Joint Venture Is Medical Marijuana Coming to Massachusetts?

Brian Fitzgerald of Springfield was diagnosed with multiple sclerosis almost 40 years ago.

“As the disease has progressed, my quality of life has declined,” he said, in a testimony gathered by the Mass. Patient Advocacy Alliance, an organization based in Jamaica Plain that advocates for regulated access to medical marijuana.

“These days I suffer from increased stiffness in my joints and muscles, which means I need a wheelchair to get around,” Fitzgerald said. “On top of that, it’s very difficult for me to get any sleep due to tremors and muscle spasms. I’ve been on an array of medications, but marijuana is the only one that calms the spasms and allows me to get some sleep at night.

“Unfortunately,” he continued, “I don’t have any way to get hold of this medicine these days, and if I tried to grow it, I would face eviction since I live in public housing.”

Change could be on the horizon for him and many other patients who suffer from chronic pain and other symptoms from a variety of diseases. On Nov. 6, Massachusetts voters wil head to the polls to not only choose their government leaders, but to decide whether to legalize the use of medical marijuana.

If ballot question 3 is approved, the initiative would permit patients to use marijuana for medical purposes under a doctor’s consent and allow for the creation of state-regulated treatment centers where patients could obtain medical marijuana.

Several advocacy groups have mobilized to support the endeavor, most notably the Committee for Compassionate Medicine, which funded the effort to get the question onto the ballot.

“For many patients suffering from debilitating illness, medical marijuana has proven highly effective as a pain management tool, an appetite stimulant, a way to decrease nausea and vomiting, a muscle relaxant, and an alternative to heavy prescription painkillers,” the organization asserts.

But others have lined up against the measure, including the Mass. Medical Society, which first wants the drug reclassified by the federal government so it may be subject to clinical trials — which has not happened yet, despite the fact that marijuana is being prescribed by doctors in 17 other states and the District of Columbia.

“We’ve had a lively debate on it, and some people have claimed patients have benefited from it used illegally, but we’re taking the position that it’s unproven,” said Dr. Richard Aghababian, current MMS president. “I don’t want to seem unsympathetic by any means. But we have to base it on a clinical approach and scientific evidence.”

The arguments will likely heat up on both sides between now and Election Day, but right now, public opinion seems to favor legalization — and that would open up a broad series of questions as to how the measure will be implemented, and for what medical conditions it would apply.

Long Road

Medical-marijuana proponents have been trying to advance legislation in Massachusetts for years, but they have encountered obstacles each time. Last year, the Joint Public Health Committee of the state Legislature met to consider House and Senate bills that would have protected sick residents from arrest and prosecution for using medical marijuana if their doctors recommended it, but the bills failed to win approval.

To make it onto the ballot this year, the campaign first had to turn in enough signatures to have their initiative go to the state Legislature. When the Legislature did not approve a marijuana initiative this session, the campaign then was free to collect another round of signatures in order to bring their cause before voters directly. Proponents successfully delivered more than the required 11,000 signatures to Secretary of State William Galvin’s office by July 3 to secure a place on the Nov. 6 ballot.

There has been no shortage of advocacy, much of it emotional, in the past several months. Among the testimonies collected by the Mass. Patient Advocacy Alliance is one from Marcy Duda of Ware, a grandmother and home-care aide suffering from the aftereffects of brain surgery. Two sisters died of brain aneurysms, and she credits her corrective surgery several years ago with helping her avoid the same fate.

“Although this surgery probably saved my life, it also left me with chronic severe headaches, nerve damage, and a loss of my sense of taste, which has led to an eating disorder,” she explains. “I have been prescribed strong painkillers like OxyContin in the past, and, in fact, these medications do reduce my pain. The problem is that, not only are they hard on my liver, but they are also very addictive and powerful. I don’t want to be addicted to OxyContin; I feel like I am in a fog when I am using those painkillers, and I can’t even take care of my grandkids.

“I don’t use marijuana to get high — just the opposite,” she continues. “I use it so I can take less of the toxic painkillers and live my life in a normal way.”

Aghababian doesn’t deny the existence of these accounts; he’s heard plenty of anecdotal evidence that marijuana may reduce chronic pain and reduce other symptoms of disease. The problem, he says, is that the medical industry doesn’t deal in anecdotal evidence; doctors prescribe drugs that have been approved by the U.S. Food & Drug Administration after a meticulous, escalating series of clinical trials.

Those have never taken place with marijuana, because it is classified as a ’schedule 1’ drug under the Controlled Substances Act of 1970, along with other narcotics, such as heroin, LSD, peyote, and mescaline, that are largely illegal to possess under federal law. The act defines schedule 1 substances as those with “high potential for abuse” and “no currently accepted medical use in treatment in the U.S.”

“Before anybody goes off and says marijuana is a medical choice,” Aghababian said, “we would like the Drug Enforcement Agency to change the categorization to schedule 2 so it can be included in trials to determine if there is, in fact, a place for marijuana treatment in medical conditions.

