Capitol Update: Rep. Lusk says state needs answers to tough questions on medical marijuana before moving ahead

Rep. Nancy Lusk of Overland Park says the state needs to dig in to the issue of legalizing medical marijuana.

Each legislative session, we provide the Shawnee Mission area’s elected officials with the chance to share their thoughts about what’s happening in the state capitol. Rep. Nancy Lusk, Rep. Brandon Woodard and Sen. Pat Pettey are scheduled to send updates this week. Here’s Rep. Lusk’s filing:

Public interest in the legalization of medical marijuana is mushrooming, as we in the legislature are well aware; favorable anecdotal reports of its medical use have become commonplace. If smoking cannabis can alleviate the pain of a loved one with cancer, people want that option.

Calls for legalizing medical use of marijuana are growing in Kansas — but many questions remain unanswered, says Rep. Nancy Lusk of Overland Park. Photo credit Dank Depot. Used under a Creative Commons license.

Because of that groundswell, the prospect of legalizing medical marijuana in Kansas has never been greater, which is why now is the time to have an open discussion and take a deeper look into this issue. There is much to consider. Ideally, the legislature should strive to strike a balance between reaping the benefits and protecting the public from any possible harm, especially to children.

Two medical marijuana/cannabis legalization bills are in the works to in the legislature – one in the House and one in the Senate, but as I write this neither is available to read yet. The Senate bill is sponsored by Sen. Tom Holland, and the House bill will be named the Kansas Safe Access Act and has several sponsors.

The array of purported benefits of the medical cannabis is varied and long. Diabetes, arthritis, epilepsy, nausea, PTSD, Crohn’s Disease and safer chronic-pain management than opiates is a short sampling of likely medical remedy prospects. The potential benefits of part the medical marijuana debate is not in much dispute at the statehouse. Instead, the current deliberation is less a question of “should we?” but more one of “how best?”

How can we strike a balance between reaping the benefits and protecting the public from undue harm? Frankly, it’s complicated. For starters, one out of ten users will become addicted. There are many questions that the legislature needs to research, think through, and discuss to ensure any law passed to legalize medical marijuana/cannabis is reasonably safe. Below is a sample list of questions:

We have to acknowledge the unwanted side effects of marijuana. Data shows marijuana significantly impairs judgment, motor coordination, and reaction time.

Will more people be driving-under-the-influence with medical marijuana legalization? What can we do to ensure that our streets and roads are not less safe?

There is no standard impairment threshold of cannabis in a breath, blood, urine or saliva test. And because the main intoxicating ingredient, THC, can be detected in the blood for days or even weeks after use, a driver with THC in their blood might not have been impaired at the time of an accident. Evidence of smoking is not enough to prove impairment. This is a problem even without legalization.

Prenatal cannabis exposure can be harmful to weight gain by unborn babies and may hurt cognitive development. Yet in Colorado 69 percent of dispensaries recommended the drug to pregnant women to help with morning sickness.

Should we forbid the use of cannabis as a remedy for morning sickness unless it can be proven safe? More research is needed, but evidence exists that suggests the risk is real.

Should there be a restriction of its use by breast-feeding mothers?

Lusk wonders whether edible cannabis products could pose an exposure risk to children. Photo credit Dank Depot. Used under a Creative Commons license.

Colorado saw an increase in the rate of accidental marijuana exposure via edibles to toddlers and young children increase 150 percent from 2014 to 2016 and is now that state is requiring that marijuana products be packaged in child-resistant designed packaging.

While the bills under consideration in Kansas are only to legalize medical marijuana and not recreational marijuana like Colorado, shouldn’t we include similar packaging rules in our law if we decide to legalize?

Second hand marijuana smoke exposure to children can make asthma worse and increase the risk of respiratory and ear infections in the same way as second-hand tobacco smoke – and we don’t want children getting high.

Has there been more exposure to second-hand marijuana smoke by children in the states that have legalized medical cannabis? If so, how are they dealing with it?

Kansas passed legislation in 2010 that banned smoking tobacco statewide in enclosed, indoor workplaces and restaurants in Kansas.

Shouldn’t the same restrictions be placed on marijuana smoking?

Several studies have linked marijuana use by teenagers and young adults to increased risk for psychiatric disorders like schizophrenia, including one from Berlin. What training requirements should be set up in law to enable physicians to make informed decisions about the benefits vs. the extra risks when prescribing for teenagers? (and for risks for all ages?)

