Transcripts For CSPAN2 Book Discussion On Stoned 20240622

Recreation use of marijuana but should marijuana and it derivatives be used for health purposes. A very controversial issue, one in which frequently there is far more heat than light and where we frequently see people who seem to be immune to data. We have experts tonight to talk about this, it will be moderated by doctor david who is chief of Palliative Care at pennsylvania. Im a psychiatrist and i often think that most people including physicians dont understand what psychiatry is. Nobody understands what Palliative Care if its a wonderful branch of medicine and needs to be better understood. We launch the book a year ago, this is his second book he is launching here, no we do not have royalties ongy n it, but in two copies of it. Dr. David kasser at will come up in a minute, we, we believe all of you are literate, we print biographies in the program, this is not an imac went to sit up for ten minutes and read every paper that people wrote. Dr. Katz it will come up and will introduce our three panelist and will moderate a discussion amongst them. If you have questions there are notecards you can write on, you can pass them and will be collected and well put a microphone up later for questions. Please dont interrupt the speakers in the middle. Thanks everyone, its its delightful to be here again, a year later. A different topic and devices as problematic. Im rearranging the script a little bit, i was supposed to ask this question in another half an hour but i would i would like to ask it now. I would like to know, what people in the audience would think about legalizing america medical marijuana in pennsylvania. You you can either before, against her undecided. So all of those of you who are for, all of those who are against, those of you were undecided which often means you have an opinion but you dont want to state it for the record. So my goal for the next half an hour is not to change your mind, im not going to try to take all of those or even one of you who are prolegalization and shift you, im surely not going to take those of you who are negative and shift the other direction, and im not going to take someone in the middle and try to nudge you one where the other. Honestly i shouldnt be able to do that, if you can be nudged that easily in the space of half an hour for an issue thats this important you havent thought through carefully enough. Thats not my goal, that should be your goal either. What id like to do in the next half an hour, and what i asked our panelist to work on in the sessions they have following this is not to try to change your mind but to give you enough data, enough evidence so you can have a thoughtful discussion to support whatever your opinion is. To do that knowing what the other person on the other side of the debate thinks too. What were after is not a consensus that medical marijuana should or shouldnt be legal, but a thoughtful discussion and wherever that discussion is up for you. Okay. Sponsors thank you for all of you folks in a round of applause for jill stall who is standing in the back in the bright dress [applause]. She is responsible for doing all of the lastminute things including giving me a glass of wine for free about 15 minutes ago which really, really helps. Thanks for that. For my conflict of interest ive asked the panel to describe their conflict of interest as well. Is she for or against . [laughter] ill take that as an undecided. We will work on that. I dont have any conflicts of interest im about to describe those of myself not to those of the university of pennsylvania. I couldnt resist putting this picture appear with a book review for stone, show this to some of our social workers on the Palliative Care service at the hospital of the university of pennsylvania asked them if this guy look like me, they said no, which was good until they said that guys much more cute than you are. So thanks for all of you. This ultimately is the question we need to wrestle with, whether youre thinking if medical marijuana could help you or loved one, or on a policy level whether it should be legal. Is it. Is it a medication, is it a weed, is it something that could be helpful, is it an illegal drug that should be banned. Or, maybe is there some middle ground we could find a consensus about. I wrote the book stone for a patient i took care of about a year and half ago. Was a hospice patient she had a band patient created cancer and she described weight loss, nausea, pain that sounded like it had a pain due to nerve damage. In that conversation she asked whether i thought medical marijuana might be helpful for her. I told her what i learned the medical school which is that medical marijuana doesnt exist, marijuana is an illegal drug, theres no randomized control data to support its used. But what i can tell you about judith issues a retired glacial professor, she spent the last 50 years of her life giving to students a tough time and crossexamining them. So. So when i said no there is no can troll to support random use she said really because i went on the internet and i found a couple of studies in here they are. She pulled them out of her bag and at that moment i had to admit to her that maybe this retired english professor knew more about medical marijuana and symptom management than i did. I promised i would look at those papers, i i look for other studies published and i would estimate my colleagues and experts in the field and get back to her with an answer whether how merit medical marijuana might help her. My advice was based on the evidence out there it could certainly be helpful to her. That realization that one of my patients, with no medical training actually knew more about the evidence for medical marijuana than i did made me realize that there are probably others out there, policymakers, legislators, patients, families, other physicians who had the same perception as i did that theres no evidence to support its use. That is what led me to Research Medical marijuana and also embark on this process of writing a book. As i did i came up with three big surprises and in the next half hour or so i will walk you through these three big surprises. Parenthetically, people in the press interviews for stone have asked me which Science Writers i find the most influential for me who ive looked to to be role models, on on how to be a medical science writer. Mary roach is someone im can paired with a lot, oliver sacks, honestly the most influential writing example for me have been travel writing. Travel narratives, the really good travel narratives like paul drew, jan morris, these are people who write travel narratives very well. What makes makes a good travel narrative . Is mistakes. Surprises, misconceptions that get rearranged along the way, good travel narratives arent about getting to point a to point b its about trying to get from point a to point b and winding up someplace else entirely. Or getting to the end and realizing its not what you thought it was going to be. When i think of what a good science, nonfiction looks like, ill share with you the ways in researching this book and reviewing studies and visiting clinics and try medical marijuana for myself, what that has taught me in terms of science and also in terms of surprises. Ways in which ive been surprised, and ways ways in which ive been wrong. The first is that there seems to be a science in the way medical marijuana will works, the second is as my english professor told me, medical marijuana does have benefits, and three that it has risks. Although not necessarily the risks that i expected. So this is the science of medical marijuana, i i really thought that medical marijuana or the appeal of it was just about getting stone, the feeling of getting high, the chance to forget whatever else is going on with you, whether that, whether that was a terminal diagnosis, pain or nausea. It was something that was dissociated and kept us from focusing on whats going on but it wasnt really therapeutically valuable, thats what i thought. A background is useful, two main species of marijuana, some people argue that a third specie is a true species, some people would mix it in with these two but generally when were talking about medical marijuana or Recreational Marijuana we are talk about two species. Were talking about the active ingredient in marijuana, the big ones, the main once we know most about is those are present in these little tri cones that look like nail holes on the leaves and stems. When you talk about the cannabinoids in medical marijuana at your not talking about the entire plant you talking about whats highly concentrated in those little male had things. Youre talking about these two molecules, there dozens of cannabinoids out there, this is present in the largest amount and has gotten the most attention in terms of what has been study. Keep in mind that what i will talk about in terms of benefits and what youll hear from the panelists, will be benefits but there are other cannabinoids in marijuana and many which we dont know what they do. There certainly reason to believe they could be there you dick or they could cause risk that we dont yet understand. Another surprise for me in this category is marijuana acts through receptors, not not just a global feeling of being high, but theyre very specific receptors in the brain and also the reproductive system, cbd binds to other receptors in the immune system and elsewhere in the body as well. Interestingly it at it works in the brain to be into think that cbd may be useful in treating neuropathic pain. Other cannabinoids that i told you and other receptors, this is just one angle, one snapshot of what we know. What convinced me that there was a science to medical marijuana, that i really hadnt appreciated is that the man pictured here is arguably the grandfather of medical marijuana, i made a pilgrimage to meet doctor in his laboratory at Hebrew University in jerusalem to hear about some of his work. He was, the one who discovered a molecule. What is interesting for us is