On Wednesday, dozens of former addicts made the tough decision to share their stories publicly, doing so before news cameras and a standing-room only crowd. The admissions were not without irony. It was, after all, a federally prohibited drug, according to the patients who spoke, that freed them from their addictions to far more lethal--though legal--prescription narcotics.
Under the Colorado Capitol's golden dome, dozens of patients gathered for a state Senate committee hearing, eager to give their two cents on the controversy at hand: How to regulate the doctor-patient relationship when it comes to physicians making medical marijuana recommendations.
After hearing testimony, committee members voted as most anticipated they would, injecting significant and potentially unconstitutional government mandates into doctor-patient relationships previously viewed as sacred to many of the state's sick and dying. Only conservative Republican Shawn Mitchell of Broomfield voted against the bill, understanding that although he may have concerns with medical marijuana's inclusion in our state constitution, lawmakers are sworn to uphold that constitution, even those portions with which they disagree.
The legislative action sadly reflects an overly emotional response to salacious headlines chronicling the alleged abuses by just a handful of the nearly 1,000 doctors who have issued medical marijuana recommendations. Their offense: they let greed trump patient health, and now stand accused of being far too flippant in making medical marijuana recommendations.
Troubling, yes. But as patient after patient testified Tuesday, any possible abuses of the state's medical marijuana registry (now host to more than 20,000 patients) should be analyzed under a larger public health care perspective. As they told lawmakers, some through tears, medical marijuana has freed them from the agony of addiction resulting not from marijuana, but rather from the dangerous narcotic pain medications they had previously resorted to in an effort to curb their chronic and often progressive symptoms.
The message was clear: Marijuana use--which has put millions of Americans behind bars over the last seven decades--is now freeing Colorado's sick and dying from their addictions to xycontin, vicodin, morphine, and a multitude of other prescription drugs incredibly dangerous, addictive, and destructive when taken over long periods of time.
Legislators should listen.
In Colorado, prescription drug overdoses are now the leading killer in our state. As we've written previously for this site, such drugs now kill more Coloradans than car accidents every year. Meanwhile, marijuana has never been independently linked to an overdose death. Not a single one.
Tuesday's testimony was compelling, with its honesty and humility too real to be some paid construction of the lobbyists who sprinkled the crowd. Lawmakers heard from a former college football star now in his 60's, a man who now suffers the excruciating effects of decades-old injuries and the surgeries that failed to make him whole. Without medical marijuana, he testified, he'd have no other option than to pop prescription pain pills by the handful. Another wheelchair-confined patient also spoke of how medical marijuana has freed him of his own long-term prescription addiction. His voice wavered as he talked tenderly of his late wife, who died seven years ago from liver failure resulting from overdosing on Tylenol PM.
Bill sponsor, Chris Romer, a well intentioned Denver Democrat, proudly proclaimed that "this is the beginning of the end of the wild west," his bill could usher in a whole new set of problems. On Wednesday, he showed a growing willingness to accept amendments that removed some of the bill's most controversial provisions. Still, while it's true that Colorado's medical marijuana industry has thus far outpaced efforts to usher in its regulation, his bill still raises issues that could result in unintended consequences extending far beyond the relationships between medical marijuana patients and their doctors.
Ultimately, one of the bill's most troubling mandates is also its most ironic. The language would prohibit any doctor who has ever had his or her Drug Enforcement Agency Schedule I prescribing license suspended--even for a day or even 30 years ago--from making medical marijuana recommendations to Colorado patients. Meanwhile, while the bill relies on this federal DEA standard to define professional competence, it then ignores the fact under the DEA's own rules, doctors who recommend medical marijuana are subjected to having this same Schedule I license yanked.
The bill also subjects doctors making medical marijuana recommendations to a new system that could very quickly result in a two-tiered witch hunt, empowering not only the Board of Medical Examiners to revoke a physician's medical license in its entirety for medical marijuana-related offenses, but also granting the state Health Department the ability to revoke any physician's right to advise patients on medical marijuana. Doctors, already looking over their shoulder when making recommendations, will now have even more to fear.
For many indigent patients in the room Wednesday, cost was the biggest issue on their minds.
One disabled veteran testified that the new changes could make getting his medical marijuana recommendation prohibitively expensive. Under current federal Veteran's Administration policy, doctors are prevented from recommending medical marijuana entirely. As the vet noted, his only source of medical care comes from the VA, meaning he'd have to go elsewhere. A doctor recommendation and follow up care could now cost him hundreds of dollars annually due to one bill provision that prohibits dispensaries from reimbursing doctors for making recommendations.
In absence of financial assistance for such required examinations, the vet would be forced to explore one of two options, neither desirable. He could either obtain his medical marijuana from the black market where physician recommendations are not required, or he could return to prescription narcotics to treat his horrific symptoms.
For years, legislators have turned a blind eye as doctors have too freely prescribed narcotic painkillers without adequately assessing patient necessity, or in many cases, without even speaking with a patient in-person before writing a prescription.
But this was only a passing thought Wednesday to too many of the bill's supporters. Law enforcement officials claimed that lawmakers have a duty to prevent illegitimate abuses of medical marijuana. Even if this obligation is presumed true, however, fighting medical marijuana abuse should be far down the public policy priority list from addressing the scourge of other, far more harmful drugs, including prescription pain killers and alcohol. A proper regulatory scheme would acknowledge the real issues facing patients and caregivers today, including the lack of assurances of medicinal quality and consistency some face when selecting medicine. (Click here to see our analysis of SB 109, including our support for several of the bill's provisions, and suggestions concerning others).
As Senate Bill 109 now prepares to make its journey through the Capitol, we hope legislators will resist rubberstamping Tuesday's emotional response to a perceived problem. While it's true that a handful of the nearly 1,000 doctors who have made medical marijuana recommendations thus far are accused of abusing the process, this legislation would remove time-tested protections to the doctor-patient relationship that would not only hurt patients, but could also begin the erosion of confidentiality between a far larger population of sick people and their doctors.
For centuries, doctors have committed to uphold the Hippocratic oath, pledging to "first, do no harm." In the aftermath of Tuesday's committee bill passage, lawmakers should consider taking their own oath.
Listen. Get the facts. Then make the prescription. Don't let emotion cloud the truths revealed through the testimony of Colorado's real experts--the patients and doctors themselves--who have resoundingly demonstrated that medical marijuana is one of the greatest tools we have in the essential fight against prescription drug addiction.
Jessica Corry and Robert J. Corry, Jr.
January 28, 2010