“In the last generation,” he explained, we as doctors have adopted the policy that we will endorse forms of therapy that have been proven in clinically controlled, statistically valued studies. And we don’t believe such studies exist suggesting that marijuana or its derivatives are appropriate for use in medical conditions.”

At its annual meeting in May, when the MMS went on record opposing the ballot question, it brought up other arguments as well, one of them legal. Specifically, because the federal government classifies marijuana as a controlled substance, while it has not yet stepped in to block its medical use in other states, it potentially could. “Technically you could lose your ability to write prescriptions for other drugs, and perhaps even your licensure,” Aghababian said.

“I know that it’s been used in other states, and I guess the DEA hasn’t chosen to crack down on its use, but that’s not a guarantee that they won’t in the future.”

A Safe Option?

Aghababian said the MMS is also concerned about the range of medical conditions associated with medical-marijuana use. “Anecdotally, we’ve heard from other states that the interpretation of what is a medical necessity is fairly liberal when it comes to marijuana, and we’d be concerned about that — or about any drug with abuse potential.”

But the Committee for Compassionate Medicine asserts that only patients with debilitating conditions, including cancer, glaucoma, positive status for HIV, AIDS, hepatitis C, amyotrophic lateral sclerosis, Crohn’s disease, Parkinson’s disease, multiple sclerosis, and other conditions as determined in writing by a patient’s physician, will qualify to participate in the medical-marijuana program.

The group also insists the initiative will be the safest medical-marijuana law in the country, creating a new felony for anyone who defrauds the medical-marijuana system with a penalty of up to five years in prison for distribution. A person who now faces a mere civil fine for possession of less than an ounce could be facing a criminal conviction and a jail sentence if they defraud the medical-marijuana system.

A Supreme Judicial Court judge at the end of June also approved new language for the ballot question after opponents successfully challenged its wording. Originally, the question would have read, “a yes vote would enact the proposed law eliminating state criminal and civil penalties related to the medical use of marijuana by patients meeting certain conditions.”

However, the new statement approved by Associate Justice Robert Cordy goes on to explain that patients would be able to get marijuana “produced and distributed by new, state-regulated centers or, in specific hardship cases, to grow marijuana for their own use.”

The original wording was challenged by the Mass. Prevention Alliance, which opposes the ballot question. Heidi Heilman, president of the group, argued that the original language didn’t make it clear that the initiative would allow up to 35 marijuana dispensaries in the state (at least one, but no more than five, per county).

“This is about selling pot in our neighborhoods,” Heilman said earlier this summer. “That’s the bottom line.”

Yet, the Committee for Compassionate Medicine also agrees with the new wording, said spokesperson Jennifer Manley, who noted that it’s important that voters have all the facts — particularly that the dispensaries would be regulated by the state.

Furthermore, the ballot initiative asserts that, to qualify to use medical marijuana, patients would have to get written certification from a doctor that they have a specific, debilitating medical condition. Such patients could possess up to a 60-day supply of marijuana, as defined by the Mass. Department of Public Health, “for their personal medical use.”

Early polls seem to be on proponents’ side. Public Policy Polling surveyed Bay State residents in June and found that 57{06cf2b9696b159f874511d23dbc893eb1ac83014175ed30550cfff22781411e5} of respondents support legalizing medical marijuana, while 33{06cf2b9696b159f874511d23dbc893eb1ac83014175ed30550cfff22781411e5} oppose it — an increase in support from March, when the spread was 53{06cf2b9696b159f874511d23dbc893eb1ac83014175ed30550cfff22781411e5} in favor and 35{06cf2b9696b159f874511d23dbc893eb1ac83014175ed30550cfff22781411e5} opposed. The poll also showed a distinct generational divide, with all three age groups under 65 showing more than 60{06cf2b9696b159f874511d23dbc893eb1ac83014175ed30550cfff22781411e5} support, but seniors oppose the measure by a 47{06cf2b9696b159f874511d23dbc893eb1ac83014175ed30550cfff22781411e5} to 39{06cf2b9696b159f874511d23dbc893eb1ac83014175ed30550cfff22781411e5} margin.

Lighting Up

However, polls don’t matter to the MMS as much as its longstanding policy of prescribing FDA-approved drugs after extensive clinical trials.

“We want the medicinal response to be tested against other forms of therapy for relief of pain and suffering,” Aghababian said.

“Not only is there a lack of scientific evidence suggesting the medical benefits of marijuana, but we don’t want people to smoke anything,” he added. “Smoking can increase the risk of cancer, and people shouldn’t be breathing harmful gases of any kind.”

But many patients continue to argue that many modern therapies are already harmful and addictive, and that marijuana would, in many cases, be a much more beneficial option for reducing pain and other symptoms.

“I’ve been participating in advocacy in support of medical marijuana legislation for more than 10 years,” Duda said, “and I just hope that people understand that this issue isn’t about getting high; it’s about patients having the right and the dignity to use the medicine that they and their doctors have determined is best for them.”