it gives us an idea of how it marijuana does what it does. We do not have a or were not born with receptors that are designed to bind with phd preceptors. We are when you take this into your body in the form of marijuana that is inhaled or vaporize, or even in the form of an edible, what youre doing really is tricking the body into thinking that it is suddenly experiencing and inrush of the substance. Youre basically hacking into the natural and okay system and you can visit the the body that its receiving a lot. Three so its important is in the system its very complicated, its in the immune system, the brain, and most organs, at least some degree and its also present in every species out there except for insects for reasons i really dont understand. So so when you are using medical marijuana or wreck relational marijuana into your system you are hacking into a very complicated system that we dont quite understand. Not only is the science of medical marijuana much more complicated than just getting stone, its more complicated than just one molecule binding to one or two receptors in the brain. Youre really tapping into a complex and in ways thats hard to understand a very complicated system in the body. That was one surprise, theres microbiology, theres receptors, there also natural variations in receptor and cannabinoid receptors are not the same as mine, so how you respond is different potentially than how i would respond to a joint, gummy bear, or brownie. One surprise is medical marijuana really does have benefits, i really thought medical marijuana was a joke starting out, but i had to admit based on some of those studies that judas showed me that there really is some good data out there. Increasingly some of the best data on marijuana for a variety of ailments including pain come from these vaporizers. You heat a marijuana but, usually to usually to a temperature thats hot enough to make the cannabinoids change and evaporate but not hot enough to get the stuff in marijuana to burn. So you are in haley viewer but youre not inhaling all of the the gross things that you inhale when you wouldnt use a joint or cigarette. Other people are starting to use it to so its beginning to be an easier way for people to figure out if theyre getting the doses of cannabinoids that they think they are which is useful for research purposes. This is what one owner told me, i said their benefits to medical marijuana i wouldnt go this far , but one thing i discovered in looking through the world of medical marijuana, particularly dispensary owners and those who have a vested interest in pushing medical marijuana is that there are a lot of overstated claims. There are medical benefits to medical marijuana i would not not say its the new best thing, i would not say its a wonder drug, it doesnt cure all ills, doesnt cure doesnt cure cancer so well just say that for the record. If you look at state laws including some indications that are in the legislation moving to pennsylvania you see very long list of things that are listed as qualifying conditions, that is one interesting fact. Another fact is there is a huge amount of agreement from state to state so what is a qualifying in one state may not be qualifying and another which is fascinating because either there is enough evidence to support the use of medical marijuana for human their pe or other ailments or there isnt. Its not like that evidence would be greater in california than it would be in colorado yet there doesnt seem to be huge amount of agreement from state to state. There are many ideas out there of how medical marijuana can help. So how much is there, really benefit from medical marijuana, i could spend, probably, probably a few hours walking you through the evidence it would be a very efficient way putting you all to sleep, which i will not do. There is a very carefully done, review of the evidence of both smoke marijuana and cannabinoids, both natural and synthetic. I may summarize the evidence more than i could reasonably do it a short period of time so i will tell you what they found. There is some evidence, but probably not as much evidence as a lot of people would like, certainly not as much evidence as many patients who are looking to medical marijuana relief would hope would be there. These are there reservations that mine, theres week evidence for some other indications. I remember looking at that list thinking thats a little bit odd, because thats not entirely opposed to what i said and stoned or the impression i got but it seemed like it was a little bit tougher, little more more harsh than what i had thought. I remember they said there is moderate evidence for medical marijuana for neuropathic pain so i took one study at random, a reasonably well done study published in a decent journal, it was a study that i cite as evidence and there seems to be a reasonable amount of evidence that medical marijuana is useful in the treatment of neuropathic pain. If you unpacked that a bit based on that journal article criteria there is notable strength, there is a controlled trial, placebocontrolled. They can remove the drug in marijuana just the way the like you can remove coffee from a coffee bean. Many of these studies use a placebo marijuana. It also used low and high dose groups, in that article they also part pointed out weaknesses, a small amount of subjects, some of the people in the active group and Placebo Group knew how they were assigned, they knew what they are getting. And that makes sense if you think about it, if you cant tell if youre getting real, honest to god marijuana or the pharmacologic equivalent of oregano, youre probably not paying attention. So some so some people manage to figure out what group theyre in. Those two weaknesses were enough to downgrade that study i was going to show you. So it degraded into a poor quality study. I dont mean to argue with those criteria, they can use whatever they feel are important but keep in mind those criteria are really tough, theyre also tough because right now theres no federal funding for medical Marijuana Research. Those of you who are researchers know its really hard to do large randomized controlled trials, this grading criteria that this article used call that a small study if there are fewer than 200 people. Thats pretty much every single study of medical marijuana thats out there. Its hard to do studies that will hold up to that level of evidence that jam article a call strong. If youre looking at the wrong criteria, when we hear discussions of evidence being weak, moderate, or strong its important to know as educated consumers, followed policymakers, followed policymakers, physicians its important to note that means. Rather than summarizing the evidence and talk about nuances i thought it be most useful to post this question for you, i think it gets to the heart of the debate of medical marijuana and how we should think about it. How much evidence do we really need . I think the answer depends on who you are. If your policymaker, if youre a hardcore researcher, the amount of evidence youd want to make sure that a new treatment, whether its a new cardiac device or a new form of medical marijuana, be sure that it actually works you would want multiple large, meaning several hundred people randomized controlled trials. If youre patient, as were many of the patients i spoke spoke with, one young guy in his 20s had a bad treatable form of lymphoma, he was having horrible nausea after every round of chemo there. That he couldnt couldnt even leave the house for a week. This is a 24yearold who is thinking about stopping his schema therapy and going into hospitalist because he couldnt stand the nausea, he he has been through several types of antinausea medication and his dr. Finally recommended he tried medical marijuana he said sure he would give it a try. I tell you that story because his level and threshold for evidence is going to be different and lower than that of an administrator at the fda, or a hardcore researcher. Im not saying one of those to his right, the administrator at the fda, his or her job is to protect the public, so their their job is to ask for the highest possible amount of evidence. If youre that kid trying to struggle through chemotherapy, or if youre a parent who is trying to get cbd oil for your kid with seizures or a guy that is suffering through ptsd, who has been through a dozen different medication, suicide attempts and need some form of relief, your threshold for what constitutes enough evidence is going to be different. Again im not trying to say one of those positions is better, i think whats going on is people know exactly how much evidence there is but they have a different tug point as to what constitutes enough evidence. So well think about that as we go forward through the debate. The other thing i learned thinking about the potential benefits of medical marijuana, and this is an oped i wrote to the New York Times for a brief period of time and its one of the most emailed articles in the New York Times. The head of it is an article about sending puppies to prison. The point of the article which has got a lot of traction has me to think a lot about what medical marijuana means, in light of the discussion we just had an levels of discussion. If it seems like the utilization of medical marijuana is getting ahead of the evidence, part of the reason for that is the Health System for the most part doesnt do a great job of taking care of patients who need extra attention, extra support, extra education, for symptom management. There many people from the Palliative Care team who i work with, i think we are able to do a pretty good job but in general thats their job. In general the Health System doesnt. Ive seen that a lot of the interest of medical marijuana not so much based on the belief of the evidence but having to go to a physician and not having time to address concerns and be in and out in ten minutes without having the support and the advice we need. Its a chance for many patients i have spoke with to begin to take control medical marijuana