I am a clinical gastroenterologist, practicing at Emory Midtown Hospital for 35 years. I am the managing member of Atlanta Gastroenterology Associates. We practice throughout the greater Atlanta area and Athens and have about 82 physicians, 30 PAs and nurse practitioners and 550 employees. We treat a large number of patients with Crohn’s disease, and the work of the medical cannabis commission is of great importance to me and my colleagues.
There are two issues I would like to address today: Crohn’s Disease and the role of medical cannabis as a therapeutic agent in the care of these patients; and the use and regulation of medical cannabis in Georgia.
Crohn’s disease is a chronic illness. It affects children, adolescents and adults and is characterized by inflammation of the small and large intestine. There is no cure; it is managed by medical therapy and surgery when necessary. Our goal is to have patients lead normal lives, and that is most often the case.
Newer medications called biologics have helped us control symptoms in a large number of patients and improved the quality of life in many others. However, there are patients who have had multiple surgeries and failed many different medical regimens. They suffer from chronic pain, weight loss and an inability to eat. The pain can result in dependency, and even addiction, to pain-relieving medication. The weight loss makes these patients, who are often on medication that lowers their immune system, more susceptible to life-threatening infections.
Can medical cannabis help these patients? Though cannabis has benefit in cell lines and in vitro studies in mitigating inflammation, there has been no substantive medical research or controlled clinical trials demonstrating the ability to treat Crohn’s disease and induce remission or prevent relapse. Further research clearly needs to be done in this area.
However, we know from extensive work with cancer patients that medical cannabis has great benefit in reducing pain, increasing appetite and reducing nausea. These benefits will be of great help caring for those with Crohn’s disease who have failed medical therapy. If we can prevent pain medication dependency and addiction, we can significantly help a subset of Crohn’s patients. Improving appetite and weight may also be beneficial in allowing other medicines to work and have synergistic effects.
Oregon and Colorado have passed legislation allowing both medicinal and recreational use of marijuana. In Bend, Ore., which has approximately 80,000 people, there are 19 dispensaries; in Portland, the number is rising into the hundreds. In Denver alone, there are 400 dispensaries (compared with 200 Starbucks) to serve the population.
The other end of the spectrum is Minnesota, with a population of 5.5 million people, which just enacted a very restrictive medical marijuana law. The legislation authorized nine medical conditions to be treated and allowed for two manufacturers and eight distribution centers. Physicians must certify a patient has one of the allowed conditions and, after approval by the Minnesota Department of Health, the patient can get the medication at one of the dispensaries.
However, Minnesota has run into problems with what I would call “docs in a box” for marijuana: Companies like marijuanadoctors.com have entered the state. They set up clinics where patients can be seen by a physician for a consultation fee of $250 and be certified the same day to receive medical marijuana. They even advertise that no medical records are necessary.
These clinics mark patients anxious or trying to skirt the law as easy prey. Already, Minnesota has had to suspend several of these ventures.
I believe the intent in Georgia is to have a highly compassionate but regulated structure that will allow patients who are truly candidates for medical cannabis to obtain it.
It should allow and encourage doctors who believe their patients would benefit to write the prescriptions and certify their patients. I think it is critical the primary or treating doctor — whether internist, family practitioner, pediatrician or specialist such as a neurologist, oncologist or gastroenterologist — be the one that initiates the certification and continues to care for the patient.
It certainly may require some education among physicians, but all new therapy does.
The medical cannabis law is an important step for patients, and it must be applied within the framework of the medical system. This will allow patients to be better cared for, and for observational and clinical studies that will better guide us as to future use and efficacy. If physicians come to believe the law is being used to turn quick profits without regard to patient well-being, it will taint the therapy and never allow it to take its place as a potentially important therapeutic tool.
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