Arizona official refuses to expand health conditions for medical marijuana

Arizona official refuses to expand health conditions for medical marijuana
East Valley Tribune
updated 7/20/2012 12:46:19 AM ET

State Health Director Will Humble refused Thursday to expand the conditions for which marijuana can be legally recommended.

Humble said there were many "moving stories'' from people who said that their use of marijuana helped them deal with post-traumatic stress disorder, anxiety, depression and migraines. He also said his agency received numerous articles about the effectiveness of marijuana.

But Humble said all that, by itself, was not enough.

"My guiding principle for making the decision was to use science and research to guide when deciding whether to add petitioned conditions,'' he wrote in his findings. And Humble pointed out that he specifically asked the University of Arizona College of Public Health to find that research.
But that, he said, came up lacking.

"In short, I didn't approve the petitions because of the lack of published data regarding the risks and benefits of using cannabis to treat or provide relief for the petitioned conditions,'' Humble said.

The decision was not surprising: Humble's own medical advisory committee recommended earlier this week he do just that.

"Because marijuana has not been subjected to any high quality, scientifically controlled testing for any of the petitioned conditions, we find no convincing evidence that marijuana provides a benefit,'' wrote Dr. Laura Nelson, the agency's chief medical officer.

"We acknowledge there is anecdotal evidence that using marijuana has helped patients,'' Nelson continued. "But there is no way to exclude the possibility that the improvement is due solely to placebo.''

And Nelson worried that allowing patients with any of the four conditions to use marijuana for treatment might actually cause harm.

"Patients may use marijuana to self medicate, and avoid seeking care from a trained medical professional,'' she wrote. "Delaying initiation of appropriate, proven treatments and therapies could result in a worsening of their condition or misdiagnosis of a more serious condition.''

Humble's decision disappointed Suzanne Sisley. She is a physician with the Telemedicine Program at the UA College of Medicine and a specialist in internal medicine and psychiatry.

She said that, despite the lack of formal full-blown scientific studies, she believes marijuana works.
"A large proportion of my medical practice is taking care of combat vets with PTSD and first responders who have PTSD,'' Sisley said.

"All these folks have gone through all the standard conventional meds,'' she said, in hopes for finding something that works.

"Often what these folks find is they cannot achieve enough stability to be able to work and be functional,'' Sisley continued. "And when they've exhausted all the conventional treatment, they end up being forced to buy cannabis on the street illegally.''

Sisley said, though, the decision comes as no real surprise.

She said that Humble, in demanding evidence from scientifically backed peer-reviewed studies, essentially set the requests to expand the medical marijuana program up for rejection. That's because the National Institute for Drug Abuse, which controls the only legal supply of marijuana for medical research has consistently refused to give the go-ahead for the kind of studies Humble said he needs.

The 2010 voter-approved law allows doctors to issue formal recommendations for marijuana use to patients who have a specific set of conditions spelled out in statute. These range from glaucoma and AIDS to chronic or debilitating conditions that lead to severe and chronic pain, severe nausea, seizures, or severe and persistent muscle spasms.

Someone with a doctor's recommendation then can get a card from the Department of Health Services allowing them to obtain up to 2 1/2 ounces of marijuana every two weeks.
But the law also requires the health director to consider adding to that list every year. That led to the requests to add the four specific conditions.

While the statute does not restrict how Humble makes that decision, his agency adopted rules which require consideration of whether marijuana use would provide "a therapeutic or palliative benefit'' to the individual.

But the rules also require those requesting an addition to provide a summary of the evidence not only that the use of marijuana will help but also "articles, published in peer-reviewed scientific journals, reporting the results of research on the effects of marijuana on the medical condition or a treatment of the medical condition supporting why the medical condition should be added.''

Sisley, who helped prepare the request to add PTSD to the list, said that pretty much predetermined the outcome.

"I knew there certainly wasn't data that rose to the level of scientific rigor that he's looking for,'' she said. "He set an unattainable standard because there will not be any randomized trials that look at the efficacy of marijuana.''
That, she said, is because of the ability of NIDA to block research on marijuana, which the federal government classifies as a Schedule 1 drug, meaning there is no medical uses for it.

Sisley said she is proof of that. She said the Food and Drug Administration gave its approval in April 2011 for a study she wants to do but that, without NIDA action, "it's sitting in limbo.''

Humble has acknowledged the lack of those kinds of studies.
But he also pointed out that more than a dozen other states have medical marijuana laws. And he said that health professionals there may be able to do some kinds of studies with marijuana made available through those state laws, getting around the federal restrictions.

Despite his decision, Humble said there may be a loophole of sorts.

He pointed out that the 2010 voter-approved measure has a list of conditions for which marijuana is presumed to be medically effective. Humble said those who suffer from migraines may already qualify under the "chronic pain'' provision in that law.