does have risks a few we are not sure about their other things we didnt expect. This is Something Else that is really not true, for those of you with medical training you will notice there is a logical flaw in this argument, marijuana doesnt have any risks, morphine is an opiate in poppies are flowers. Because marijuana is natural, because its a flowered has to be safe. This is honestly not true. A few known risk, addiction, i actually didnt think it was a significant risk of marijuanas certainly not as big of risk as cocaine or heroin but when youre looking at risk it, it could be similar to alcohol addiction. Theres a not syndrome are really dont understand that is about it could inhibit nausea and vomiting, it could be treated with a hot shower for reasons that i dont understand. No risk, a lot of unknown risks. These are listed in no particular order, honestly if we had more time id walk you through, as i do it stoned where i think the evidence lies for each of these. I think some of these are more likely than others, psychotic episodes, Myocardial Infarction and stroke, probably not, longterm cognitive dysfunction, i probably dont know yet but will find out the next few years, not cancer, not lung disease because those are the areas in which they had been a lot of large and very well done studies. I spent time talking with a test physician at ucla and he said some of the biggest, best studies of lung function over time and he said there really isnt any decrease overlong fiction, from chronic marijuana smoking. It makes no sense. The stuff that you inhale when you smoke a joint is exactly more or less, the stuff you inhale when he smokes cigarettes so why doesnt that cause emphysema . There couple of explanations, some theoretical cup probably the simplest one is the most obvious and most logical and that is the matter of dose. A stork in the virginia, many of the veterans i took. Care of it with smoke two to three packs cigarettes a day for 30 or 40 years. Often thats what it takes, the dose is what it takes to cause lung damage. Imagine what youd be like if you smoke 40 or 60 joints a day for 30 or 40 years. Your long function would be the least of your problems right. If you really manage to smoke that much which would take a real guts, real determination, if youre able to really smoke that much then yes you might end up with emphysema but in the way that most people smoke its really not a concern. Honestly edible, vaporizing is vaporizing is not a concern us all. Its worth pointing out that there some flaws in the data we have. Lots of case reports so somebody use marijuana recreationally and had something bad happen to them. That resulted in a case report and literature. That doesnt necessarily mean that marijuana use cause whatever it is, its possible to find case reports if you really wanted to on someone eating strawberry ice cream and then having a migraine. Is that causative factors that coincidence . It takes a lot to try to sort through that. The second point is probably one of the most important and that is we dont have very good safety studies on medical marijuana. There are lots of studies on Recreational Use but there are some important differences. Its hard and risky to generalize from studies of Recreational Marijuana use to medical use. And maybe have pathetically that a 24yearold uses Recreational Marijuana four to five times a week along with auger drugs like math and other things is at increased risk of a psychotic episode in the next two to three years. Does that mean an Administrative Assistance in the Oncology Division who uses marijuana once his week to get to sleep, she, she also at risk in the same way . I dont think so but we dont know. Thats the bottom line, the studies that have been done have been on Recreational Use in a very different setting. Many of the studies can control for all the other things that go on. So heres a challenge for you, something we need to think about as we begin to wrap up, ive tried to describe to bear medical marijuana use is common, there probably at least 1 Million People who are registered medical marijuana users around the country. For every person who is a registered user in a state program there probably several, maybe a dozen more who are nonregistered who or who are using non legally. So that 1 million is probably a low estimate. It would be great if we could track everybody who is using it and what they are using it for, it would be great if we had all those trials but we dont. Honestly well probably not have an Adequate Bank of Clinical Trials really in the next five or ten years, probably more. Again no funding for research it is going to be hard to build that bank of Clinical Evidence that. So what i want you to think about is how we can get better at crowdsourcing research, how we can get better at learning from the experiences that people have. Think about that 1 million registered users across the country, there is really no organized way to collect data about their experiences, theres no organized way to collect data on their longterm effects, side effects, and risks. There is a lot of expense out there going to waste. I dont know what to do about that, we we did this as an experiment to see whether it is to get patients to collect and report data both so we could than from each other and so researchers could learn from patients. If you see five reports of someone using marijuana for a benign tumor, thats interesting. But if you see 50 or 100, or 200, then some researchers are probably going to start paying attention and think going to start paying attention and think maybe we should do a randomized controlled. The advantages that we be using crowdsourcing to do research in the right direction. There really is a science out there, there are medical benefits, probably not as many as some dispensary owners claim but probably more than some of people who oppose medical marijuana would admit, it also has risks which Everyone Needs to admit. As i told you the risks are not necessarily the ones that you think about. Medication, we, i will leave that to you to think about and the panelists to help you think through significant benefits, real risks, hardest if the medication because one plant is one plant, its not a medication thats done in the same way as a pills dumper medication. There medication. There certainly are molecules in marijuana that do have real physiological effect and some of those effects are beneficial. Think about what terminology you want to use, hopefully ive given you enough facts related to science, related to benefits, and risks to think about. I have a few thank youse to many people who i interviewed along the way, including sasha the wonder dog who stands guard over this dispensary outside of california, its like the perfect local environments. All of the outpatients had a German Shepherd like sasha all of our patients would be happy. Limit stop there and thank you for being very attentive as i have walked through more science than you really wanted to hear. Especially this time of the evening but you have been patient so thank you for that. Next i am going to introduce our panel briefly. Im looking for jill for advice, am am i going to introduce ourt panel briefly. I left them all to come up, you have in your handouts there biographies. You have the bios, i will not walk to the bios, i will invite them to say a few words about themselves if there are elements their bios that underrepresent them. We have decided that well use first names so in the questionandanswer session as he began to pass questions for please refer to me as dave, to my far right will jones from washington d. C. , steve, and joseph who also joins us from philadelphia. Well ask them to do ten minute presentations, as they do if people have questions please pass questions forward to me, i will probably save those questions until i get through their presentations because i want them to have a chance to give them their perspective. Although ive tried to give you an unbiased view im aware that what ive told you could certainly be perceived as having one directionality over the other. I will give you a chance to set the stage a different way if you feel its appropriate. A few requests, and a reminder this is a topic that lots of people feel strongly about, either because you have political or intellectual leanings that are in a good grip direction, some of you have your personal Health Experiences or those of a family member, its something people feel strongly about. I would encourage you to be extra careful, courteous in your comments. Last but not least its not going to surprise you to learn after having looked at peoples bios, that that there is both a spectrum of use about medical marijuana before you and that will jones, its probably on more of the conservative end. And given how how many hands went up in favor of medical marijuana when i did that pull 30 minutes ago, i would ask us all to be particularly respectful of will jones, reminding us reminding us all that he is a guest here in philadelphia. I promised him that people in philadelphia are much mice nicer and more polite than the politicians he is used to dealing with in washington. I so promised him that we have better restaurants and that we had nicer weather, so two out of three isnt bad so please dont make me a liar that. I have no doubt that mr. Jones can take care of himself but he is a guest and i would ask that we all be respectful. Gentlemen do we have an order . Im glad because i dont have an order. [applause]. David is a hard act to follow so im going to call for help from a past president of the college of physicians. Doctor hobart who wrote in 1887 and published in the therapeutic gazette, clinical and physical physiological notes on the action of cannabis indigo. Quote cannabis has been before the profession for many years as a remedy to be used in combating almost all forms of pain, yet variations of found to exist to this activity it has not received the confidence which i think it now deserves. I agree president , they wrote these words in 1887, he