Tishler: Is Delaware on right track with medical cannabis?
Dr. Jordan Tishler is the president of the Association of Cannabinoid Specialists.
Recently, the Delaware House of Representatives, following ideas from Washington, D.C., passed a law to do two things: (1.) remove the list of qualifying conditions from its medical cannabis laws and (2.) allow people over age 65 to “self-certify” that they need marijuana for medical purposes.
At the Association of Cannabinoid Specialists, the medical cannabis treatment experts, we think the bill does not demand sufficient professionalism from clinicians and that self-certification is misguided.
The removal of the list of qualifying conditions is actually something we have supported since our inception. We believe that clinicians should be able to prescribe cannabis or cannabinoids for whatever purpose is supported by human clinical trials. In most states, the list is driven by politics, not science.
For example, nearly every state has glaucoma on the list, despite it being malpractice to use cannabis for this disease, as cannabis is vastly inferior to conventional medications for this illness and puts patients’ vision at risk.
Why, then, is the removal of qualifying conditions deficient in the case of Delaware? The Delaware bill is for the expansion of the cannabis industry. It does nothing to safeguard patients or to facilitate the ability of clinicians to provide appropriate care to patients.
If Delaware were serious about patient care, it would have included more specific provisions for clinicians to make exact prescriptions for patients, while also directing boards of licensure to enforce basic standards of care, like informed consent and close follow-up.
More ridiculous is the idea of self-certifying. This bypasses knowledgeable medical guidance entirely. The role of medical care is to be sure that the patient knows the risks and benefits, and is advised on the best practices that help mitigate the risks.
In essence, clinicians work to see that their patients use the least amount necessary (of any medicine) to experience benefit and to avoid problems that arise from excessive use. Whereas, of course, the industry would like people to use as much as possible.
Further, rules like self-certifying normalize the idea that cannabis isn’t real medicine and that people should just “MacGyver” their way along, until it all blows up in their faces. Have we learned nothing from the opioid crisis? Can we not see a looming cannabinoid crisis? Guidance from clinicians would help prevent this, if those clinicians are held to account for providing actual care to patients.
While misuse is clearly visible among young people, it is not limited to them. The fastest-growing segment of Americans using cannabis is the over-65 crowd, and it’s also the segment in which cannabis use disorder is growing the fastest. Overall, this is because people are not getting the guidance that protects them.
Further, older people have other health problems, too. The interplay between their various health problems and their often extensive medication lists is crucial to how safe and effective cannabis can be for them.
The libertarian argument that people should be able to make up their own minds is flawed. It assumes that people have access to accurate information about their health and about the risks and benefits of cannabis (including drug interactions), and that they have the depth of understanding to reasonably interpret that information.
This is what health care is all about. Practitioners are there, having spent countless years studying and accruing experience, to help patients understand their options and the risks, benefits and best practices to mitigate those risks. The cannabis industry wants to bypass this knowledge because it limits their sales.
So, is Delaware on the right track? Mostly no. If it was serious about patient care, it would be eliminating qualifying conditions, while reinforcing professional responsibility to clinicians for their recommendations and outcomes. It would reject any idea that allows patients to bypass medical care, as this puts patients at risk in favor of increased sales for the industry.
We call upon Delaware and other states (as well as the federal government) to get serious about regulating cannabis medicine in accordance with our knowledge of what makes patients healthier and safer.
If you would like to discuss this further, please contact the Association of Cannabinoid Specialists at info@cannaspecialists.org. We look forward to creating an open dialogue on the subject.
Thank you for your time.
Reader reactions, pro or con, are welcomed at civiltalk@iniusa.org.
