Mission Health’s President & CEO clarifies position on medical marijuana, differs from July 1 Asheville Citizen-Times report

ASHEVILLE, N.C. (July 2, 2017) – Mission Health would like to address an Asheville Citizen-Times report that appeared in the June 30th edition, which focuses on a debate surrounding the legalization of medical marijuana at the Asheville City Council meeting on Tuesday evening, June 27, 2017. While Mission Health did not attend the City Council meeting, we understand that many factions voiced positions, both pro and con.  Mission Health seeks a correction/clarification on the position of Ronald A. Paulus, MD, President and CEO of Mission Health, as reported in the Asheville Citizen-Times yesterday.

Mission Health Position:

Mission Health does not have a position on the legalization of medical marijuana.  As such, Mission Health neither supports nor condemns any legislation that seeks to legalize medical marijuana use.

Please attribute statement to: Rowena Buffett Timms, SVP of Government and Community Relations

With respect to Dr. Paulus’ personal views on marijuana, they are summarized below[1]:

I have a mixed, science-based view of the pros and cons of marijuana. By way of background, many assume that marijuana first appeared on the scene in the 1960’s. However, history tells us that the medicinal properties of cannabis have been recognized for centuries. The medical use of marijuana is documented in Egyptian papyri dating back to 1,550 BCE. It was used in ancient India to treat insomnia, headaches and labor pains, and there are numerous other examples.  The most absurd aspect of current marijuana policy is its DEA classification as a Schedule 1 drug, defined as having no accepted medical use and a high potential for abuse. Other Schedule 1 drugs include LSD and heroin.  I believe that drugs should be classified based upon science, not emotion. Schedule 1 classification significantly impairs the ability to do rigorous research, which prevents the true pros and cons of medical marijuana from being discerned.

Pros:

More recently, nearly two decades of research have shown that marijuana can be beneficial in alleviating pain and other symptoms associated with an array of illnesses, including glaucoma, cancer, multiple sclerosis, anxiety and pain control to name a few. A 2013 study in Israel showed that smoking marijuana significantly reduced Crohn’s disease symptoms in 10 out of 11 patients, and caused a complete remission of the disease in five of those patients.  That’s a small study, but other research has shown similar effects. The cannabinoids from marijuana seem to help the gut regulate bacteria and intestinal function.

With respect to the comments attributed to me in the recent discussion, it is in fact quite possible that broader legalization of marijuana could help more people with unmanageable pain find relief; it could even have a positive, mitigating effect against the opioid epidemic. Although marijuana clearly can cause health problems, there are no known cases of somebody dying from a marijuana overdose. The same cannot be said for opioids. The CDC reports that overdose deaths from opioids have quadrupled since 1999. In 2015, more than 15,000 Americans died from overdoses involving prescription opioids. Those prescription pills now account for nearly half of all U.S. overdoses from opioids.  In addition, an average of 1,000 Americans are treated in emergency rooms every day for misusing prescription pills.  Research in some of the 25 states where medical marijuana is legal has found a possible “protective effect” against opioid overdose deaths. A study led by Dr. Marcus A. Bachhuber, published in August 2014 in JAMA Internal Medicine, found that from 1999 to 2010, states across the country had steep increases in opioid overdose deaths.

But in states where medical marijuana was legal, mortality linked to opioid use declined steadily in the years after implementation of the marijuana law – by almost 25 percent – compared to states where marijuana was not legally available. This effect was much more robust than those linked to statewide regulatory initiatives such as mandatory opioid prescription medication registries and other well-intentioned efforts.  Adding to that data, a letter to physicians from then U.S. Surgeon General Vivek H. Murthy noted that opioid overdose deaths have quadrupled since 1999 and now “nearly 2 million people in America have a prescription opioid use disorder.”  We are experiencing extraordinary problems with opioid use in western NC on a daily basis.

In addition, smoking marijuana doesn’t appear to have the same long-term medical consequences of using tobacco: an increased risk of cancer, obesity and heart disease. In fact, a study published in the Journal of the American Medical Association in January 2012, showed that marijuana does not impair lung function and can even increase lung capacity. And regardless, there are also other forms of marijuana that can be available including oils and edibles.  Similarly, marijuana use is far less harmful statistically than alcohol use.  Health-related costs for alcohol consumers are eight times greater than those for marijuana consumers, according to a 2009 assessment published in the British Columbia Mental Health and Addictions Journal, the annual health-related cost of alcohol consumption is $165 per user, compared to just $20 per user for marijuana. This should not come as a surprise given the vast amount of research that shows alcohol poses far more – and more significant – health problems than marijuana.  Violent assaults, in particular, are often fueled by alcohol but research shows rates of interpersonal or domestic violence are actually lower in people who smoke marijuana than people that don’t. Also tipping the scales against drinking is the fact that 1,800 college students die each year from alcohol-related accidents and almost 600,000 are injured while under the influence of alcohol, according to the National Institutes of Health.

Cons:

Most importantly, we know that legalization dramatically increases the level of marijuana consumption and not all of it is appropriate clinical treatment. Typically, the age to legally consume marijuana is set at 21, but it would be naïve to assume that easier availability would not have a trickle-down impact and that the drug would find its way to those under legal age.  And we know for certain that heavy recreational use of cannabinoids can adversely affect the brains of young people –pre-adolescents to those in their early 20s – probably related to the continuing development of brain structures and functions in that age group. Such use can also affect the brains of people already exhibiting substance abuse issues or mental illness. In addition:

  • Regular use of marijuana can hasten the onset of psychotic illnesses in predisposed individuals. In fact, high-dose THC – one of the most widely studied molecules in the marijuana plant – has been found to cause acute/transient psychosis.
  • Chronic marijuana use is connected with what, in popular culture, has been called “slacker behavior” – increased risk of dropping out of school, lower achievement, diminished IQ and probably lower life satisfaction – not to mention addiction, physical dependence and withdrawal symptoms.
  • By their late 30s, chronic users face a greater risk of certain respiratory problems, such as bronchitis and periodontal disease.
  • There are other, less serious side effects including hyperemesis (extreme vomiting).
  • Certain forms of marijuana, most notably edibles, dramatically increase the risk that a child may be exposed inadvertently.