was president of this college 1925 to college 1925 to 1928 when he wrote this he was a perfect presser of medical materials or pharmacology at jefferson. So lets fastforward to a more recent source of material medical this wonderful book called cannabis pharmacy published last year, it goes over many different medical conditions far more than on davids list as well is a discussion of dosing, strains, and methods of administration. Back when cannabis was a medicine, it was generally only available as tinctures, this is an example of a four to avenue cannabis and it takes its form prior to being banned for political and racial reasons in 1937. There were other forms, this comes from australia, a combination of cannabis and delegate on a which was used for excess mucus conditions and hey fever. The we have drugs for this conditions now. Cannabis was a part of american medicine even beyond the presidency and its in the middle upper row who i began to talk with. The textbooks i have is the principal and practices of medicine by sir william auslander, in 1914 addition. He was also a professor at the university of pennsylvania, the coauthor Thomas Mcclain was a professor at was a professor at Jefferson Medical College a few blocks away. This college sits in between them. So i want to quote one thing from this book, one of many things about cannabis and this is under cannabis indigo, under migraine. Cannabis is probably the best remedy, the most satisfactory remedy, we recommend a prolonged course of the drug. So cannabis was part of American History and is nothing is new under the sun it is being rediscovered. There is more to cannabis the plants, then cbd and chc, there any other cannabinoids which are present in small quantity and which influence the effect of the other cannabinoids, this is called the entourage effect or the whole is greater than the individual parts. As an analogy, one could have a diet of totally processed foods and take vitamins and live. Or one could eat very healthy foods, fresh fruits and vegetables, nuts, oils, and live and glow. The difference is the sum, or the whole is greater than any individual parts. Thats. Thats the mystery of the cannabis plant. In addition to several nap anoints beside cbd and thc the plant also can taints terpenes. Terpenes are found in other plants, there generally recognized as safe, they have activities and this is what gives different strains, different orders, different colors. Terpenes and cannabinoids together also have an entourage effect and this is the reason why one strain and another strain of the plant may have identical qualities or quantities of thc in cbd, but but the other cannabinoids and the other terpenes are going to make the difference in the therapeutic effect. For example, classic some of the restraints are some strains are considered sedating. Some with severe pain who cant get out of bed like one strain may be more useful for them, for someone with inflammation, arthritis, crohns disease, who wants to go to sleep, the indigos strain may be a better choice for them. I want to talk about a littleknown federal program that has been supplying medical cannabis very long time to a very small group of patients. This can represents 300 cannabis cigarettes, that the federal government has been giving to urban rosenfeld for about 33 years, urban road of book about it, called my medicine, and to help launch national movement. Medical marijuana, in large part is still to his efforts. He has a very rare bone disease and he discovered by serendipity that smoking cannabis worked. He tested this on and off, and sure enough it provided more relief for him than any other medication, including fda approved drugs. So i want to basically stress that there is a lot of ingredients in cannabis we dont know about all of them, but they are a fax from the plant that are not present in the isolated ingredients. Each strain has slightly different qualities, in fact they may be even referred to as a scientific treasure trove. Also our bodies systems from the implementation of a the earliest part of pregnancy to what stimulates the newborn baby to drink. Its the presence of the end of can have annoyed in the mothers breast milk that gives the newborn babel, the munchies that results in them getting nutrition. So so the endo cannabinoids system is a system that works by signaling, it helps restore imbalance, it helps some of the other neurotransmitters. In fact, people who use cannabis medically, can reduce their opiate use by perhaps up to 50 because of the interactions. Also opiate addicts who have access to medical cannabis are more successful in their recovery from opiates. Im sure youre going to have a lot of questions, we will be begun to scratch the surface. Thank you very much. [applause]. I am steve, i would like to thank david, joseph, joseph and will michael panelist here and also think the college for inviting me to speak. And on a personal note not having my picture next to a big revert. Thats all i need, as a lawyer. I represent a couple of Business People who are old interested in opening up dispensaries here and also some amish who are interested in growing hemp. Its an interesting dynamic, do i want to be a pot lawyer or a District Attorney who wants to represent cannabis. So again thank you for not having my picture next to a big pot leave. I was asked to give a bit of a synopsis where we are legislatively in pennsylvania. I will talk about some of the political movements, what a medical marijuana infrastructure would look like here in the state, and as a transition to will, will, some of my personal reservations here. Last year, we had a senate bill that passed unanimously through the subcommittee, it passed a 43 to seven in senate but stalled in the house. This wouldve been the medical cannabis act and got renamed when it was reintroduced and it came to be senate bill three. Were were taking it from 1182 to now three. We have reserved the title and this is now going to helps state veterans, our kids, traumatic brain injuries, cancer, very debilitating medical conditions that quite frankly we cant wait for the federal government step up to the plate. The Political Climate has changed here in pennsylvania, thats attributed to many factors. When i first started talking about medical cannabis in pennsylvania, there are a few significant poles, what people thought about medical cannabis in pennsylvania and then it was at 84 and 85 . Right now its covered in 88 and 89 of pennsylvania. That figure, people in pennsylvania at least with cannabis they dont just check a box are you a favor, are, are you against it, undecided, that figure translates to a ballots office. 100 of the politicians who put their name on the senate bill 11821 reelection on their primaries by a landslide. So 100 of the people who put their name on medical cannabis bill one reelection by a landslide. Those not them just bowing to graciously to political pressure, its people who are taking a great interest into medical opinions, 20 minutes today i can peruse the internet and medical societies that were supportive of this bill and legalization from medical purposes, i will send spend 20 seconds. American medical american medical association, American College of physicians, america california medical nurse associated california pharmacies third association, colorado Nurses Association, Epilepsy Foundation leukemia and the foam a society, state of new york, mississippi Nurses Association, New Hampshire Nurses Association asian, new yorkers association, state Nurse Association texas, and many others. The senate bill 1182 was then reintroduced by senators as senate bill three, this this again unanimously passed the senate subcommittee, it passed 427 in the full senate and it uses senate bill 1182 as a marker. It added chronic pain and other functions to help people with diabetes, it was brought over to the house and got stalled him house. Its currently being redrafted and being put into another bill. Under house bill 1432. We are hopeful that we will have it out of the committee by early fall, still having her fingers crossed. Senate bill three, which this will be the framework consecrated limited number of license of whose can actually open up dispensaries. People who are going to process the plants and people who are going to then sell it. Theyre going to be 65 license for groves, 6464 for processors and 130 for dispensers. Were expensive these nevers will be cut down which is unfortunate because theres over 12 mill people in this commonwealth. Compare 130 dispensaries to how many Liquor Stores there are, there are 601 Liquor Stores. Thats a. Thats a very arbitrary and low number. One of my fears is that someone in pennsylvania is going to be in an area where they cant get access to his medicine. Someone who wants to open up a dispensary is not going to be in a low patient area understandably. So far ready limiting the number of dispensaries, i fear tremendous for veterans who live out in the countryside. A couple of benefits of what were going to see in this house bill 1432, thats not, its not going to be a constitutional amendment. One of the things we saw in florida and one of the things we do not have full medical cannabis employed is because they try to push it there is a constitutional constitutional amendment. The reason for that was because they wanted to ensure patient protection, we can have another tom corbett come in and shut off our right for patient protection. So were going to sleep straight to the legislative process here. Next to senate bill three is not going to turn pennsylvania into california. In pennsylvania if a patient will need to have a preexisting relationship with a dr. In california have been told, if you have 75 you can walk off to a dr. With a good story and youre getting a recommendation. That will not be the case in pennsylvania, you are going to have a dr. With a preexisting relationship, youll have to go back for exams, this is a medicine quite similar to Everything Else well see. The next as this is not going to be cb be only