JOINT FAVORABLE REPORT
AN ACT CONCERNING THE PALLIATIVE USE OF MARIJUANA.
Joint Favorable Substitute
SPONSORS OF BILL:
American Civil Liberties Union (ACLU)
REASONS FOR BILL:
Presently, Connecticut residents with debilitating medical conditions are not allowed to use marijuana for the purposes of relieving painful and often unbearable symptoms.
SUBSTITUTE LANGUAGE: Technical language changes.
RESPONSE FROM ADMINISTRATION/AGENCY:
Representative Penny Bacchiochi, 52nd District: Supports this bill. To be effective, a medical marijuana bill must remove criminal penalties for patients who use, possess and grow marijuana with their doctor's approval. Removing criminal sanctions is at the core of all effective medical marijuana legislation.
This legislation clearly outlines the responsibilities of the doctor, qualifying patient and primary caregiver regarding marijuana usage and the state's administrative expectations. The bill also clarifies issues for law enforcement officials. The bill clearly outlines that either a person meets the criteria for a medical marijuana usage or they do not.
I have personally witnessed the devastating effects of terminal disease and the wasting away of life. I can testify to you medical marijuana works. It works for some people who have tried every other drug without success. It works for people who have tried Marinol without success. Medical marijuana can give quality of life to those who have lost it. And as a state government, if we cannot offer these people protection from prosecution, I ask you, who will?
Representative Toni Boucher, 43rd District: Opposes this bill. I became increasing convinced that the argument that smoked marijuana is medically necessary is untrue. In Connecticut alone, Yale and Connecticut Medical Societies have determined that smoke marijuana causes damage to the brain, heart, immune system, and lungs, as well as impairing learning and memory, perception and judgment. It also contains cancer causing compounds. Marijuana is also linked to a high percentage of automobile crashes and workplace accidents. Other studies link marijuana use with the loss of motor skills, increased heart rate, and impairing the ability of the body's T-cells to fight off infections. Marijuana now surpasses heroin and cocaine as a reason for emergency room visits. In addition, the drug treatments centers of Connecticut site that 60% of their admission are now for marijuana addiction.
Passing bills that encourage a smoked filled lung from whatever the source: tobacco, pollution or a smoked drug such as marijuana is not safe and makes no sense.
NATURE AND SOURCES OF SUPPORT:
Sally Joughin, Barbara Fair, Bill Barrett, Mary Johnson, Anne Higgins, Audrey Richards, Allan Brison, Paul Cabral, People against Injustice: This bill protects very sick people who were not sufficiently helped by other drugs when medical marijuana can relieve their suffering. We also recognize the use of Marinol as an alternative; however, there are many who get better results from smoking marijuana, particularly those who have difficulty with ingesting food and other drugs.
Dawn Fuller-Ball, President, A Better Way Foundation: This bill does two important things: 1) offers some protection for patients and caregivers especially those who reside in urban areas of CT; and (2) it enables a judge to distinguish between a recreational user and a patient/caregiver in court.
Gabriel Sayegh, Director, State Organizing and Policy Project, Drug Policy Alliance: This bill provides the necessary protections for both patients and doctors in Connecticut.
The medical research regarding the efficacy of cannabis for medical use is firmly established in studies and organizations throughout the world, including the Institute of Medicine (IOM). A 1999 report by the IOM, conducted at the request of the White House Office of National Drug Control Policy, included the following: “The accumulated data indicate a potential therapeutic value of cannabinoid drugs, particularly for symptoms such as pain relief, control of nausea and vomiting, and appetite stimulation.” The IOM followed by recommending that Congress authorize single patient trials whereupon subjects could legally use inhaled cannabis medicinally in a controlled setting. Unfortunately, this hasn't happened yet because ideology and rhetoric continue to trump sound science.
In the United States, eleven states now allow patients to use doctor-recommended cannabis. The laws generally protect patients, their caregivers, and their doctors from state-level prosecution, which is critical because 99% of all marijuana prosecutions are on the state level. Similar legislation is now being considered in six states.