Looking more broadly to other public health measures, there is somewhat conflicting evidence on the dangers of people operating motor vehicles after using marijuana. In Colorado, recent figures correlate with the years since marijuana legalization to show a dramatic decrease in overall highway fatalities – and a two-fold increase in the frequency of marijuana-positive drivers in fatal auto crashes. Studies in Washington State showed similar findings.  Legalization poses challenges for law enforcement in determining truly impaired driving from marijuana. There is no field sobriety test like there is with alcohol. On many occasions, officers apply a sniff test after pulling over a driver suspected of being impaired. That is, could they smell marijuana smoke in the vehicle?  More recently, Stanford University researchers created a potential solution, applying magnetic nanotechnology, previously used as a cancer screen, to create what could be the first practical roadside test for marijuana intoxication.

Conclusion:

Marijuana should be treated in a science-based manner like all other drugs that have positive impact on patients and also serious side effects.  Framing it as either a “boogeyman” or a “perfectly safe panacea” is nonsensical.  Legalization is a complex political choice, particularly given conflicting interpretation among states and the federal government; but from a science standpoint it is very clear that more robust research should be pursued.

Please attribute personal statement to: Ronald A. Paulus, MD

 

[1] These statements are the individual, personal opinion of Dr. Paulus and are not those of Mission Health.  Dr. Paulus’ statements incorporate information and statements in the public domain, most notably commentary by Dr. Thomas Strouse, medical director of the Stewart and Lynda Resnick Neuropsychiatric Hospital at UCLA and the Maddie Katz Chair of Palliative Care Research and Education (see: http://health.usnews.com/health-news/patient-advice/articles/2016-10-12/marijuanas-public-health-pros-and-cons).

UPDATE: Q&A

PUBLICATION: Asheville Citizen-­Times

REPORTER: Joel Burgess

TOPIC: Medical Marijuana

DATE: July 3, 2017

Please Attribute Statement to:

Rowena Buffett Timms

SVP of Government and Community Relations

QUESTION 1: Did Bothwell and Frost misunderstand or misrepresent what Paulus said – that Paulus was advocating use of marijuana as alternative pain killer to opioids?

RESPONSE: We can’t comment for a third party. We recommend you speak with them with directly.

QUESTION 2: Why won’t Paulus take a public stance? As the chief executive in charge of the region’s largest health care system doesn’t he have an interest and responsibility to help legislators do the right thing for people’s health? Is he saying he doesn’t know if it should be legalized?

RESPONSE: With respect to Dr. Paulus’ personal views on marijuana, they are summarized below[1]:

I have a mixed, science-­?based view of the pros and cons of marijuana. By way of background, many assume that marijuana first appeared on the scene in the 1960’s. However, history tells us that the medicinal properties of cannabis have been recognized for centuries. The medical use of marijuana is documented in Egyptian papyri dating back to 1,550 BCE. It was used in ancient India to treat insomnia, headaches and labor pains, and there are numerous other examples. The most absurd aspect of current marijuana policy is its DEA classification as a Schedule 1 drug, defined as having no accepted medical use and a high potential for abuse. Other Schedule 1 drugs include LSD and heroin. I believe that drugs should be classified based upon science, not emotion. Schedule 1 classification significantly impairs the ability to do rigorous research, which prevents the true pros and cons of medical marijuana from being discerned.

[1] These statements are the individual, personal opinion of Dr. Paulus and are not those of Mission Health.  Dr. Paulus’ statements incorporate information and statements in the public domain, most notably commentary by Dr. Thomas Strouse, medical director of the Stewart and Lynda Resnick Neuropsychiatric Hospital at UCLA and the Maddie Katz Chair of Palliative Care Research and Education (see: http://health.usnews.com/health-news/patient-advice/articles/2016-10-12/marijuanas-public-health-pros-and-cons).

Mission Health Position: 

Mission Health does not have a position on the legalization of medical marijuana. As such, Mission Health neither supports nor condemns any legislation that seeks to legalize medical marijuana use.

QUESTION 3: Has any legislator ever consulted Paulus on medical marijuana?

RESPONSE: We are not aware Dr. Paulus has spoken with any legislators on medical marijuana.


PUBLICATION: Asheville Citizen-­? Times

REPORTER: Joel Burgess

TOPIC: Medical Marijuana

DATE: July 3, 2017

Please Attribute Statement to:

Ronald A. Paulus, MD

QUESTION 1: I’ve seen the emails from Frost and Bothwell. I checked in with Bothwell today and he said he took Paulus’ statements as an endorsement of the medical use of marijuana. I don’t really see how that’s possible without its legalization. (Unless of course one was to advocate for its illegal use.)

RESPONSE: Marijuana should be treated in a science-­?based manner like all other drugs that have positive impact on patients and also serious side effects. Framing it as either a “boogeyman” or a “perfectly safe panacea” is nonsensical. Legalization is a complex political choice, particularly given conflicting interpretation among states and the federal government; but from a science standpoint it is very clear that more robust research should be pursued.