cdb has got a lot of attention lately. There are hundreds of components and components, cbd does not get you high. It hasnt been shown, in pennsylvania children who suffer from epilepsy can have hundreds of epaulet dick episodes a day. Some lasting more than 20 minutes in duration, we give these kids up to seven narcotics, some which is xanax. Can imagine given. Can imagine given a 7yearold xanax . In colorado states where we have legal acts theyre getting cbd you cannot get high from it and its 200 to 700 episodes a a week, go down to 120. The problems we are now seeing is these kids who are addicted from xanax from birth because thats only been giving them are now seven to nine years old and theyre trying to get them in rehab from xanax. These these are the problems were having, we are going to be more inclusive, were going to be having things to help our veterans. The next thing well see and im just at the men one minute mark so ill give the transition to will. One of my concerns and when i saw the Cannabis Association in pennsylvania and was asked to be the chapter president we talk about the edibles. I have have friends have dispensaries in colorado and when i visited them, quite candidly i will give a segue to will one of my fears was seen the gummy bears and the gummy worms, and the cookies that are attractive to children. I have a three and halfyearold at home, hopefully sleeping and i think its frightening that we have medicine that could be a attractive and attracting two children. Im here with the organization smart approaches to marijuana which was founded by an adviser for three administrations, clinton, bush and obama, and the only Senior Adviser to the bush and obama administration. As we were also founded by congressman patrick kennedy. And ive, im going to start out here, my thoughts on marijuana just in general have developed immensely over the past few years. To be honest, im 25 right now, and, but, you know, a few years ago i did not have any conclusive view on the marijuana issue. I, you know, i knew it wasnt something that i wanted to do personally as a personal choice, but on the legality of it in medical marijuana and all of these things, i had no concrete position. I began to do some research for myself on the issue, and thats led me to be staunchly against legalization general, for Recreational Use. Were not talking about that tonight. But also against medical marijuana. Im going to explain my reasons for why i think that we shouldnt rush into medical marijuana as it seems that the tide today, the momentum is to lets welcome medical marijuana in. Im going to bring up a few reasons why we might want to put on the brakes and slow down before we welcome this with open arms. I would say that every person in this room wants anyone that can be treated by a medicinal component of the marijuana plant to have access to that treatment in a safe form. I dont think theres any person here that would, you know, stand up and say i dont want someone that could be treated by something in marijuana to be treated by that because, you know, marijuanas bad. I dont have any moral issues with the marijuana plant. I dont think its, like, a devils weed or anything like that. But i do look at, and im looking at this less from a, less from a medical perspective and more from a societal perspective. What is going to be the impact of medical marijuana on society. Whats going to be the impact on youth in our society of medical marijuana. And, again, its not so much the fact can people be treated by medicinal components in the marijuana plant. I think that we would all say, yes, probably so, and we need to do more research to see what can be treated by this. Our organization, s. A. M. , we definitely support research into this process, and ive met people as was just shared, especially kids that are suffering from epilepsy, seeing how theyre able to access the oil and how thats able to treat the epilepsy, i think thats a great thing that we should accelerate the research for that in order that they can have access to that and have a better quality of life. What i am very concerned about, though, is and i think we all should be concerned about this is the influence of corporations and businesses in our society particularly on this marijuana issue, whether were talking recreational or medical. Now, im going to bring up a reminder for all of us. It was not too long ago that there was another plant that was reputed to have many medical benefits. There were doctors endorsements as for as long of a list as you could wish testifying to the medical benefits of this plant, and we as a society welcomed it with open arms, and now were reaping the consequences of that. Im referring to tobacco. Theres on our site theres videos of panels and panels of doctors and congressmen testifying to the Medicinal Properties of tobacco and how its going to be this great thing. We let tobacco have a, purchase a great place in our society, and were now paying the cost at close to 500,000 lives per year are lost to tobacco. And my concern is not necessarily that people theres going to be, you know, deaths from marijuana, although, you know, thats another issue. Not going into that there. But the impact of an industry, an industry that profits off of addiction and that profits off of young users, unfortunately. The founder of n. O. R. M. A. L. , one of the organizations that lobbies for marijuana and medical marijuana, at Emory University he said were trying to get marijuana classified medically. If we do that this is a quote, just prefacing that, this is the quote were trying to get marijuana reclassified medically. We can do that, well be using the issue as a red herring to give marijuana a good name. Again, im not afraid that people will be able to be treated by medicinal componentings in the marijuana plant, but i am afraid of the industry thats emerging, particularly the one, the recreational one, but as well the medical Marijuana Industry which, as was already pointed out, in places like california its ridiculous. Npr wrote an article showing how in los angeles, for example, the number of marijuana dispensaries outnumber the starbucks. Theres about a thousand this article was done in 2009, but at that time there were about a thousand marijuana dispensaries in los angeles versus about 6700 starbucks. And this is a very profitable industry. Jermaine shivly, former microsoft executive, says he wants to create the starbucks of marijuana and mint more million theirs than microsoft. And we have to be very careful when there are big financial interests in a medicine or any other thing, but were talking about medicine this evening, that were not seeing skewed search results, that were not research results, that were not being blinded unduly by the push of billions of dollars which its estimated that marijuana could bring if its legalized across the nation. That were not being unduly influenced by that as we have been in the past. And i like to ask people a question. For example, lets look at the medicines that we do have. Would you grade our, how we handle medicines and opioid abuse across the nation, would we give it an a, a b, a c, a d, an p . A lot of an f . A lot of people say were not doing that great. A lot of people get addicted to the medicines we currently do have, and its becoming this certain states, opioid abuse is becoming an epidemic. And this is what im very concerned to see, that marijuana were already seeing epidemics with drugs that have gone through all of the research processes that are out there, that are fda approved and all of the Clinical Trials with the many restrictions that are required to become medicine. Were already seeing abuse with those things that are prescribed by doctors. We see abuse from that. Im wondering, what are we going to see when we welcome an industry that has very little restrictions in terms of a medicine, in terms as a medicine . Thats not fda approved. How will people even know if theyre really receiving medical marijuana . For example, the fda recently did a study on things that were supposed to have the oil in them, and only about 50 actually had what they said on the label that they had in them. A lot of people would argue that this brings, is a case for, well, lets legalize it so that we can better regulate it. But again, i would say lets first look and see how were doing with what we are regulating and ask are we ready to introduce a new drug that has huge financial incentive into the discussion . Now, we should do everything that we can for people that need immediate use, for example, kids with end epilepsy. They should have access to Experimental Research and treatment as were discovering this, but theres no reason to kind of give marijuana an exception that no other medicine has had, no other medicine can you selfprescribe, can you selfdose which is often, most of the time the case with marijuana. And we like to point out as well you dont have to smoke okay, ill put it this way. The way that medical marijuana is most often used is that its smoked when were referring to that. My times almost up. But you dont have to smoke marijuana or any other medicine to receive the Medicinal Properties of it. For example, we dont smoke opium to get the medicinal benefits of that. Likewise, we shouldnt have to do that with marijuana. So in conclusion, we are i think everyone in this room would be in agreement that we need to do everything that we can to see that marijuana, the marijuana plant like any other plant is responsibly researched and available for people that can be treated by, treated by it. But we have to be very careful, very careful that corporations are not unduly influencing our quick acceptance of this drug that has the loosest restrictions for any medicine that we have. And, again, were already having a problem with opioid abuse across the nation. Are we going to add to that problem on a massive, nationwide level, and i dont even have time to go into the, you know, potential downsides as well, but some of those were touched on as well. Are we ready to welcome that