Cannabis legalization must address medical use, not just recreational use

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Legislation to legalize cannabis at the federal level recently proposed by Sen. Chuck Schumer (D-N.Y.) and a group of Senate Democrats is long overdue. While it aims to fix injustices done to communities of color that have been most harmed by the war on drugs, it excludes one very important demographic: patients.

The bill is presented as “comprehensive” cannabis reform. It makes cannabis legal in the United States for recreational use and has many provisions for expanding the cannabis industry. It also adds taxes that provide revenue to the federal government and stipulates that some of the money collected be used to enhance the lives of communities that have been most hurt by the failed war on drugs.

Leaving out patient care overlooks the largest group of people who will or may be affected by this new law.

An estimated 115 million Americans over age 50 will develop one or more illnesses such as osteoarthritis, anxiety, insomnia, or cancer that are treatable with cannabinoid medicines. Not providing for them in the discussion draft underscores that lawmakers are not paying attention to the needs of patients, the ways in which patients differ from recreational users, and the ways in which a recreational paradigm does not support needed clinical care.

My colleagues and I at the Association of Cannabinoid Specialists, a professional organization dedicated to science-driven education for clinicians and lawmakers on the use of cannabinoid medicines, believe that a medical cannabis paradigm should include four key components, which we shared with Schumer and his colleagues.

First, legislation should decouple medical and recreational cannabis. While legalization of recreational cannabis may address the needs of healthy people, it does not address people’s medical needs. People need competent care based on sound science that is aligned with the same fundamental values that apply in all areas of medicine, including respect for patient choices through informed consent, beneficence through sound medical advice that ensures patients benefit while minimizing harm, issuing exact prescriptions to ensure that patients get the right medicine, and justice by ensuring that everyone is treated fairly and all have the same treatment opportunities.

Second, national standards must govern the production and safety of cannabis medications. Packaging must be consistent across the country with ingredient and potency labeling that is accurate and easy to read. Many states have already established their own standards addressing some of these concerns, but these rules vary from state to state. We believe that part of the role of a federal law should be to incorporate the best of these policies into a national standard. This is commonly referred to as harmonizing standards, and my colleagues and I believe it will be welcomed by many state lawmakers and regulators.

To ensure that national standards allow for innovation in the field of cannabinoid medicines, the Association of Cannabinoid Specialists promotes ongoing research and collaborative efforts between the industry, scientists, clinicians, and regulators.

Third, all states — even those without medical cannabis programs — must allow individuals to move freely across state borders with cannabis medications, something they are currently prohibited from doing. Individuals with nationally recognized prescriptions under a new federal law should be free to use their medication and travel with it across jurisdictions and state borders, including by air, within all U.S. states and territories.

Fourth, there needs to be a clear set of rules for properly advertising cannabis products, whether they are sold in recreational or medical markets. Such rules must include a restriction on distributors giving medical advice at the point of sale — only qualified, licensed health professionals should be guiding patients’ care. Sellers must also be required to fill medical cannabis prescriptions as written, without attempts to sell additional or differing products.

Federal rules should also prohibit advertising that is deceptive, false, fraudulent, or creates a misleading impression — whether directly or by omission or ambiguity — or that promotes overconsumption or encourages consumption of higher-potency products.

With so much focus on cannabis as an economic opportunity and a method to correct social injustice, it is easy to forget that cannabis is also a medicine and that support of patients is a social justice issue.

When creating and implementing cannabis legalization, the health and safety of patients who rely on cannabis to treat numerous physical and mental diseases cannot be forgotten. The guidelines we have proposed for federal regulations will ensure that cannabis patients are not forgotten and that they — like any other patients — will have ready access to safe and efficient treatments.

Jordan Tishler is an internal medicine physician, founder of the inhaleMD medical practice in Cambridge, Mass., instructor in medicine at Harvard Medical School, and president of the Association of Cannabinoid Specialists.

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