Medical Cannabis Clinical Evidence Is Becoming Immune To State Borders

[Editor’s note: This article is by Rob Dhoble, Managing Director at Havas ECS. It originally appeared in Benzinga on May 14, 2020 and is reprinted with the author’s permission. Rob does an excellent job of addressing the decidedly unscientific de facto US policy that a patient’s access to medical cannabis, and her physician’s education about the endocannabinoid system and cannabis based medicine, is primarily based on their state of residence.  -Rod Kight]

What if physicians in all 50 states consistently understood the endocannabinoid system (ECS), and the extensive clinical data supporting use of medical cannabis, prescription cannabinoids, and hemp-derived non-prescription cannabinoids?

Would each US state expand its list of qualifying conditions? Would the expanding compendium of cannabinoid medical science advance patient rights in every state and territory?

Might consistent physician understanding accelerate the United States towards a 50-state medical cannabis reality that lowers cost and safely improves health outcomes?

A growing number of healthcare professionals, scientists, and legal experts say yes-yes-yes. 

In practice, a 50-state medical cannabis reality could follow the spirit of the Oklahoma medical cannabis program, which allows every licensed physician to alone determine if medical cannabis is relevant for specific patients, without use of a state-mandated list of qualifying medical conditions. In practice, a 50-state medical cannabis reality would require Oklahoma physicians to study and pass an independently developed, AMA recognized CME foundational course focused on the ECS and current medical evidence for cannabinoids (there are no ECS or cannabis CME training requirements for Oklahoma physicians). Enabled by such training, physicians across all 50 states will be better able to deliver enhanced care for more patients, by more safely, more scientifically, and more consistently, integrating cannabinoids into clinical practice.

So, what KEY FACTS support a 50-state medical cannabis reality?

• Endocannabinoid Medicine has emerged as a scientific and internationally valid medical discipline, relating to the diagnosis and treatment of over 30 medical conditions, and the informed use of 3 FDA-approved Rx cannabinoids (and more coming), medical cannabis, hemp-based cannabinoids, and even terpenoids and flavonoids,
• Endocannabinoid Medicine has established itself globally through accrual of decades long scientific and clinical research, now representing a compendium of medical evidence, quite capable of supporting exam room decisions and courtroom arguments,
• Across the 34 states and 5 territories with medical cannabis programs, only 9 require any CME physician training, with such CME programs being dissimilar, and largely inaccurate and outdated.
• Endocannabinoid Medicine trained physicians are better able to maximize the value, and manage the risks, of cannabis and cannabinoid therapeutics as part of individualized treatment regimens, each requiring proactive management of known drug-drug interactions, warnings, and precautions,
• In medical cannabis states, real-world health outcomes improve across many medical conditions, with corresponding reductions in prescription volume, saving public and private insurers millions of dollars on the backs of patients paying 100% out of pocket for their medication. This includes a 5.8% reduction in Medicaid opioid prescriptions and related addiction risk among medical cannabis states between 2011 and 2016.
• All state medical cannabis programs have different qualifying medical conditions, despite the fact that the human endocannabinoid system works exactly the same in every city, state, and country,
• Patient medical treatment rights, relative to endocannabinoid science, are inconsistent across all states, and inconsistent across medical conditions within each medical cannabis state,
• With mounting evidence of the efficacy and safety of medical cannabis, courts have ordered some insurers to reimburse for medical cannabis. The same evidence has propelled the German government to reimburse 100% for medical cannabis prescribed by physicians for qualifying conditions. German patients pick up their medical cannabis at regular pharmacies, not dispensaries. Regarding the cost of medical cannabis, “If medical marijuana became a regular part of patient care nationally, the cost curve would bend because marijuana is cheaper than other drugs.” https://www.npr.org/sections/health-shots/2016/07/06/484977159/after-medical-marijuana-legalized-medicare-prescriptions-drop-for-many-drugs,
• Given the large economic and clinical value of medical cannabis, states would be wise to support and even subsidize the consistent education of medical professionals on the ECS, and on the role of cannabinoids and cannabis as part of individualized, condition-specific treatment regimens. At least until such topics and clinical competencies commonly reside within curriculum of leading medical schools. https://ajendomed.com/articles/prescription-and-nonprescription-cannabinoids-a-dual-path-regulatory-framework/,
• The Endocannabinoid Medicine Certification program is a comprehensive remote learning system for physicians in every state, with exam-based completion resulting in 12 AMA PRA Category 1 credits. https://ajendomed.com/university/,
• The Endocannabinoid Medicine Certification program was independently developed in partnership with Vox Media, an ACCME accrediting organization https://www.cmeplanet.com/, and the American Journal of Endocannabinoid Medicine, a peer viewed medical journal focused on the ECS as a therapeutic target https://ajendomed.com/,
• Having one common CME physician training requirement across all states, will serve to unite and advance the practice of medicine in 34 medical cannabis states and 5 US territories, strengthen the medical cannabis access legal argument in all 50 states, rationalize the DEA category II rescheduling of cannabis, and establish a basis for medical cannabis insurance reimbursement.