A study found for every $1 in alcohol and tobacco tax revenues, society loses $20 in social costs.

Could this be the case with marijuana? Has the marijuana tax revenue in other states been enough to cover the expense of increased social costs? How can such effects/expenses be identified and measured?

In states where medical marijuana has been legalized, has the need for mental health services increased? Mental health services in Kansas are already underfunded.

Will the future marijuana tax revenue be enough to cover other physical health costs? An example is long term marijuana use increases the risk of lung cancer in young adults.

While the general populace has been lobbying us to legalize medical marijuana, physicians, pharmacists and other health professionals have been voicing strong reservations. Rather than bearing the responsibility to sign off on giving permission to patients to self-medicate by smoking marijuana or consuming edibles (which “medical marijuana” in practice typically means), many physicians and hospitals would much prefer having rigorous peer-reviewed research done to come up with marijuana medications to treat specific diseases and conditions . . . and that those marijuana drugs be tested to find safe and effective set dosage amounts and lengths of usage, and to find out how the risks of how each reacts with other drugs . . . and ultimately, to have those drugs meet the drug quality, safety, and effectiveness standards required to pass approval by the Federal Drug Administration, like other drugs approved for sale.

Just because we pass the legalization at the state level, it may not follow that doctors will be prescribing it. In Ohio where medical marijuana became legal last September, the state’s three major health systems are prohibiting their staff doctors from recommending it as long as it remains illegal at the federal level. No matter what we decide at the state level, medical marijuana will not be covered with Medicaid or Medicare dollars. With the recent crackdown on the overprescribing of opioids, another concern of physicians and hospitals is the uncertain legal implications of malpractice liability regarding their certification of patients and prescribing of medical marijuana.

The American Medical Association and the American College of Physicians are calling on more research to be done because more needs to be known about how cannabis effects the body and the brain. There are over 100 separate compounds, or cannabinoids, that can be derived from marijuana and each has its unique effects, both positive and negative, necessitating individual testing for each compound.

Unfortunately, we have little high-quality evidence on the effects of cannabis because of its illegality nationwide. If the U.S. Drug Enforcement Administration would change the federal legal status of the drug from a Scheduled 1 Controlled Substance to a Scheduled 2 Controlled Substance – enough to ease existing limits on medical research – it would really help.

That’s not to say no research is available. Studies on cannabis have been done in Europe and Australia, and with the complete legalization of marijuana in Canada more research information should be coming from Canada. And we should take advantage of finding out what is working, and what is not, in terms of outcomes in the states which have already legalized medical marijuana.

Last year’s Kansas House bill to legalize marijuana was 87 pages long. This year’s new version looks likely to be even longer. I have been told that it will address at least some of the questions posed here. I look forward to checking it and the Senate bill out.

If the House Health Committee decides to undertake a hearing this year (that is up in the air at this point), my suggestion would be to divide the bill in parts, assign them to subcommittees, or at the very least, plan for three days of hearings and a couple of committee days to work the bill.

There is no denying that the promise of medical marijuana benefits appears to be great. My request of constituents is for patience, as we sort this issue out.

Last year I voted for the legalization of CBD oil, a derivative of marijuana that has no psychoactive effects, and for a measure to legalize medical marijuana in Kansas that came up as an amendment on the House floor.

I remain open to doing so again this year, but the health professionals have me taking a second look. I remember how I was startled when a health professional who I greatly respect and deals with delivering addiction services recently told me she would prefer the legalization of recreational marijuana over medical marijuana, but I have come to understand what she meant. This quote from an opinion piece in the JAMA: The Journal of the American Medical Association entitled, “Medical Marijuana. Is the Cart Before the Horse?” sums it up:

If the states’ initiative to legalize medical marijuana is merely a veiled step toward allowing access to recreational marijuana, then the medical community should be left out of the process, and instead marijuana should be decriminalized.
Conversely, if the goal is to make marijuana available for medical purposes, then it is unclear why the approval process should be different from that used for other medications.

Evidence justifying marijuana use for various medical conditions will require the conduct of adequately powered, double-blind, randomized, placebo/active controlled clinical trials to test its short- and long-term efficacy and safety. The federal government and states should support medical marijuana research.

Since medical marijuana is not a life-saving intervention, it may be prudent to wait before widely adopting its use until high-quality evidence is available to guide the development of a rational approval process. Perhaps it is time to place the horse back in front of the cart.

Food for thought.

My credo has always been: If we do it, let’s do it right.

The hard part can be deciding what is right.