Add your comment below for Resolution #7
Comments Submitted by Most Recent-Updated by MSMA
I am relatively neutral on this resolution. I think that the evidence of harm from marijuana is relatively thin as compared to other completely legal substances (namely tobacco, nicotine vape devices, and alcohol). In many circumstances we rely on citizens to demonstrate personal responsibility rather than relying on complete prohibition. For example, we have mounting evidence that there is no safe level of alcohol consumption and that all alcohol use is associated with health consequences (https://www.thelancet.com/article/S0140-6736(18)31310-2/fulltext). Yet no one has advocated for making Missouri a dry state and I imagine that if I did propose such a resolution I would be shouted down. What I am attempting to point out is that taking a strong stance against one specific substance based on the available evidence (or lack thereof) seems inconsistent with other MSMA viewpoints. Whether you oppose marijuana or not, your patients are using it. Whether or not it is legalized for recreational use will not change that. What does change with legalization (or as I would prefer, decriminalization) are the clearly deleterious effects and exorbitant cost of legal action against those who are prosecuted for clearly non-violent and relatively minor charges (i.e. marijuana use). If we are to oppose marijuana legalization as an organization, I think we should consider the consequences of criminalization and offer a statement advocating for decriminalization strategies for marijuana possession. This would be in line with AMA policy H-95.924 which states the AMA “supports public health-based strategies, rather than incarceration, in the handling of individuals possessing cannabis for personal use.”
-Nathan Nolan, MD, Representing self
Samantha Lund, writing on behalf of the MSMA Medical Student Section board in opposition to this resolution. Although we agree with the spirit of the resolution-- more research should be done on medical and recreational marijuana-- we do not feel that this resolution is ready to be adopted as MSMA policy due to a number of reasons including: no mention of current MSMA or AMA policy, no mention of the potential fiscal note, no references of any kind, and a single and vague resolved clause that does not address what type of research should be done. Thank you.
-Samantha Lund, Representing self
Recreational marijuana has not had adequate research to determine risk/benefit ratio nationally. Missouri has just passed “medical marijuana”, and has not yet had time to study that impact on public health in Missouri.
Recreational marijuana will be addressed at the ballot box funded and supported by people inspired by financial gain. It is very appropriate for organized medicine to oppose recreational marijuana, just as we would any psychoactive drug, until adequate studies are completed and discussed.
-Jim Blaine, MD, Representing self
I am making a subsequent posting because Dr. Sherman has made false and inaccurate statements about my posted testimony. FIRST LET'S HAVE A DISCLOSURE OF CONFLICT OF INTERESTS> FROM ME AND DR. SHERMAN> I receive no monies from the cannabis industry, hold not investments or stocks and revenue from cannabis is not a part of my professional income. CAN DR. SHERMAN DO THE SAME? Usually posts like his are in some manner connected to making money off cannabis. There is a voluminous medical literature, that is increasing every year about the deleterious effects of cannabis on both youth and adult health. I cannot post it all in a short testimony but the great majority of studies coming out depict medical, mental and social problems associated with the increasing use of cannabis. Favorable studies usually are financed by the cannabis industry just like the tobacco industry used to buy researchers to churn out papers showing smoking and tobacco use had no adverse health affects. Missouri Medicine, the official journal of the MSMA, had published over a half dozen scientific articles on the adverse affects of cannabis use. Another article in the publication queue shows the pregnant women who use cannabis have a multitude of health problems including lower birth weights, premature delivery, and higher than normal birth defects. Dr. Sherman is either uninformed, misinformed or shilling for the cannabis industry.
-John Hagan, III, MD, Representing self
For the very reason why MSMA came out against legalization of medical marijuana (lack of well-designed studies), is the same reason why I feel like MSMA can not be 'strongly opposed' to recreational marijuana (lack of well-designed studies). In fact, since the resolution includes "Research Marijuana" it would make sense that the MSMA should not be opposed at all. As written, the resolution states that the MSMA should be 'strongly opposed', "until further research can better clarify the risks and benefits." If this resolution is passed, MSMA would be saying both that more research is needed AND that we strongly oppose this research. That doesn't seem right. I would recommend that we remove "Research" completely from the resolution, and because quality studies on marijuana (showing either benefit OR harm) are limited, we should either be neutral, or, at worst, opposed (vs. 'strongly opposed'). As a neurologist, I know that marijuana is sometimes prescribed in our field with success. I don't think that it is necessary to take such a strong stance, a stance that is possibly, becoming outdated.
