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Guest Commentary: A physician’s response to Rep. Roach’s guest commentary on medical marijuana

By Barton K. Hershfield, M.D. - | Apr 21, 2021

As a physician who specializes in medical cannabis, I am compelled to respond to Rep. Spencer Roach’s Guest Commentary “The Fight to Save Florida’s Medical Marijuana Program.”

I agree with Rep. Roach that at recreational doses, THC has intoxicating effects, and that it can have an adverse cognitive effect on a teenager’s developing brain.

However, medical doses of THC are much lower, and can not be compared to the effects of recreational doses. For example, at medical doses, THC reduces pain, anxiety and other symptoms without causing intoxication.

Like prescription medications, medical dosing of THC is based on the total number of milligrams (mg) taken, not the strength of the preparation used. For example, if a 20 mg dose of the medicine Lisinopril is needed to control a patient’s blood pressure, but a law was passed to limit the strength of Lisinopril pills to 10 mg, the patient would have to take two of the lower concentration pills. An effective medical dose of THC for many people is 5-10 mg. Based on the average THC percentage of flower obtained from dispensaries, that equates to 2-4 inhalations per dose. If flower obtained from dispensaries was restricted to 10% THC, 4-8 inhalations would be needed to obtain the proper dose, resulting in double the amount needed to obtain a medical dose, double the cost, and double the amount of products of combustion that would be inhaled.

Rep. Roach refers to marijuana as a “narcotic.” Actually, it is not classified as a narcotic. Unlike narcotics, it does not cause a physical addiction in the majority of patients that use it, does not depress the body’s drive to breathe, and has never caused a death when over-consumed.

He states that medical marijuana users have twice the risk for prescription opioid abuse compared to non-users. A review article published in July 2020 which looked at the results of nine studies showed “There was a 64-75% reduction in opioid dosage when used in combination with medical cannabis.” In our own practice, we have also seen a reduction in opioid dosage, with many patients being able to discontinue opioids completely.

Rep. Roach refers to a “startling increase in (medical marijuana) certifications.” Isn’t that the idea–to decrease the number of people who have to use dangerous opioids to control their pain by increasing the number of patients who use much safer medical marijuana instead? Florida’s opioid dispensing rate per 100 in 2016 (before the medical marijuana program was established) was 66.6. It went down to 45.4 in 2019 (the most recent year for which the CDC published data). Success–not concern!

I agree with Rep. Roach that the state’s medical marijuana program should be used for medical, not recreational reasons. However, his statement “What we now have is a recreational drug program masquerading as a medical marijuana program…” is a very unfair characterization of the hundreds of thousands of military veterans and other Floridians with chronic physical and psychological pain who use medical marijuana responsibly, and benefit from it. If there are physicians who are certifying, and patients who are purchasing recreational doses, that absolutely should be addressed on a case-by-case basis. Unfortunately HB 1455 would not prevent a minority of individuals from abusing the program, but instead would hurt the vast majority of legitimate patients in the program, resulting in “throwing out the baby with the bathwater.”

–Barton K. Hershfield, M.D., is with Medical Cannabis Physicians of SWFL, Cape Coral