IN-TRAINING/STUDENT CATEGORY
2019 RICHARD SPEAR, MD, MEMORIAL ESSAY CONTEST
vary significantly. This has made conducting clinical research even
more of a challenge.
HOW PATIENTS ACCESS MEDICAL MARIJUANA IN LEGAL-
IZED STATES
Patients can typically purchase medical marijuana from a licensed
dispensary after receiving a recommendation from a physician.
These recommendations are often written for treatment of chron-
ic pain, multiple sclerosis, seizure disorders and Crohn’s disease
(10).
It can be difficult for patients to receive a recommendation for
medical marijuana even if they have one of these conditions. Of-
ten times, physicians choose not to make recommendations for
several reasons. Many doctors worry about discrepancies between
state and federal laws. The lack of evidence supporting its medical
use and safety concerns are also factors (11). Still, there are sever-
al physicians who have reputations as “marijuana doctors.” Many
patients seek out these physicians for their history of making fre-
quent recommendations.
THE CURRENT BILL IN KENTUCKY
The introduction of House Bill 136 on January 9, 2019 has excited
many Kentuckians. This bill, if passed, will legalize medical mar-
ijuana in the Bluegrass State. The bill permits restricted growth
and use of medical marijuana by qualified patients. However, the
legislation may not be as big a step as many proponents would like
to think. (Editor’s Note: House Bill 136 was not voted upon in the
2019 legislative session.)
For one, it limits marijuana use to select private places. It also
allows employers to restrict marijuana use amongst employees
who are legal medical marijuana cardholders. This means that a
patient who uses medical marijuana legally may not have job pro-
tection. Lastly, the bill introduces strict regulations on growth and
distribution (12).
Despite these draw backs, the bill could be beneficial for pa-
tients with chronic medical conditions. According to State Repre-
sentative Diane St. Onge, legalization of medical marijuana could
help treat 40,000 to 60,000 Kentucky patients with symptoms that
are untreatable by conventional medicines (13).
Another prospective benefit involves the treatment of chron-
ic pain. In 2016, Kentucky was among the top 10 states with the
highest rate of opioid-related deaths (14). Some studies suggest a
link between the passage of medical marijuana laws and a reduc-
tion in opioid-related deaths (15). Although this evidence does
not suggest a one-stop-fix for the opioid epidemic in Kentucky,
the potentially mitigating effect of marijuana legalization on pre-
venting opioid-related deaths is worth noting.
the state. Kentuckians should wonder if the cost of regulation will
outweigh the benefits of treating only a small subset of patients.
Legalizing marijuana can have great economic benefits in states
like Colorado. But, it is unclear if the bill will be as economically
impactful due to the regulations it will impose.
THE OPINION OF A MEDICAL STUDENT
Medical marijuana legalization offers several pros and cons. On
one hand, legalization at the state level only, rather than the state
and federal level, has led to significant challenges. Medical mar-
ijuana products are still unregulated by the Food and Drug Ad-
ministration (FDA) due to the drug’s Schedule I classification,
which means that recommending physicians do not know the ex-
act composition of medical marijuana products. There is also the
lack of definitive evidence on the efficacy of medical marijuana.
The potential side effects are unclear and mechanisms are difficult
to isolate due to the biodiversity of the plant and its numerous
compounds.
On the other hand, a few compounds within marijuana have
been developed as pharmaceuticals. One notable drug is Epidi-
olex. In 2018, it was FDA approved for the treatment of seizure
disorders (16). This drug is a testament to marijuana’s legitimacy
in medical practice. Unfortunately, the current Schedule I classi-
fication hinders progress in research (17). This only increases the
lack of understanding and regulation of marijuana-based medi-
cines and reduces the likelihood of discovering legitimate mari-
juana-based pharmaceuticals like Epidiolex.
Statements released by organizations like the American Asso-
ciation of Family Physicians (AAFP) and the American Associa-
tion of Pediatricians (AAP) have supported the revision of federal
marijuana laws (18)(19). These organizations’ pleas for federal
legislative reform are important. Medical marijuana has proven its
potential for legitimate use in medical practice. Yet patients that
live in legalized states are using unregulated products. Moreover,
barriers to research limit physician’s understanding of the medical
marijuana products they recommend.
In conclusion, it is up to Kentuckians to decide whether or
not they are ready to move forward with the legalization of mar-
ijuana. These decisions should take into account the potential for
providing beneficial therapies and possible side effects. Kentuck-
ians should also consider whether or not those potential benefits
are logistically sound under the proposed legislation. Lastly, they
should consider advocating for federal legislative reform of the
Schedule I classification and further research.
Ahmed Saleh is a rising second year medical student at the University of Louisville
School of Medicine.
Still, the bill could impose massive administrative burdens on
JULY 2019
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