on a national level, or are there more responsible ways forward than having legislators say we can, that we are going to determine what can be treated by something thats not approved by fda or anything else and let people decide for themselves . So were really encouraging us lets put on the brakes and take a responsible route forward with this plant. [applause] thanks very much. That worked out much better, honestly, than i thought it might. Not sure why i thought that, but i think those dovetailed perfectly, so thank you, gentlemen, for taking the time to prepare those statements. Those of you who have questions on notecards, if you could pass them to wherever you see the beautiful and talented jill staal, pass it in her direction, she will collect, sort, shuffle and then hand some to me. While were waiting, a couple of questions we already have that have been used to stack the deck which requires me to choose. Let me ask this question, actually, of everybody and give everybody a chance to weigh in briefly. So if medical marijuana becomes legal in pennsylvania or potentially in other states, should physicians who have a moral, ethical, medical objection be allowed to opt out and not to provide those recommendations . Maybe ill ask each of you in whatever order you choose to weigh in on that, or you can pass if you want. Joseph, do you want to go first . Of course physicians can opt out. The simple ising analogy simple analogy is most gynecologists wont perform therapeutic abortions. Most internists wont prescribe cancer chemotherapy. So, of course, yes, physicians can opt out. Thanks. Sure. I dont have any problem with it either. Just as david had alluded to in his introduction, medical schools dont teach outside of california, they dont teach this. And if a physician doesnt feel comfortable and knowledgeable in this area, we shouldnt force them to do it. And, yeah, i would be in agreement. If if a physician does not feel it is good for his patient, theres no reason he should have to prescribe that for the patient. Thanks. So another question, this is for will, and ill try to work these around if other cards come in, ill try to choose them so we dont put any one person on the hot seat more. But this is a question that we got from the audience that i was curious about, will, for you. And that is that, certainly, there are and im paraphrasing a little bit, but there are other substances out there, alcohol, tobacco which you mentioned which are also addictive and also have health benefits. And this sounds like a leading question, but i dont think it was meant that way, and i certainly dont mean it that way. Are there ways in which marijuana is different that makes you more concerned about it than about alcohol or tobacco, or is some of your resistance to legalizing medical marijuana and Recreational Marijuana, essentially, expressing the same concerns that you would have about alcohol and tobacco . In other words, is marijuana different, or is it all part of the same Public Health concern. Does that make sense . Yes. Love the question. One thing i think thats different about it is that im alive now and have the opportunity to speak up and Say Something about this issue whereas in the time of alcohol or tobacco i was not alive. I did not have the opportunity to speak up or research, and, you know, say maybe we shouldnt do this so quickly. So just in terms of timing, thats one way i like to see it, just that it is very different. Whats happened with alcohol and tobacco in the past is what happened. We cant, you know theyre embedded in our culture, theres, you know, culture and all these other reasons why we tried prohibition with alcohol, and you cannot, you know, it didnt work. Now, in terms of medically speaking there is a difference with marijuana. Many studies in, for example, the lancet psychiatry journal and other medical journals point out that marijuana can have and, again, the debate rages back and forth, so im not going to say that, you know, the studies that i cite are the only studies out there. But for every study that would say, you know, theres great things to it, theres also studies that are showing, again, the lancet recently published Research Showing that it can lead to an eightpoint iq loss, that it can lead to psychosis, that it can lead to schizophrenia. There are many personal stories about how marijuana has personally helped, and people share those anecdotal stories. I can also share an anecdotal story about a close relative of mine, my age, that started using marijuana and now has mental issues. So we have to realize that theres a difference. Back does not impair your driving, you know . Theres no really studies showing that its going to impair your driving which would cause you to endanger other people. Theres other dangers with tobacco. But there are definitely, you know, differences in marijuana versus the others. And not so much, again, that i would say it has to be treated differently. If it was in my book, id say lets take them all out of main street, lets take all the Liquor Stores off the corner, lets take out all the tobacco advertising, so i would be consistent. But my consistency wouldnt be to make it easily available to everyone. Great, thanks. Another question, ill do my best to sort these on the fly. We will not just for claritys sake get to all of these. If you can see the podium in front of me, it looks likely professor judith explained to you a few minutes ago had a really, really bad grading afternoon. Its just a mess up here. So we wont be able to get to all of these. But could i get you maybe all or some of you depending on how strongly you feel about this to weigh in on this question, which again, ill paraphrase a little bit. There is a movement in many states toward legalization of medical marijuana. There is also increasing interest in Recreational Marijuana. Certainly, thousand legal in colorado now legal in colorado, oregon, alaska, i believe, and other states are certainly considering it. Is that a potential problem for some of the discussions weve been having about very, very careful use about marijuana as a drug . Is it a problem . And how should we this is not on the question, but im asking this how should we deal with that . Yeah. This is a question that ive thought about a lot. If a state has specific criteria for medical cannabis use and the patient does not have one of those conditions but the state also has a recreation alcan bit provision Recreational Cannabis provision, then they can pressure cannabis be on the recreational side, pay the tax in colorado its 25 and have the same product ideally that is qualitytested, quantified and certified to be free of pesticides, molds and toxins. So the answer is recreational can certainly help the medical patient. Finish. I think the two issues are frequently conflated, unfortunately. The only thing that medical marijuana and recreational, adult taxed and regulated marijuana have in common is the word marijuana. My interest tonight and hopefully the scope of this debate is getting medical, safe medical access to those who need it most. There are those who are strongly for and against expanding that to having adult choice, and they would cite a multitude of reasons for that. Some of which, i mean, theyd just cite statistics of whats going on in colorado right now. Theyre seeing a precipitous and dramatic decrease in violent crime, in burglaries in downtown denver. This is the epicenter of the legalized Marijuana Movement in the country if not the world. And theyre seeing increased tax revenues, and theyre actually seeing decreased traffic fatalities. But, again, i want to go back to the fact that i think this we need to avoid conflating the issues. Something that will had brought up in his concern was the impact; specifically, the impact in children. I would encourage everyone to take a look at an article put out in forbes last month, june 15th, citing a study from columbia university. And this study, it was a 24year study, 48 states, one million kids 1318, and they have shown rather conclusively that legalizing cannabis for medical purposes does not increase teen usage. Quite the contrary. Actually, theyre showing that its going up everywhere, teen usage is going up everywhere except for the states that have legalized it for medical purposes. Perhaps i mean, this is speculation on my part its how the narrative is being shown. Were showing kids that this is medicine. Theres a difference between use and abuse. And when we show that this is medicine, that this is for sick vets and our sick kids and people with aids, cancer, hiv, etc. , its no longer viewed as a party drug, and kids dont use it. So there are many reasons to legalize it for beyond medical purposes, but tonight my focus and hope in this discussion is for medical purposes. Yeah. If were talking about Recreational Use, i could go on all night about why i think thats a terrible idea. Again, not based on thinking its some moral evil, but on the impact thats going to have just on society based on different studies that are out, so on and so forth. Not going to go into that. Its interesting that in a lot of states that have medical sorry, in the states that have Recreational Marijuana, the market for medical marijuana is sharply dropping. And one could say that, you know, theres no need then to get the medicine kind, no need to go to the dispensary, you can get it at, you know, the closer shop or what have you. But i find it interesting if somethings truly a medicine, do we become comfortable then just buying it from a nonmedical place . And i think that points to the fact that, you know, we dont really know what were getting in these. This is not a dosage type thing, this is not a prescription type thing. And for some for a few people they try very hard to do it that way. But, again, its not its unregulated. Theres no standard on these things. And so the reality is that medical marijuana for many people is just like Recreational Marijuana. In terms of pure number of people that get, just the pure number of people that get medical