Lorraine Jalbert, R.N., Connecticut Nurses' Association: We support this bill for the following reasons:
1) Marijuana/cannabis has a wide margin of safety for use under prescribed supervision, and it is effective for numerous conditions and cannot cause lethal reactions.
2) Marijuana/cannabis seems to work differently from many conventional medications, making it a viable option for persons resistant to conventional medications.
3) Many desperate patients and families risk breaking the law to gain access to marijuana/cannabis for therapeutic use.
4) Sister organizations with the American Nurses Association (ANA) have taken positions in support of access to marijuana/cannabis for therapeutic use.
5) In 1996, ANA's Congress on Nursing Practice supported the education of registered professional nurses regarding current, evidence-based therapeutic uses of cannabis and the investigation of the therapeutic efficacy of cannabis in controlled trials.
6) Nurses have an ethical obligation to be advocates for access to healthcare for all.
Robert L. Painter, M.D.: This bill is a thoughtful bill that workably frames the palliative use of marijuana as a medical issue and allows Connecticut to join other states in adding this treatment modality to our ability to relieve suffering.
I recognize that bills like this one raise many concerns. Drug use and our war against drugs are serious problems. Marijuana is thought to be a gateway drug for serious drug abusers; however, only about 2% of marijuana users subsequently become addicted to hard drugs. Not one single death has ever been recorded due to marijuana.
I do not like drug use or drug abuse. As a surgeon, I have been confronted with a myriad of problems that included confusing symptoms, the chance for a missed diagnosis, and the risk of succumbing to AIDS through the slip of a needle or knife, but in doing my job I hope to have available for my patients a range of therapeutic tools, including medical marijuana, which strikes me as more of an opportunity than something to be feared.
Let me summarize: Some diseases and afflictions, particularly those associated with nausea, vomiting, and resultant weight loss are particularly suited to marijuana's ability to relieve symptoms and its low toxicity. Marinol, an FDA approved oral medication containing the active ingredient (THC) in marijuana, is an alternative, but is often slowly absorbed and slow to take effect, may produce excess psychotropic effects, and, of course, cannot be used by people who cannot eat. For those who are able to take it and have good results, it is another option. However, it is expensive and has a fixed dose. Marijuana smokers can more reliably achieve the minimum effective dose and stop before other side effects kick in. The deleterious effects of smoking any substance have less meaning for these patients, many of whom are suffering from life-ending conditions. Studies in California show no increase in the adolescent use of marijuana or increase in drug use by the general public in places that allow marijuana for palliative purposes.
Paul Armentano, Senior Policy Analyst, National Organization for the Reform of Marijuana Laws: This bill seeks to shield qualified patients who use cannabis therapeutically with a doctor's recommendation from criminal prosecution.
I have examined the science surrounding the medicinal use of cannabis and cannabinoids since 1995, publishing more than 100 articles and papers, and have worked as a consultant for London's biotechnology firm GW Pharmaceuticals – the only legally licensed firm in the world to cultivate medical cannabis and perform clinical trials on various preparations of oral spray cannabis extracts, also known as Sativex, which is available in Canada, Spain and the United Kingdom.
Modern research suggests that cannabis is a valuable aid in the treatment of a wide range of clinical indications. A recent article published in the Journal of Ethnopharamacology studied 70 controlled clinical trials concerning the medical safety and efficacy of cannabinoids as therapeutic agents. The results of the trials indicated that cannabis and its consultants possess therapeutic utility as antiemetics, appetite stimulants in debilitating diseases and as analgesic agents. Other studies show that cannabis provides symptomatic relief for multiple sclerosis, spinal cord injuries, Tourette's syndrome, epilepsy, and glaucoma, among other serious diseases. Most recently, the first US-sponsored clinical trial assessing the efficacy of inhaled cannabis in nearly two decades reported that cannabis significantly reduces HIA-associated neuropathy, a painful nerve condition that often goes untreated by available analgesics.
Many in the scientific and health community endorse legal access to the use of cannabis as medicine, including the American Public Health Association, the American Nurses Association and the AIDS Action Council. According to the Journal of Addictive Diseases, nearly half of all doctors with an opinion on the subject support legalizing cannabis as a medicine. A recent poll in Connecticut reported that 83% of respondents favor the use of marijuana with a doctor's permission.
