By Carly Zervis | Citrus County Chronicle
It was not the potential benefits or harms of medical marijuana, but its regulatory status and economic potential, that took center stage at a Thursday evening conference on the drug at the College of Central Florida (CF) in Lecanto.
Citrus County doctors and other citizens got professional opinions on medical marijuana from of a trio of doctors at the conference, which was hosted by the Citrus County Medical Society Inc. and the American Academy of Continuing Medical Education Inc. at CF.
The panel included Dr. Christopher Fallows, Dr. Robert Goethe, and Dr. Ralph Massullo. Massullo also represents District 34, which includes Citrus County, in the Florida House of Representatives. Dr. John Grace also spoke, and served as the moderator.
Fallows specializes in anesthesiology and interventional pain management; Goethe practices anesthesiology as well as pain management through medical marijuana; Grace’s certification is in general psychiatry; and Massullo is a dermatologist.
The doctors’ presentations highlighted the potential benefits and risks of various forms of the drug, as well as the research — or lack thereof — behind it and what they agreed was the need for further studies.
“You’ll see people say marijuana is a cure-all,” Grace said during his introduction of the topic. “You’ll also see people say it’s a core contributor to the degradation of society.”
While they didn’t arrive at either conclusion during the evening’s discussions, all four doctors agreed that marijuana would have to be federally reclassified in order for further much-needed research to take place.
“We need to have better studies,” Fallows said during his presentation. “We need to get this off of Class 1 status so we can get these studies approved, so we can have more data and pick the right compound for the right patient.”
Currently, marijuana is federally classified as a Schedule 1 drug. Schedule 1 drugs are those that the Drug Enforcement Agency describes on its website as “drugs, substances, or chemicals … with no currently accepted medical use and a high potential for abuse.”
Other drugs on the Schedule 1 list include MDMA/ecstasy, fentanyl, peyote, and heroin. By contrast, the DEA list of Schedule IV drugs, described as “drugs with a low potential for abuse and low risk of dependence,” includes alprazolam (Xanax), diazepam (Valium), dextropropoxyphene (Darvocet) and tramadol.
“We need our FDA (the federal Food and Drug Administration) to investigate it,” Massullo said. “The only way that can happen is if we lower it down on the schedule, from 1 to 2, and the only way that’s going to happen is if the FDA decides that’s what it wants to do. Currently, our attorney general says he doesn’t want that to happen.”
In January, Attorney General Jeff Sessions rescinded policies dating from the Obama administration that took marijuana off the list of federal drug enforcement priorities as an increasing number of states legalized marijuana for medicinal or recreational use — or both.
“Marijuana is not the kind of thing that ought to be legalized. It ought not to be minimized,” then-Sen. Sessions said in April 2016. “It is in fact a very real danger.”
While generally supportive of the medical potential of the plant’s derivatives, the doctors didn’t downplay the risks Thursday evening. The most often highlighted danger: Inconsistencies and inaccuracies in dosing.
“I’m actually going to stop writing (recommendations) for it,” Grace said. “Not because people haven’t benefited from it, but because I don’t have very much control as a prescriber. It’s very imprecise.”
Doctors cannot write traditional prescriptions for medical marijuana. Those who are licensed by the state to recommend it can do so after consulting with a patient seeking it as a treatment option and, the doctors said, they have no control over how closely patients follow their dosing guidelines or way to understand the specific origins of the product their patients procure.
“We’ll recommend what you start with, but you can buy anything you want,” Goethe said. “We start you on a super-low, super-safe dose.”
Goethe introduced himself as “the medical-marijuana doctor” of the bunch and, even considering the possibility of imprecise dosing, was the most enthusiastic about the drug’s potential.
“I (recommend) medical cannabis because I believe in it,” Goethe said. “In my years of practice, all the way back to the Navy in the 1970s, I’ve seen a lot of changes in medicine and they aren’t particularly good.
“A lot of it has to do with the for-profit model,” he continued. “As the years have rolled by, I’ve seen the opiate crisis unfold. … I’ve seen the cost of medicine go sky-high. I’ve become a little bit of a cynic about traditional American medicine.”
Goethe’s discussion focused on the history of marijuana, including the 1936 film “Reefer Madness.”
“It’s one of the most ridiculous things I’ve ever seen,” he said of the film. “This movie really caught on, and because most Americans didn’t really know much about marijuana, they believed it.”
After a surge in the popularity of marijuana in the 1960s, the DEA under President Richard Nixon added it to the Schedule 1 list — essentially consigning the drug to the scrap heap of potential medications. Without federal approval, major research and drug trials can’t be conducted.
“This didn’t really stop people from using it,” Goethe said of marijuana’s addition to the Schedule 1 list. “It didn’t really put a dent into anything other than the fact that it made it an outlaw drug and all of a sudden — since there’s no medical use for it — no research could be done on it. And that was a real problem. For 46 years, we’ve had nothing in our literature as far as controlled trials, what it can and cannot do.”
Although Florida, along with 30 other states, has legalized marijuana for medicinal purposes and created regulatory statutes, drug trials and research still can’t take place on a national level through the FDA’s process for approving medications for prescription and use in the United States. That also means the stuff can be difficult for low-income would-be patients to access.
Visits to doctors who can recommend the drug — necessary to attain a medical marijuana patient card from the state in order to purchase it — can cost hundreds, and that’s before the cost of the products themselves, and there’s no state or insurance aid available.
“The state can’t sponsor a health clinic to use any particular modality or medication that isn’t approved by the FDA,” Massullo said during the question-and-answer session in response to a question about whether Florida could create state-sponsored clinics to provide a lower-cost option.
“These people who are having success with it, which I’ll say is the majority — some of them are having trouble affording it,” Goethe said later in the Q-and-A. “And one of the worst things that could happen is they hand it over to the pharmaceutical industry.
“In my opinion, Florida is shooting itself in the foot,” Goethe continued. “Last year, Colorado made $200 million in tax revenue. … If Florida taxed it like Colorado, at 33 percent, we’d make almost a billion dollars in tax revenue a year. … What comes to me is the school resource officer program that no one seems to have money for.”
Massullo noted that marijuana is legal for recreational use in Colorado, not solely for medicinal use. “Florida treats it like a medicine, and in our state we don’t tax medicine,” he responded. “If it ever becomes legal for recreational use, we’ll tax it.”
Contact Chronicle reporter Carly Zervis at carly.zervis@chronicleonline.com or 352-564-2925.