Debating Medical Marijuana in Kentucky

By John Gregory | 2/05/19 8:00 AM

This year the Kentucky General Assembly will again consider legislation to make medical marijuana available to certain patients in the commonwealth. House Bill 136 would create a highly regulated system for cultivating, processing, and dispensing cannabis to registered patients.

Similar bills have been proposed in the commonwealth for the past seven years, but none have made it to the governor’s desk. More than 30 other states have legalized some form of cannabis for medicinal purposes even as debate continues over the efficacy and safety of the drugs derived from hemp and marijuana plants.

KET’s Kentucky Tonight explored the pros and cons of medical marijuana and HB 136 with Rep. Jason Nemes (R-Louisville), a sponsor of the bill; Dr. Jared W. Madden, a family physician in Manchester; Dr. Danesh Mazloomdoost, a pain management specialist in Lexington; and Ed Shemelya, national coordinator of the National Marijuana Initiative under the United States Office of National Drug Control Policy.

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A Proposal for Medical Marijuana in Kentucky
When Rep. Nemes first ran for the legislature in 2016, he opposed medical marijuana. But after taking office, a woman approached him at a public forum in his district to tell him how medical marijuana had relieved her daughter’s seizures. The woman admitted to Nemes that she had committed felonies to get the drug that helped her child. Then other people at the forum shared similar stories of how medical marijuana had helped them.

“I thought to myself, these people aren’t liars, they’re not lawbreakers, they’re not trying to do wrong,” Nemes recalls. “So maybe there’s something to this.”

After researching the issue, Nemes, who says he’s never smoked pot in his life, became a convert to the promise of medical marijuana to relieve chronic pain, chemotherapy-induced nausea, seizures, muscle spasms, and other conditions. Now he’s one of seven Republican and Democratic cosponsors of HB 136. He says the legislation will license people to grow, process, and dispense marijuana products, and provide quality controls to ensure those products are safe.

Doctors who want to recommend medicinal marijuana to their patients must first seek approval from the Kentucky Board of Medical Licensure. Patients seeking marijuana must register with the state and have an on-going, bona fide relationship with an approved doctor.

“What this bill does, it doesn’t mandate that you get it if you’re on chemotherapy or whatever,” says Nemes. “It allows the doctor that additional option to help our people so they don’t have be felons, continue to be in pain, or move out of Kentucky” to a state where medical marijuana is legal.

A new state agency, the Division of Medicinal Marijuana within the Department of Alcoholic Beverage and Cannabis Control, would monitor the system, with additional oversight from state and local law enforcement and the medical licensing board.

“Doctors will lose licenses, patients will go to prison if they misbehave,” Nemes says. “We are not playing around here. We’re trying to solve problems, not create new ones.”

The legislator says the regulatory system should pay for itself, but not be a revenue generator for the commonwealth. He says he’s not interested in profiting off patients in need of relief.

Competing Medical Perspectives
Nemes says entities like the American Cancer Society and National Academies of Science, Engineering, and Medicine support medical marijuana. But other health professionals are more skeptical and urge caution about allowing patients to smoke marijuana or inhale its vapors. They contend that it’s specific compounds in cannabis that seem to offer medical benefits, while much remains unknown about the long-term safety of smoking marijuana itself.

“When we talk about marijuana, the water gets really muddy really fast.” says Dr. Danesh Mazloomdoost. “When we talk about marijuana, are we taking about all cannabinoids, are we talking about hemp-derived cannabinoids, are we talking about synthetic cannabinoids? You can’t lump all that in one category and then try to have a debate about this.”

Mazloomdoost says he gets frustrated when marijuana advocates cherry-pick from data or misquote research reports. He says components of marijuana do have value, but he contends the hemp actually has higher concentrations of the compounds that have healing properties, without also containing the higher levels of psychoactive THC found in marijuana. He says he has recommended cannabidiol (CBD) oil, which can be extracted from marijuana or hemp, to some of his patients, but he also cautions them about its use.