-David Kuhlmann, MD, Representing self
I speak in favor of the resolution. MSMA should oppose recreational marijuana (RMJ). Keeping tally of organizations that formally oppose RMJ at this time (4/7/2020) include the AMA, The national Osteopathic Medical Association, The Missouri Society of Eye Physicians & Surgeons, The Kansas City Medical Society, The Greene County Medical Society, The Missouri Association of Osteopathic Physicians & Surgeons. There are other organizations that were in the final steps of opposing RMJ when the COVID-19 quarantine struck. So called medical marijuana is a totally different issue than the much more health/social fabric destroying RMJ. Do NOT equate the two. As reported in the March/April Missouri Medicine (page 114) Missouri ERs were seeing increased problems related to easier access to pot through passage of medical marijuana. There is a huge volume of peer-reviewed studies done world-wide that show deleterious effects of chronic pot use especially the ultra-high (THC=95%) recreational marijuana. The most disturbing of these (which I do not have space to post but come up in any PUBMED search) show increases if birth defects, low birth weight, psychosis, schizophrenia, etc. The most common drug found in toxicology studies of domestic abuse and teen suicide is cannabis alone or with alcohol and/or opioids. This link will take readers to some of the articles about adverse effects of medical pot and RMJ. LINK https://www.msma.org/marijuana-education-resources.html Let us look at another state California with both medical and legal recreational marijuana. During the COVID-19 Pandemic the physicians at the U of San Francisco School of Medicine have found that regular marijuana users are more susceptible to COVID-19, have more severe cases and seem to be more effective vectors for spreading the Coronavirus. They have modified their ER COVID-19 protocol to inquire about use of marijuana and method of use. This is a LINK to their protocol https://www.lucidchart.com/documents/view/44787696-d0cd-4314-9032-6f2487a77177/oDWFl5GZwFk2 I personally have been contacted by commercial interests hoping to pass RMJ use in Missouri and offered monies to support or not oppose their cause. I won't repeat what I told them. The money and organizational efforts behind the efforts to make RMJ legal in Missouri are in it for the money just like BIG TOBACCO. As physicians let us take a step now to oppose RMJ and not support it as physicians in the 1940s and 1950s supported tobacco use. Thank for your consideration. MSMA should oppose recreational marijuana in Missouri.
-John C. Hagan III, MD - Representing self
It is premature for MSMA to take a strong opposition because of lack of research. Efforts should be made on facilitating and monitoring the current law allowing medical marijuana. Twenty-two states have legalized medical marijuana. Where do you think the data came from regarding public safety? It came from the other states. Eleven states have legalized recreational marijuana and several more are expected to legalize recreational marijuana in 2020. You cite data from one state, Colorado, as evidence to oppose recreational marijuana. This limited data is not even close to drawing conclusions by any scientific method. Statisticians would scoff. How about compiling data from the other 10 states? Professional healthcare organizations, like MSMA, are held to a higher level of accountability. Please respond only to issues that have the data to back it up. Resolution #7 does not provide the data. One more comment: You cite the American College if Pediatricians, albeit erroneously because you summarize the research by stating that marijuana "use by youth is grave." Please stop with the inaccuracies. Research has shown there is an increase likelihood of developing addiction in adulthood when using addictive substances at an early age. Nothing more definitive, including the use of marijuana, can be made. Many factors come in to play, and difficult to control, such as Dimensions 3-6 in ASAM guidelines. What is more worrisome is legalizing recreational marijuana at the age of 21 or even 18. Studies have repeatedly shown the adolescent brain is not fully developed until the age of 25. If recreational marijuana is legalized in Missouri, the age restriction should be for those 25 and older. For medical marijuana the age is at least 18 years of age. As a physician, I carefully screen the younger patients to make sure the benefits of medial marijuana outweigh the risks before I certify the youthful applicant.
-David Sherman, MD, Representing self