The Medical Marijuana Mess

A Prescription for Fixing a Broken Policy

John Hudak

• Publisher: Brookings Institution Press
• Year: 2016
• ISBN:
  9780815729556
• Topic: Medicine
• Subtopic: Health Policy

The uncertainty and inconsistency surrounding federal and state laws for medical marijuana use, distribution, and research is placing unnecessary obstacles in the way of suffering patients, their families, and the people trying to help them.In The Medical Marijuana Mess, senior fellow John Hudak illustrates the extreme dysfunction of medical marijuana policy through two different narratives: the Collins’, who make the painful choice to split up their family in order to treat their daughter’s debilitating epilepsy with CBD oil, and Rabbi Jeffrey Kahn, a medical marijuana dispensary owner who encountered unimaginable obstacles, scrutiny, and personal liability in order to help other patients in need.

THE BROOKINGS ESSAY

THE MEDICAL MARIJUANA MESS

A prescription for fixing a broken policy

JOHN HUDAK

Contents

An Ancient and Honorable Medical Tradition

First Do No Harm

Legal Limbo

The Research Gap

The Information Gap

Business Limbo

Comprehensive Reforms in Three Areas

About the Author

Copyright

IN 2013, PATRICK AND BETH COLLINS WERE DESPERATE. Thirteen-­year-­old Jennifer, the younger of their two children, faced a life-­threatening situation. In response, the Collins family took extreme measures—­sending Jennifer thousands of miles away in the company of her mother. Beth and Jennifer became refugees from a capricious government whose laws threatened Jennifer’s health, the family’s safety, and the life they had built together.

Beth and Jennifer did not run from crime or war or famine. They did not flee from some country ruled by a murderous despot to a less dangerous place. They are Americans who found it necessary to move from their home in Virginia to another state in order to seek treatment for Jennifer’s serious medical condition—­a treatment that was illegal according to the laws of both Virginia and the federal government.

And so, in December 2013, Beth and Jennifer said goodbye to Patrick and to Jennifer’s older sister, Alexandra. They moved to Colorado, joining thousands of other people who’d gone there wanting to avail themselves of one version or another of this taboo treatment: marijuana-­based medicine. Their hope? That Colorado cannabis would do what prescription drugs could not—­treat Jennifer’s epilepsy.

An Ancient and Honorable Medical Tradition

Patients like Jennifer Collins seek out medical marijuana every day. In the United States, it is currently only available in certain states, for certain people, and under specific conditions, though the number of venues where it can be obtained has been growing ever since California legalized medical marijuana in 1996. At the time of writing, 22 other states and the District of Columbia have followed suit. Privately owned but state licensed and regulated dispensaries dole out medical marijuana in most of these places.

Jeffrey Kahn, a congregational rabbi, owns one such supplier—­the Takoma Wellness Center, which is described on its website as “D.C.’s Family-­Run Medical Marijuana Dispensary.” A five minute walk from the owner’s home, it also happens to be located just six miles away from the White House. Like many such owners, Rabbi Kahn feels he is providing his customers with a critical medical treatment. In fact, his decision to go into this business was inspired in part by the suffering of his in-­laws. When he opened the Center, he dedicated it to them. Their 1952 honeymoon photo—­which could double for a black-­and-­white beach movie still—­hangs in a prominent position across from the welcome desk. A half century after that photo was taken he watched them suffer and eventually die from serious medical issues. His father-­in-­law had spent decades battling multiple sclerosis—­a battle occasionally alleviated by puffing on black-­market marijuana. His mother-­in-­law had lung cancer. The doctor who diagnosed it told her she might be able to mitigate the devastating effects of chemo and radiation by using marijuana. But she died before the family could find a dealer.

Those experiences gave Rabbi Kahn a new perspective on pot, and a desire to serve those in need of it. Now he has patients suffering from the same illnesses his in-­laws died of who are finding relief at his dispensary.

The federal government, however, views the rabbi not as a health care provider offering much needed treatment to the afflicted and the vulnerable, but as a drug dealer. A mild-­mannered, middle-­aged gentleman, Rabbi Kahn is a devoted husband and father who bears no resemblance to the stereotypical marijuana dealer. Nor does his dispensary resemble the stereotype of a drug-­dealer’s place of business. The Takoma Wellness Center looks part pharmacy, part acupuncture clinic. Though the smell is quite different—­the aroma of disinfectant replaced by the scent of grade-­A cannabis—­the Center is clean; it is welcoming; it is relaxing. The waiting area could double for that of a doctor’s office, and the experience of being in the consultation room with Rabbi Kahn is very much like what happens in a doctor’s office as well. Rabbi Kahn spends an hour or longer with each new patient, getting to know her, her diagnosis, and her previous experience with cannabis. Only then does he begin to map out a plan of action.

