Guam – The Guam Medical Association is the largest association of professional health care providers on island. An integral part of our mission is to advocate for public health and for patients.
As such, we are concerned that our opinion on this public health issue of marijuana for medicinal use was not obtained and we are opposed to this legislative form.
Although we acknowledge that the intent of the bill is to help patients, Bill No. 215-32, as authored by Senator Tina Muna Barns and Senator Aline Yamashita has instead caused confusion for the general public and patients, leading them to believe that the diseases which they are affected can be either cured or alleviated when the scientific facts may not support their efficacy. The diagnosis and treatment of diseases should be left to
trained medical professionals and not be legislated especially when we are requiring physician’s prescribing authority.
We understand that Department of Defense’s current policy, regardless of state of residence, does not allow for any lawful use of marijuana regardless of circumstances, including medical, for all military members, including reservists and Department of Defense civilians. Uniform Code of Military Justice applies to military members regardless of state, district or territorial legislation. Thus, military members continue to be subject to prosecution under Article 112a of the UCMJ for marijuana use, possession, or distribution-regardless of where the use, possession or distribution occurs, including foreign countries. Guam has a large military presence and the impact of this legislation as to be weighed with the input from our military presence on island now and the future build up concerns.
Another concern with the use of prescription marijuana by employees creates a new challenge for employers. Marijuana can remain in the body for weeks, and this certainly creates a liability crisis for the work place even though Marijuana is not used on the premises. How do you deal with an employee in a safety-sensitive role who has a medical marijuana license and as important is the DRUG TESTING POLICIES through out all work places may create another serious liability for the employer.
This broad legislation calling for health care providers’ signatory prescription authority for the use of Marijuana has created controversy. A legislation that affects public health and safety raises serious concerns especially when lawmakers create a false reassurance that the use of Marijuana for many of the diseases listed in the legislation is a cure or will help patients. Any prescription authority required from physicians need to have solid
scientific evidence based and not anecdotal.
• The American Society of Addiction Medicine’s (ASAM) public policy statement on “Medical Marijuana,” clearly rejects smoking as a means of drug delivery. ASAM further recommends that “all cannabis, cannabis-based products and cannabis delivery devices should be subject to the same standards applicable to all other prescription medication and medical devices, and should not be distributed or otherwise provided to patients …” without FDA approval. ASAM also “discourages state interference in the federal medication approval process.”
• The American Medical Association (AMA) has always endorsed “well-controlled studies of marijuana and related cannabinoids in patients with serious conditions for which preclinical, anecdotal, or controlled evidence suggests possible efficacy and the application of such results to the understanding and treatment of disease.” In November 2009, the AMA amended its policy, urging that marijuana’s status as a Schedule I controlled substance be reviewed “with the goal of facilitating the conduct of clinical research and development of cannabinoid-based medicines, and alternate delivery methods.” The AMA also stated, “this should not be viewed as an endorsement of state-based medical cannabis programs, the legalization of marijuana, or that scientific evidence on the therapeutic use of cannabis meets the current standards for prescription drug product.”
Policy H-95.952 ‘Medical Marijuana.” American Medical Association, Report 3 of the Council on Science and Public Health Use of Cannabis for Medicinal Purposes.
• The American Cancer Society (ACS) “does not advocate inhaling smoke, nor the legalization of marijuana,” although the organization does support carefully controlled clinical studies for alternative delivery methods, specifically a tetrahydrocannabinol (THC) skin patch. “Experts: Pot Smoking Is Not Best Choice to Treat Chemo Side-Effects.” American Cancer Society.
• The American Glaucoma Society (AGS) has stated that “although marijuana can lower the intraocular pressure, the side effects and short duration of action, coupled with the lack of evidence that its use alters the course of glaucoma, preclude recommending this drug in any form for the treatment of glaucoma at the present time.” “American Glaucoma Society Position Statement: Marijuana and the Treatment of Glaucoma.”
• The American Academy of Pediatrics (AAP) believes that “any change in the legal status of marijuana, even if limited to adults, could affect the prevalence of use among adolescents.” While it supports scientific research on the possible medical use of cannabinoids as opposed to smoked marijuana, it opposes the legalization of marijuana. Committee on Substance Abuse and Committee on Adolescence. “Legalization of Marijuana: Potential Impact on Youth.” Pediatrics. See also, Joffe, Alain, MD, MPH, and Yancy, Samuel, MD. “Legalization of Marijuana: Potential Impact on Youth.” Pediatrics.
• The National Multiple Sclerosis Society (NMSS) has stated that it could not recommend medical marijuana be made widely available for people with multiple sclerosis for symptom management, explaining: “This decision was not only based on existing legal barriers to its use but, even more importantly, because studies to date do not demonstrate a clear benefit compared to existing symptomatic therapies and because side effects, systemic effects, and long-term effects are not yet clear.” “Recommendations Regarding the Use of Cannabis in Multiple Sclerosis: Executive Summary.” National Clinical Advisory Board of the National Multiple Sclerosis Society, Expert Opinion Paper, Treatment Recommendations for Physicians.
• The Federal Drug Enforcement Agency (DEA) have stated that “Organizer behind the “medical” marijuana movement have not dealt with ensuring that the product meets the standards of modern medicine: quality, safety and efficacy. There is no standardized composition or dosage; no appropriate prescribing information; no quality control; no accountability for the product; no safety regulation; no way to measure its effectiveness (besides anecdotal stories); and
no insurance coverage. Science, not popular vote, should determine what medicine is.”
The Guam Medical Association has requested the U.S. Attorney General Alicia Limtiaco to weigh in on the federal statues and the Federal DEA to respond on this legislation. Additionally, we have requested the input from the Attorney General of Guam Leonard Rapadas on local regulation. We hope to also work with our law enforcement officers as will as DEA agents to ensure that our health care providers are not violating any federal law that would ultimately place physicians’ licensures at risk, and more importantly, placed patients at risk for a non-scientific basis for the use of Marijuana.
Guam’s military presence is an important consideration and we should consider the impact that this legislation will have on our military colleagues on island. Until such a time where our health care providers have ensured public safety, and evidenced based prescription authority is established, along with all law enforcement officials both localand national agencies are in concurrence, this legislation should be cautioned.
The board and members of the Guam Medical Association will come together to further discuss the public health concerns with the use of Marijuana and how it impacts patients and engage Guam’s Public Health Director along with the Guam Board of Medical Examiners.
We will ultimately place patients care first, but based on solid scientific medical evidence that guide us in the treatment and diagnoses of diseases, especially when it requires our signatory prescription authority.