Together, the 12 key facts above support strategies that advance a more consistent practice of endocannabinoid medicine for the benefit of all Americans, to attain improved health outcomes at lower total cost for a broadening range of ECS-related medical conditions.  To illustrate the unifying value of one common medical cannabis CME physician training requirement across all states, two medical cannabis experts offer their view:

“There is a large body of growing scientific evidence that cannabis is a beneficial treatment option for a wide range of medical issues, yet it remains unlawful under US federal law. At the state level, the legal status of medical cannabis varies across the country. This has resulted in a patchwork of divergent, and often restrictive, qualifying conditions for patient access to medical cannabis. It has also resulted in dissimilar education requirements by state medical boards for physicians who are diagnosing and treating medical issues with it. Although these dilemmas are rooted in the law, it is imperative that patient access be based on sound science and that physicians receive comprehensive and uniform education regardless of the state in which they practice.” – Rod Kight, Editor, Kight on Cannabis and Principal of Kight Law Office, PC

“We must have a unified approach, a dedicated curriculum, and mentors to teach us as we did in medical school or graduate science programs.  This article embodies the desire, the necessity, and the importance of developing a curriculum for all.  We are a nation of 50 states filled with clinicians who must pass the same USMLE exams.  We as clinicians must understand the endocannabinoid system as a vital part of human physiology just as we learned basic physiologic parameters in medical school such as blood pressure.  Wouldn’t it be a sin if Dr. X in California only had beta blockers to take care of hypertension, but Dr. Y in New York could use diuretics and calcium channel blockers.   This is the current state of medical cannabis in our fifty states and we owe it to our patients to deliver more consistent and comprehensive care.” – Eric J Exelbert MD, Pediatrician, Hollywood, Florida

As the compendium of domestic and international medical cannabis clinical evidence expands across dozens of medical conditions, the skilled consistent practice of endocannabinoid medicine will increase in economic value.  Why? Because with each new cannabis clinical  research report,  each new cannabinoid FDA approval,  and each new ECS-related scientific discovery, the established “standards of medical care” are evolving, specifically in the individualized use of cannabis and cannabinoids for conditions including ADHD, ASD, Cancer, Chronic Pain, Fibromyalgia, IBD, OUD, PTSD, Movement Disorders, Migraine, and even Tourette Syndrome.  How would a common 50 state approach to medical cannabis physician education impact health and wellness in your state?  Medical cannabis access? Medical cannabis businesses? Post this article and share your view!

May 15, 2020

This article was written by Rob Dhoble, Managing Director at Havas ECS, a leader in endocannabinoid research and education.

Rod Kight is an international cannabis lawyer who resides in North Carolina. He represents businesses throughout the cannabis industry. Additionally, Rod speaks at cannabis conferences, drafts and presents cannabis legislation to foreign governments, is regularly quoted on cannabis matters in the media, and maintains the Kight on Cannabis legal blog, where he discusses legal issues affecting the cannabis industry. You can contact him by clicking here.