Takoma Wellness may be less than three years old, and its business an exotic novelty in the District of Columbia, but Rabbi Kahn is part of a long line of healers—­some of them religious leaders like himself—­who have been treating the sick with cannabis for millennia. During earlier eras, marijuana was much more commonly recommended for medical purposes than it is now. Five thousand years ago the Chinese, for example, were using cannabis as an appetite stimulant, pain reliever, and anesthetic. British physicians used cannabis for a variety of illnesses and disorders, even administering it to Her Majesty Queen Victoria for pain. As recently as the early 20th century, doctors in the United States, too, found medical applications for marijuana, using it as an anti-­convulsive drug, a pain reliever, and an anti-­inflammatory.

First Do No Harm

When Jennifer Collins showed signs of a serious disease, her parents counted on modern medicine to provide the best care possible. The medical community not only failed them, it could even be said to have violated the Hippocratic Oath, because the side effects Jennifer suffered from the legal medicines her doctors prescribed for her condition—­Jeavons Syndrome—­did little to help her, and much to harm her.

The most distinctive symptom of Jeavons is a series of short seizures with jerking movements in the eyelids and eyeballs. The seizures are frequent and can occur spontaneously, or because of something as simple as seeing a bright light or closing one’s eyes. It is a lifelong disorder that can only be managed; there is no cure.

Luckily, most people have never heard of Jeavons Syndrome. It is a rare form of epilepsy that can be debilitating in severe cases. Jennifer’s case is severe.

Her seizures began when she was quite young. When Patrick and Beth noticed the jerking motions in her eyes, which were occurring in short stints over dinner and at other times during the day, they took her to a neurologist, who diagnosed her with a mild form of epilepsy. For several years, the condition was manageable. Seizures were few and Jennifer was living the normal life of a girl her age.

Over time, however, Jennifer’s condition worsened. Sporadic eye twitches gave way to dramatically more frequent, more noticeable seizures. Some days, these small seizures would occur in dense clusters—­close together and in rapid succession. There were days when Jennifer had more than 300 seizures, as many as 15–­50 of them in the space of an hour. On New Year’s Eve 2011, one of those clusters led to a more dangerous, full-­body grand mal seizure. This was her first grand mal seizure, but it would not be her last. Soon she was having repeat episodes.

When her condition was mild, her parents had opted to forego prescription drug treatment, largely because the possible side effects alarmed them. As Jeavons began to affect Jennifer’s daily activities and quality of life, however, they knew they had to change course. The doctors they went to prescribed anti-­seizure medications, which Patrick and Beth opted to give to her, despite the potential side effects, in the hope that they would relieve the worst of her frightening symptoms.

Eventually, they found themselves consulting a seemingly endless round of specialists—­pediatricians, neurologists, epileptologists, psychiatrists—­who put her on a constantly changing regimen of drugs, in a perpetual search for something that would work well and cause minimal collateral damage. But all that came of these efforts was an ever sicker, more frightened pre-­teen, taking prescription drugs that brought virtually no relief.

Jennifer’s seizure disorder is considered “intractable.” That is, it is not well treated by conventional drugs. Clinically, it is said that Jennifer failed a dozen different medications. In reality, each one failed Jennifer, who continued to suffer hundreds of daily seizures, as well as the side effects of the drugs.

As time went on, the cumulative effect of all these drugs, and of the high-­fat diet recommended as a treatment for seizure disorders, changed Jennifer dramatically. She became depressed. Once a gifted and talented student, she saw her grades plummet as the medications caused cognitive impairment and decline, undermining her ability to think and learn. The special diet she was on caused her to gain 30 pounds, which only compounded her depression. One drug regimen resulted in Jennifer planning suicide. Another drug sent her into spontaneous, manic rages, during which she physically attacked her mother, father, and sister.

Since none of the doctors or their drugs were able to help Jennifer, Patrick and Beth began to research alternatives themselves. They read books, consulted online resources, and spoke to doctors in other parts of the country.

One alternative that was suggested was marijuana. Medical marijuana comes in many forms, some of them intoxicating, some not. Intoxicating products are those rich in psychoactive chemicals, namely THC. The non-­intoxicating versions have been stripped of those psychoactive chemicals. Patrick and Beth read that one of marijuana’s non-­intoxicating components, CBD (cannabidiol)—­had been used in treating epilepsy, even in children. Desperate for help, they were willing to do what they would previously have found unthinkable: give their daughter marijuana.

There was a problem, however. Despite the fact that board-­certified neurologists told Patrick and Beth that Jennifer might get relief from medical marijuana, they could not give it to her. Under federal law, marijuana—­even its non-­psychoactive chemicals—­is illegal under all circumstances. While many states have defied that prohibition and legalized access to medical marijuana, Virginia, their home state, was not among them at that time. Virginia law held that distribution of an ounce or more of marijuana to a minor was a felony punishable with a mandatory minimum sentence of five years in prison.

Nor would it have been an option for them to take Jennifer to Rabbi Kahn’s dispensary, a mere 30 miles away from their home across the Potomac in Northern Virginia. Not only was possessing CBD oil in Virginia a felony, but crossing state lines with marijuana was—­and still is—­a federal offense.

The Collins family had come face-­to-­face with a public policy that threatened the well-­being of their daughter. They’d discovered a substance that might provide her much needed medical help, but their government—­at both federal and state levels—­told them she was not al...

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