marijuana cards across the country. Now, again, theres some people that with very terminal illnesses, kids with epilepsy that are not using it recreationally, but just in terms of pure numbers, most people that are right now saying that they have for medical purposes, its really a, its been a guise. And studies id be happy to share the articles with, you know, anyone afterwards if they want, show that the average user of medical marijuana is a white male with selfreported back pain. So i think its very interesting. Our perspective is that medical marijuana is to create a broader social acceptance of marijuana so that we can then get to the real moneymaking scheme which is recreational legal marijuana. Okay, great. Thanks. Im going to switch gears a little bit and ask questions pointedly at one panelist or the other, so try to keep this moving a little bit more quickly and also give maybe some time to point out some different views and see if that works. So to steven, a question for you. As weve discussed i think in all the presentations, state laws identify qualifying conditions. Those state laws often vary, so whats a qualifying condition in colorado might be in california and may be in washington or vicar is saw. Vice versa. This question relates both to that and, i think, broadly to whether you think its a good idea that state legislatures should be determining what the qualifying conditions. Theres actually a second part to that which is whether as states begin going down that road rather than having state laws determine qualifying conditions, how you think there might be benefits or risks potentially to having either a state medical board or another organization that can make more realtime decisions about whats a qualifying medical position rather than requiring a change in law. It was kind of a convoluted translation of what was actually a fairly simple question, so apology ises for that. Does that make sense . The twopart question as i understand it, the first part is you take a look at different medical marijuana bills across the united states, some of them specifically enumerate conditions. If you have one of these conditions, you can get access to cannabis assuming you actually have this condition and you meet with a doctor whos willing to write a recommendation for it. First is are there more liberal laws, perhaps, that leave it up to a doctor to decide should you get access to this or should you not get access to this. On a personal level and i hope everyone in this room would agree with me that i view this as a medical issue, not a political issue. And i dont know about you, but if im in hospice, i dont want a politician in harrisburg making medical decisions what i can do and put in my body. I [applause] i would hope that people are, who are making these decisions are physicians. And if, if we read dr. Davids book, im sure were seeing that many physicians are not trained in this yet. If if physicians, people we trust our lives to to make medical decisions dont yet understand this drug, how can we expect politicians to make and understand these drugs . So one can make an argument that we should leave it up to doctors to make this issue, given that its a medical issue not a political issue. That having been said, im a realist, and i live in the real world as we all do, and often times we unfortunately have to make political concessions, unfortunately, at the rights and on the backs of sick pennsylvanians. I mean, if we were to take a look at the thensenate bill 1182, there was three pages of qualifying conditions. Everything under the sun that has been used in other jurisdictions. And i was privy to some revisions to this, and people actually took a red line to hiv and aids. Meaning someone in harrisburg decided it was a great idea, hey, you want my vote on 1182 . Take out aids and hiv. This is the type of political posturing that our commonwealth, unfortunately, is right in the midst of. Its not big tobacco thats doing this, its people with, you know, all sorts of agendas and ties to Big Pharmaceutical Companies that the head of the house health department, no secret, mr. Matt baker, has accepted 22,000 plus in big Campaign Finance donations from the likes of merck, astra general ca, big pharmaceutical companyings. And he is companies. And hes the responsible party for not blinging it out of the brings it out of the House Health Committee and allowing, literally are, people to die. So im hesitant to allow or to, you know, tacitly agree to allowing a list of minimallyqualifying conditions but, unfortunately, thats going to have to happen. But fortunately, our legislature, they recognize that they are not physicians, and this body of evidence is constantly expanding. And so we need to have an Oversight Board that acts with great transparency to review the now medical evidence and evolving medical evidence to expand these criteria. And im sure joseph can speak at better length of who would make a good fit to that. You know . You want to take it . My very simple answer is that having patients with chronic diseases on a medical board would really appeal to me for the obvious reason. They are suffering, they may have information from other people with similar disorders, and thats all that i want to say on that. Thanks. Okay. And i would agree that it seems bizarre that politicians would be deciding who gets medicine and, you know, especially with the wide variance across states of what qualifies as medical marijuana. We dont, again, we dont treat any other medicine like that, so im kind of scratching my head wondering why marijuanas getting this pass . Of course, my solution is that its part of, you know, part of recreational. But i dont think it should be left in the hands of politicians to decide who gets access to certain medical treatment. What i do think would be much better is if we do it like any other medicine, and there are many other options for moving forward with Marijuana Research that were, to be honest, not exploring that were, to be honest, not exploring because another unfortunate reality for those that differ with the marijuana agenda as we see it, theres a lack of funding for those that disagree with the legalization stance. But i will bring up, for example, another medicine that received an exception to move forward, this was marinol. It had 20,000 patients, it had 3,000 doctors that participated, it used thc, so it was a schedule i substance. And compassionate treatment was, again, for those over 20,000 patients who were able to use that while they were studying something that was under schedule i. They put it in schedule c after there were the proper medical trials to show that it was effective, then it was removed from that special category, and people can now access that. I think thats how we should be moving forward with medical marijuana, or i prefer to say the Medicinal Properties of the marijuana plant. It should be done in a medical way, not in a political way at all. Chris, thanks. So we have about ten minutes left, a little bit less. We have about 18 questions, to so do the math, gentlemen. Ill direct questions at each of you, ask you for very brief responses, and then well try to get on and try to get through at least maybe three of these if were lucky. So, dr. Joseph, should medical marijuana be covered by Health Insurance . You dont have to do just a yes or no, you could probably explain your answer a little bit. Im going to leave that between the individual patient and their Health Insurance company. Do you think Health Insurance should be obligated to pay for medical marijuana in the same way they pay for statins or beta blockers . A softball for you. [laughter] i think that thats more of a political question. But i think that if cannabis is the answer is i dont know. Its not really a medical question. Oh, i think it is. Well, let me weigh in. This is not my question, but i loved it, so im going to weigh in and answer which is, yeah, i think you can make an argument they should for a couple of reasons. One, it has medical benefits, right in and number two, we know or at least i think i know there are lots of patients out there who are stopping their medications and switching to marijuana instead. As joseph said in his presentation, people like to use medical marijuana. Theres data that it gets you off opioids. The Health Insurance Companies Pay for the opioids, but theyre not paying for the medical marijuana that youre buying at the corner store, then the Health Insurance companies are making money off the medical marijuana. I think that argument could be made. [laughter] youre still taking the fifth. Okay. [applause] mr. Jones, what about diversion . Weve talked around it a little bit, but how much i know this is something were probably all worried about to some degree, but how much diversion do we know is actually going on right now from medical to people who are using it recreationally in states in which its not legal . The lines are very, very blurred because it depends a lot on what the qualifying conditions are in a specific state and whether its something that someone can pretend that they have or its actually verifiable that they have this certain illness. But, again, theres places like california as i think you mentioned earlier, its pretty much de facto legalization there. So theres a broad spectrum. Theres also states that have very restrictive medical marijuana laws. So i would say that the abuse of medical marijuana for Recreational Purposes is a lot harder. So it really depends on the specific legislation and the respective states as to how much is being done. But on a pure again, just on a pure numbers overall across the nation from the studies that have been done, there are some, because i know there are some that would say otherwise, but some studies that are showing that the vast majority of people that say that they use medical marijuana its for Recreational Purposes. Thanks. Steven, one question from the audience. We talked a little bit about the number of dispensaries recommended in the current bill in pennsylvania maybe not