In 1999, the U.S. Institute of Medicine noted the benefits of medical marijuana and recommended to Congress that they authorize single patient clinical trials and noted that the FDA-approved synthetic oral THC drug Dronabinol (Marinol) had “poor bioavailability,” slow onset, and adverse effects such as “anxiety, depersonalization, dizziness, euphoria, dysphoria, [and] somnolence”. Also noted was the preference of natural cannabinoids or inhaled cannabis over Marinol because they are fast-acting (allowing the consumer to self-titrate the dose), less dsyphoric, and, in general, provide greater therapeutic relief than synthetic THC.
The 2002, the Canadian Senate's Special Committee on Illegal Drugs advised Parliament to revise federal regulations to allow any “person affected by one of the following [medical conditions]: wasting syndrome; chemotherapy treatment; fibromyalgia; epilepsy; multiple sclerosis; accident-induced chronic pain; and some physical conditions including migraines and chronic headaches…” access to cannabis.
Eleven states now have laws protecting authorized medical cannabis patients from state prosecution. A federal General Accounting Office (GAO) report examining the implementation of statewide medical cannabis laws noted that law enforcement in states with protective laws for cannabis patients “…had not greatly affected their law enforcement activities.”
Roger C. Vann, Executive Director, ACLU of Connecticut: The bill is narrowly and specifically drawn. It provides immunity from criminal liability under state law to patients with terminal or certain debilitating illnesses that, with the consent of a treating physician, have small amounts of marijuana in their possession. The bill also protects from liability physicians who advise their patients of the benefits and risks of medical marijuana use.
The following shared personal stories regarding benefits of medical marijuana:
Mary L. Sanders
Ellison Banks Findly
Joseph M. Spreng
Timothy Black, Ph.D.
NATURE AND SOURCES OF OPPOSITION:
Joyce Nalepka, President, Drug-Free Kids: American's Challenge: Passing this bill would present the message to Connecticut's children that “marijuana must be good for you!” It is tragic that many of our nation's citizens are being misled by groups like the Drug Policy Alliance (DPA), the Marijuana Policy Project (MPP), and the National Organization for the Reform of Marijuana Laws (NORML) to believe the biggest “medical lie” since Laetrille.
There have been many drugs publicized as treatments or cures for painful medical afflictions, including Laetrille, which was later determined to be nothing more than ground apricot pits, and Talldomide, which was found to cause serious birth defects. Because of these medications, and many others, the Food and Drug Administration (FDA) has been designated as the only United States agency that can approve medications. The FDA approves only medications that are safe and effective and marijuana is neither. To date, the FDA has not approved smoking marijuana for any condition or disease indication.
The Institute of Medicine and the National Institute of Health has declared that smoking marijuana is largely ineffective as a treatment for glaucoma. There are six classes of approved drugs and multiple surgical techniques available to treat glaucoma that effectively slows its progression and there are 18 layers of better medication to treat cancer.
Today, more young people are in treatment for marijuana than for all other drugs, including alcohol, and that 13 major mental health agencies recently produced a ½ page ad that linked marijuana usage to depression, increased thoughts of suicide and increased risk for schizophrenia later in life.
Mary S. Gillespie, R.N.: This bill is being promoted by a few very well-financed groups dedicated to the legalization of illicit drugs. Taking time to research this issue will demonstrate that the people and groups behind such efforts are nefariously using ill and suffering people for their own devious ends.
As a former school nurse and youth drug prevention activist, I am well aware of the harm done to vulnerable youth by the disingenuous efforts of these groups to promote smoked marijuana cigarettes as medicine, which conveys to naïve youth, especially those attracted to the idea of using illicit drugs, that it couldn't be harmful.
Jeanette McDougal, MM, CCDP, Director, National Alliance for Health and Safety: Legalizing “medical” marijuana would bypass the FDA process for approving medicine. We have many concerns, including what warnings the “medical marijuana cigarette” would contain and whether it would note the 4,000 chemicals contained therein. We also have many questions regarding the legislation, including concerns regarding age restriction, use by school-aged students on school grounds or would the students (much like in California) be forced to retreat off campus and therefore return under the influence, second-hand smoke, operation of motor vehicles after having smoked, and more.
