Monday, November 26, 2018

Thoughts on Texas medical marijuana

With the Texas medical marijuana program still in its relative infancy, something has become apparent: Misinformation is a problem, and it’s coming not just from reefer madness fearmongers but from physicians themselves.

Two recent occurrences hammered that home for me:

I asked a physician acquaintance if she had signed up on the Compassionate Use Registry of Texas. She said she hadn’t, mainly because she had heard from another physician that insurance wouldn’t cover visits from patients who are prescribed the cannabis derivative cannabidiol (CBD), and that you have to see patients every month. Neither of these statements are true, and that she heard them from a doctor makes it doubly disturbing.

While keeping up on CBD research and news, I watched a program on Medscape’s Continuing Medical Education platform titled Pharmaceutical vs. Dispensary-Sourced Cannabinoids: What’s the Difference? I was dismayed to hear two neurologists presenting information that included:

“It is illegal for physicians to prescribe any marijuana or marijuana-based product according to federal law.”

“It is important to remember that products currently available in dispensaries are not regulated, are not consistent, and do not have the same oversight as the purified plant-based medications that are going through the FDA approval process.”

“There is no truth in labeling with most dispensary products, which can be dangerous when the labels do not reflect the amount of CBD or ratio of THC and CBD available.”

Let’s recap what the Texas medical marijuana program entails: Per the Compassionate Use Act, patients with intractable epilepsy can only obtain Texas CBD medication through the prescription of a registered physician. The wording of the law provides concrete protections for physicians who prescribe low-THC, high-CBD medicine that’s regulated by the state. (Disclosure: I am chief medical officer for licensed dispensary Compassionate Cultivation.)

The restrictive federal status of CBD and cannabis has been debated as a concern for Texas physicians. My point of view is that physicians not only should, but must be involved as prescribers. 

CBD is a medication, and prescription of CBD is no different from other efficacious anti-convulsant medications. Within the context of the Texas Compassionate Use Program, I am practicing medicine as a responsible physician and providing my patients with the guidance they need to integrate CBD into their complicated medical regimens.

In the Medscape presentation that was ostensibly about cannabinoid education for physicians, it was disheartening to see the presenters deliver so many broad-stroke statements about unreliability of CBD products and anti-dispensary messaging. It’s also important to note the presentation was funded through a grant from a pharmaceutical company whose cannabis-derived drug Epidiolex has received approval from the U.S. Food and Drug Administration and is expected to be available by the end of the year.

These alarmist claims are not helpful to expanding an understanding of CBD among physicians, which is a pressing need as the number of states allowing some form of medical marijuana has grown to 46.

I call on my fellow physicians to dig deep into research when educating themselves about CBD and state regulations.

It’s unfortunate, though understandable, that the tightly regulated Texas dispensaries could be relegated to assumption that their products are unreliable. The national CBD market is unregulated, and inaccurate product labeling of CBD content is a known issue. This is indeed concerning and a primary reason I was initially wary of CBD. However, state law holds Texas dispensaries accountable to produce rigorously tested CBD oil products.

Having witnessed success in some of my most challenging cases since I first started to prescribe Compassionate Cultivation’s CBD in February, my goal is to maintain access to treatment for all of my refractory epilepsy patients for sustainable care.

If physicians dismiss this promising, state-sanctioned treatment option, they miss the opportunity to alleviate suffering and improve the quality of life for many patients.

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