with as large as maybe not be as large as it should be. Whats an optimal number . Its an unfair question, obviously, but maybe the question underneath that is how do we begin to figure out what the appropriate number of dispensaries would be to provide open access . Is there a formula that doesnt involve the number of state liquor board stores near you . Theres a couple ways to approach that issue in terms of how many dispensaries there should be. We can take a look at population densities, but more specifically lets take a look at patient counts of where these people are. Perhaps theres actually, ive been told i havent independently verified this, but philadelphia has the fourth largest concentration of hivpositive people in the united states. I dont know the thats true, thats just what ive been told. Perhaps we would have more dispensaries located in this area of the state. But certainly at least one in every county. I mean, people shouldnt have to be expected to drive an hour and a half to get medication. Okay, thanks. So i have one last question for joseph, and then ill ask each of you to maybe say 30 seconds to a minute of wrapup statements. Im giving you a chance to prepare and then, joseph, you want to go last on that angle to give you a little bit of time to think. So, joseph, the question focused for you is if medical marijuana becomes legal in pennsylvania or as it has in other states, what sorts of barriers do you see that well face in encouraging, cajoling, nudging physicians to embrace or at least consider medical marijuana as a therapy . Thank you. Thats an excellent question. Medical [laughter] education is really important, and medical education comes formally through continuing medical education credits. It also comes in other ways, from are listening to your patients from listening to your patients and reading some of the nonspecific medical literature. So i want to very briefly address it. The medical education is part of the board exam for the American Academy of canaan void medicine is excellent. As far as listening to your patients, i wrote a recommendation or a medical history for a patient out of this state, in fact, out of this country, and i watched him medicaid for multiple sclerosis. He had two types of pain. One went away immediately with the first inhalation, the second changed in character. Thats learning from your patient. And the third is from other sources. Will pointed out that medical cannabis is really just an excuse to get on the recreational side. I think its the exact other way around. That many of the socalled illegal users because we dont have it are really selfmedicating. So lets go down with the industry of the drug pushers, of the drug importers, of those who poison cannabis with pesticides just to sell it and have Clean Cannabis that patients can use without fear of arrest that are certified as to their ca nabi nowed content and being free of pesticides. [applause] [inaudible] excellent clapping. So that will suffice as your closing comment, yes . Perfect. I dont think youre not going to be able to top that. [laughter] so i would just, i would just run with it. [applause] closing comments, though, from steven first and then will. Sure. Brief, 30 seconds to a minute. Brief. Again, thank everyone for coming out, giving us your attention and, again, especially taking care of our guest will over here. Were the home of the boobirds, we have a jail and a court in our state [laughter] and were taking care of our guest here, so thank you and thanks again for having us. Just in brief summation, take a look at whats happening in other states and whats being done efficiently and effectively. Were not seeing zombies walk the earth here, that kids are having safe access to nonsegway cannabinoids, and were seeing 24 reduction this opiate use. Were not seeing big cannabis, i mean, whats the alternative, a cartel . I mean, lets take a look honestly at colorado. Were seeing decreased crime, both violent and in burglaries. Whys that . Its because the cartels are wholesale leaving colorado, and theyre going elsewhere. I would posit to everyone in this room that you cant even get Mexican Ditch weed in colorado if you wanted to. Instead, patients are getting safe access to medication that has been tested for efficacy efficiently for mold, and theyre giving safe access to alternatives that are heretofore our medical industry has been failing on. Thank you. [applause] will, truly the last brief word. Its been a pleasure to be here to participate in this discussion. I think that myself and everyone here wants people that can be treated by any medicinal components of the Marijuana Plants to be able to have access to that, and i think we all want it to be in a medical way. And i think that too often though the discussion on marijuana whether its legalization or medical marijuana goes into false dichotomies and easy answers. I think that if we just look at, again, the wide variance in medical marijuana laws across the u. S. , that it shows that this is not really medical, how were going about it. I think theres ample evidence, again, with other drugs that were very restricted but that went forward with preliminary studies for people that really needed what they were studying that we can follow with marijuana as well so that, again, those that need it can have that. But the medical marijuana laws as they stand and as were seeing medical marijuana move forward across the country, i dont see very much thats very medical about it. Its opening, its basically allowing people to use marijuana if they feel it will help treat something that they have. And so i say lets either just go all the way and say legalize marijuana and then well deal with making it medicine later. But i think calling it what were having right now, medical marijuana, is not properly in the category. So, you know, i think it would be, again, more honest to say lets have legalized marijuana or not versus medical marijuana as were seeing it across the country right now. Great, thanks. [applause] so thanks to all of you, thanks to our panelists. George has a few last words, but i i just wanted to thank you personally myself for being a great audience, for sticking around to the almost bitter end, for being thoughtful, for being curious, for asking great questions, most of which i regret we didnt have a chance to get to but which well have a chance to ask the panelists later. Its really easy, ive found, to have an opinion about medical marijuana. Its even easier to have a really strong opinion. Its a lot harder to think and process and listen and ask the right questions, and i really applaud you for doing that, and i applaud our panel for helping us all do that tonight, so thanks. [applause] i can think of no better place than the college of physicians in philadelphia, the oldest professional society in the united states, to have had this discussion this evening. I also want to say that i hope i never need his professional services, but dr. Casaretts manner, style is just wonderful, and [applause] im going to put in a prepublication order for his novel which i suspect is going to be just amazing. I want to take chairs prerogative here. Full disclosure, amongst other things im an addiction psychiatrist. Some of the worst things ive seen in Emergency Rooms have been people who thought they were smoking marijuana and were actually smoking lots of other really, really bad things. Secondly, one of the things that i as a physician am concerned about is that there are many physicians perhaps who are capable of treating addictions and capable of treating very severe championic pain but chronic pain but dont want to because they really dont want guys with gold badges showing up in their offices. And its a very significant discouragement to people in the medical field. Do i think we should be regulated . Yes. Do i think selfregulation is sufficient . I wont give you my opinion. But thats a real issue. I also think its important, and will jones referred to it very gracefully and didnt go there, but in a city with such Significant Health care disparities on both sides of the examining table who are the patients and who are the treating people, the socioeconomic and ethnic differences about drug use and access to medications are very significant. This fall were having a program here on the pricing of pharmaceuticals. Just simple molecule drugs. Next spring were having a program on biologicals and things that have somehow come in under the orphan drug act which are bankrupting, frankly, our systems. Thats a political statement. I shouldnt make them here as the head of this place. But i would invite you to come back and listen to that. And the socioeconomic disparities of access to medicine, the use of illicit drugs, etc. , i think, is something worth considering. I think our panelists did a wonderful job. I wish more of our fellows had been here tonight. I want to thank jules staal for her tremendous work in organizing this and the hospice and the Good Shepherd partners for sponsoring this. Look on the back of your programs. We are a medicallybased organization. We sometimes have fun. Were having a beer party at the end of august. No medical if you want to talk about alcohol, sure, we can do that. Therell be three of us. [laughter] later were having in honor of the popes visit a discussion by a faculty member of Jefferson Medical College about the shroud of turin. People i know who have heard this talk have come out sort of thinking differently than when they walked in, as we hope you did about medical marijuana tonight. And then well talking about louis pasteur. Everything we do is at www collegeofphysicians. Org. And i wish you all well and godspeed and thanks. [applause] [inaudible conversations] every weekend booktv offers programming focused on nonfiction authors and is books. Keep watching for more here on cspan2 and watch any of our past programs online at booktv. Org. Nation magazine correspondent ari berman is next on booktv. He looks at the years following the passage of the Voting Rights act of 1965. August 6th