
Marijuana has ample medical value. It has a low potential for abuse, if any. Its safety is universal and its effects are better tolerated than just about any pharmaceutical out there. By any scientific analysis, marijuana does not belong in Schedule I.
Senate Bill 1182 is a well thought out bill that PhillyNORML fully supports. It protects patients, medical professionals, caregivers, and growers/farmers from arrest or prosecution. It spells out a workable program for cultivation, manufacturing of concentrated forms, and distribution. It gives medical professionals wide berth in the types of conditions for which they can write a patient a recommendation for medical cannabis. It gives physicians, registered nurse practitioners, dentists, physician assistants, nurse midwives, psychiatrists, and other professionals who are licensed under Pennsylvania law to prescribe Schedule III to give written certification that a patient qualifies for medical cannabis. For writing a valid certification for a patient, no medical professional can be fired, fined, arrested, or penalized by the state Medical Board. There are no strain restrictions or cannabinoid ratio requirements. Most importantly, it removes marijuana from Schedule I of the PA CSA.