Children believe that what is “medical and legal” is “healthy and good.” Could “medical pot” soften children's attitudes toward recreational marijuana? The known and potential hazards are too great. The Citizens of Connecticut want safe and effective medicines, not toxic, tar-laden snake oil remedies.
David G. Evans, Esq., Executive Director, Drug Free Schools Coalition: This bill lacks a scientific basis. Section 1(1) of the bill lists many conditions that “medical” marijuana could be used for; however, there is no scientific research regarding marijuana and its effectiveness, risks, benefits, interactions with other drugs, and impact on pre-existing conditions for all these conditions. There have been no studies regarding the quantity of dose and frequency of administration for marijuana for all the medical conditions in the bill and these studies are necessary before a drug can be used as medicine.
Last year the FDA declared that marijuana has a high potential for abuse and has a lack of accepted safety for use. There is sound evidence that smoked marijuana is harmful and there are no sound scientific studies supporting the safety or efficacy of marijuana for medical use.
Section 2(3) of the bill permits the qualifying patient to have four marijuana plants. Four plants can produce up to 9,080 joints. This will lead to abuse and more kids having access to marijuana.
Marijuana is intoxicating, but it does not mean that patients are getting any better. In fact, marijuana may be harmful and may cause the worsening of a condition. To permit this is not compassionate; it is absolutely useless and may conversely harm unsuspecting ill people.
Arthur T. Dean, Major General, U.S. Army, Retired, Chairman and CEO, Community Anti-Drug Coalitions of America (CADCA): Marijuana is illegal and sends the wrong message to America's youth.
Efforts to promote the myth of “medical” marijuana severely dilute the prevention efforts of community anti-drug coalitions across America, which seek to communicate that marijuana is dangerous and can have serious consequences.
Studies have shown that the decline in the use of any illegal drug is directly related to its perception of harm or risk by the user and advertising marijuana as medicine sends the wrong message to America's youth – that marijuana is not dangerous. It is notable that the states with “medical” marijuana provisions have some of the highest addiction rates in the country and rank among the lowest in terms of perception of risk associated with smoking marijuana once a month.
The IOM has not condoned the use of smoking marijuana as a medicine and while the CADCA does not wish to prolong the pain and suffering from those with long-term illnesses, there are a number of other safe and effective medicines that are available for all of the conditions that smoke marijuana purports to alleviate, including Marinol, and has found no sound scientific studies to support medical use of marijuana for treatment in the United States and noted that measures that have passed in other states are inconsistent with the stringent scientific testing that is necessary before medicines are proven safe and effective.
Mark Stanford, Ph.D., Director, Addiction Medicine and Therapy for the Santa Clara County Department of Alcohol and Drug Services: This bill is extremely unwise and dangerous to suggest that an individual smoke or ingest crude marijuana to obtain possible medical benefit.
The American Medical Association takes a firm stance that marijuana should not be used medically and, l though there are some specific chemicals within the marijuana plant that may have some potential therapeutic value (called cannabinoids), the whole plant does not and ingesting the whole plant could create a host of clinical and safety concerns.
Over the last 35 years the potency of the marijuana has increased from .5% THC (the most psychoactive cannabinoid in the plant) in the 1960's to varieties today with a THC potency in excess of 30%, which has increased episodes of psychiatric emergencies. Further, ingesting marijuana in the form of brownies is associated with increased heart rate, nausea, vomiting, loss of consciousness, and anxiety.
A marijuana cigarette contains 483 compounds, which increases to 2,000 when smoked, some of which are carcinogenic, and these compounds affect each person differently and can be magnified by other drugs, fatigue and stress. There is no way to determine the appropriate dose for medical purposes and the potency differs between each plant (hybrid or otherwise) and the grower.
Another concern is absorbency and the time in which the compounds remain in the system. THC is fat soluble and is retained in the body for a much longer time period than water soluble compounds. That being the case, after one or two days of self-dosing, there is no way to tell how much marijuana remains in the body, thereby creating increased potentiality to interact adversely with other drugs.