“There’s so much that we don’t know and has known harm to it that we can’t make a blanket statement that physicians understand this drug enough to be prescribing or recommending it,” says Mazloomdoost.

Another issue, according to the doctor, is that concentrations of the medicinal and psychoactive compounds can vary widely from plant to plant. He says that makes dosing of marijuana products especially challenging. Plus Mazloomdoost says there’s nothing to give patients who do have an adverse reaction to marijuana compounds.

But osteopathic doctor Jared Madden contends a person can’t overdose on marijuana like they can on opioids, so no reversal agents are needed. He says side effects like sedation, intoxication, and memory loss generally come from higher doses, and usually dissipate after one or two hours. Madden says doctors who recommend medical marijuana will closely monitor their patients and adjust the dosages as needed.

“We’re not going to dose grandma and Willie Nelson the same,” says Madden. “I will tell you, however, that if grandma takes 100 milligrams of THC when she should’ve taken 10, she’s not going to die. If grandma takes 100 milligrams of Oxycontin when she should’ve taken 10, we’re going to be burying grandma.”

Madden acknowledges that scientists don’t know everything about all the chemicals in marijuana, but he believes there’s enough research and practical experience to know that it’s not dangerous. In fact he contends marijuana is less addictive and harmful than tobacco and alcohol. Even without conclusive research on the safety and efficacy of marijuana, Madden argues there is enough evidence to justify its use in patients who don’t get relief from conventional pharmaceuticals.

“If the risk-benefit ratio is quite easy to assess, I’m going to do things that are not that risky that could potentially be beneficial for my patients,” Madden says.

A Law Enforcement Perspective
But getting more scientific research into cannabis won’t be easy as long as the federal Drug Enforcement Administration continues to classify marijuana as a Schedule 1 narcotic. (Such research is possible but requires scientists to gain approval from multiple federal agencies and navigate a myriad of other regulations.)

“I’m a cop, I’m not a doctor, but here’s what I do know: we have to have more research on this drug,” says Ed Shemelya of the National Marijuana Initiative.

He says the rush to pass medical marijuana laws is being based on assumptions that aren’t backed by peer-reviewed research, which he contends should follow long-established protocols.

“We have now voters and state legislators trying to circumvent the FDA [approval] process,” says Shemelya. “We have a tried-and-true process, whether you like it or not, whether it’s too slow, too cumbersome, too burdensome, we have a process for determining the efficacy and safety of the products that we consume.”

From a law enforcement perspective, Shemelya has a number of concerns about the rush to embrace medical marijuana nationally and Kentucky’s HB 136. He says the legislation doesn’t address potency of the products or what amount actually constitutes a 30-day supply. Plus he says there are no financial provisions to deal with any potential negative impacts.

Shemelya also worries that law enforcement doesn’t yet have a good way to detect marijuana impairment among drivers. He says that’s important because states that have legalized marijuana have more incidents of driving under the influence of drugs. Nemes contends that’s true for states that allow recreational marijuana, but not those that only allow medical marijuana.

Another aspect of HB 136 that Shemelya opposes would allow low-income patients who can’t afford to purchase medical marijuana to grow up to six plants for their own use.

Nemes says those individuals would have to register with Kentucky State Police and local law enforcement. But the legislator says he’s open to removing that provision if lawmakers can find a way to ensure access to medical marijuana to anyone who qualifies for it, regardless of their ability to pay.

Overall Shemelya contends that allowing medical marijuana will inevitably lead to legalization of recreational marijuana. Nemes says he opposes recreational use and has worked to craft a bill that he believes would prevent that from happening in Kentucky.

Shemelya remains unconvinced.

“As well intended as you are to try to keep it from being recreational, it will be out of your control as soon as this [law] is passed,” Shemelya says.

HB 136 has not been assigned to a committee yet, but Nemes hopes it will be heard later this month. Even if the legislation can pass the House of Representatives, Nemes says it will face a significant hurdle in the Senate, where he says leadership is split on the issue.