Roger D. Morgan, Californians for Drug-Free Schools: Illegal drugs cannot be legalized for any reason without jeopardizing the safety and well being of all Americans.
The FDA has not approved marijuana for medical purposes and it does not heal. It provides relief from symptoms, but there are other medicines that are better and don't have the harmful effects of marijuana. Legalizing marijuana will increase its use because of availability, decreased perception of harm, and lower prices, as has been the case with alcohol. It will also increase crime rates for juveniles and adults, increase levels of youth suicides and violence, cause more traffic accidents, increase health care costs to the public sector, increase medical health costs, adversely effect unborn babies, lower productivity by those who smoke marijuana, and cause many other deleterious effects.
Diane Grace: I oppose this bill as a parent and program director of a mentor program for teens. This bill will erode the passion and capability for schoolwork and attention among our youth. It will also contribute to poor decision making by today's teens who feel marijuana is harmless. By passing this bill, there is a distinct possibility of marijuana falling into the wrong hands as a high priced commodity in an industry that is already out of control, and send the wrong message to our youth that smoking marijuana has medical benefits.
Calvina L. Fay, Executive Director, Save Our Society From Drugs: Marijuana is a toxic weed that has been rejected as medicine by most major health organizations, including the FDA. Modern medicine relies on proven scientific research to ensure safety before a drug is made available to the public.
Smoking marijuana is unhealthy and dangerous for several reasons, including the difficulty in administering safe and regulated doses. It's classified as a Schedule I drug, which indicates it has a high potential for abuse, and it is linked to serious respiratory problems such as emphysema and lung cancer. Smoking marijuana combines the worst elements and long-term impact of smoking tobacco, plus mind altering components and impaired judgment.
There is no controversy about the use of purified chemicals in marijuana to treat any illness; however, marijuana cigarettes are not medicine. Marijuana is harmful, addictive and potentially deadly. The false portrayal of smoking marijuana as medicine, coupled with its decriminalization, has contributed to increased use of this and other drugs by young people. If children perceive marijuana as harmless, or worse, helpful medicine, they won't think twice before experimenting.
Stephen A. Wyatt, D.O., Connecticut Chapter ASAM; President, American Osteopathic Academy of Addiction Medicine; Director of Duel Diagnosis Program, Middlesex Hospital: The Connecticut Chapter of the American Society of Addition Medicine (ASAM) opposes this bill in accordance with National ASAM policy in that no critical research has been performed establishing the efficacy or safety of marijuana.
There are other acceptable medications, including Marinol, a marijuana derivative, that can provide relief from painful symptoms. Marinol has the added benefit of having gone through the necessary testing, established efficacy, side effect profile, and accurate dosing regimen. Marinol also lacks the component in marijuana that affects the central nervous system, which eliminates the “high”, paranoia, and confusion. With marijuana, there is no way to control the dosing, contamination from other chemicals or molds, or the harmful effects on the lungs and immune system.
Passing this law would increase usage among adolescents and is often the first elicit drug that young people of Connecticut are introduced to, second to only cigarettes. There is also good evidence that the use of marijuana on a regular basis by adolescents is a strong marker for ensuing drug problems later in life. There is also strong evidence regarding an association between regular use and drop in scholastic performance, increased involvement with the juvenile justice system, and emotion problems in young people.
There is clear evidence that marijuana usage can result in dependency, which can cause compulsivity even when their health, education, job, interpersonal relationships, while also legal status are in jeopardy. In 2002, over 4,000 patients came into treatment in Connecticut citing marijuana as their primary drug problem. Over 700 of these patients were between 12 and 17 years old. There is clear evidence that the perception of harm is a very strong deterrent to the use of drugs by young people.
Lastly, passage of this bill will lead to unnecessary use of tax dollars and public administrative oversight and litigation in attempts to regulate its use.
Mark L. Kraus, M.D., Connecticut Chapter of American Society of Addiction Medicine; Chairman, Connecticut State Medical Society, Committee Alcohol and Other Drug Education: We, the American Society of Addiction Medicine, and the Connecticut State Medical Society, oppose this bill as marijuana, a dangerous chemical, with life altering properties, is being considered for use as a viable medicine.
We are deeply concerned that the myths surrounding the medical use of marijuana pose a grave danger to patients. Proponents of the legalization of medical marijuana create the impression that it is a reasonable alternative to conventional drugs. But unlike conventional drugs, smokable marijuana has not passed the rigorous scrutiny of scientific investigation and has not been found safe and effective in treating pain, nausea and vomiting, or wasting syndrome.
Current findings also demonstrate that marijuana cigarettes, in contrast with the tobacco cigarette, deliver over four times the amount of tar and a much higher concentration of plycyclic aromatic hydrocarbons, such as the carcinogen benzopyrene. Studies also note inflammation of the lungs, lower immunity, tumor cells, tachycardia, abrupt changes in blood pressure and alterations of the reproductive system.
Alternatives exist to medical marijuana, including Marinol, which is a synthetic version of the naturally occurring component of marijuana, that is intended to treat chronic pain, chemotherapy related nausea and comiting, and HIV/AIDS associated Wasting Syndrome. Marinol, unlike marijuana, is a pure chemical that has been subjected to rigorous chemical research that has established its efficacy, safety, side-effect profile, and proper dosing, and eliminates the “high”.
We must reject efforts to give marijuana medical credibility by equating it with other more pharmacologically advanced drugs that have passed the rigors of scientific investigation/research and demonstrate significant efficacy in treating pain, nausea, and vomiting or HIV/AIDS Wasting Syndrome. Medical marijuana is not credible, has not passed the rigors of scientific investigation, has no demonstrable efficacy in symptom relief and causes harm.
Debbie Angell, CT Elks State Drug Awareness Chairman: Marijuana can be harmful to everyone, with an abundance of unknown chemicals as well as secondhand smoke. I believe this will only cause more problems in the future. I do have compassion for those who may feel they need a hit (marijuana) to feel better but again, there are legal drugs for this purpose. Pharmaceuticals are in fact that- clean drugs that have been tested and approved. I believe Marinol fits this category. Marijuana and its seeds do not. We will be opening up Pandora's box if we legalize this product. Putting marijuana in the hands of the ill will take more innocent lives, maybe not on purpose, but it surely will happen.
Joan Bellm, Director, Center for Drug Information: Legalizing a psychoactive plant that has not passed scientific muster would be irresponsible; therefore, compromising law enforcement efforts and endangering public health and safety.
Dr. Eric A. Voth, Chairman, The Institute on Global Drug Policy: Allowing such legislation to become law is riding a wave of emotion and mob psychology that has been carefully crafted, financed, and driven by the marijuana lobby. Marijuana is an extremely impure substance that has 488 separate constituents that turn into literally thousands of products when smoked. The percentage of THC is highly variable in street marijuana, and is not consistent like legitimate medicine. Marijuana is not a safe drug, and is far from clearly effective. The active ingredients of marijuana are already available to the public by medical prescription. What other drug would even be considered appropriate to deliver by smoking. Marijuana has been clearly demonstrated to serve as a gateway drug in numerous studies. The gateway effect is unfortunately used to deflect from some of marijuana's serious side effects.
While this is a minimally important issue for terminal cancer patients, it is a serious issue for young users and those who may use it chronically. Some of the most consistently identified problems with marijuana are the effect on memory, concentration, and coordination. Studies have found that not only does marijuana have this effect acutely, but some effects have been identified even after 2 years of abstinence. The effects on driving skills and coordination are extremely serious, and marijuana is regularly implicated in trauma. Marijuana also has effects on the lungs, and has been found to damage lung immunity. Marijuana has serious effects on the fetus which has been documented not only at birth, but has also been seen in the children who used during pregnancy.
Steven H. Steiner, Americans for Drug Free Youth: I oppose this bill. My son passed away from a drug overdose.
Dr. Harvey Graves, President/CEO, Pinnacle Medical Management Corporation
Reported by: Jared W. Kupiec