Federal Vs. State Marijuana Laws: The Battle Over Medical Marijuana Dispensaries in Rhode Island

Posted by Soren Sorensen

According to a new Gallup survey, 50 percent of Americans now support the legalization of marijuana. In Rhode Island, even though medical marijuana is legal, Governor Lincoln Chafee recently said that the state wouldn’t be licensing medical marijuana dispensaries, also known as “compassion centers.”

Governor Chafee, who says he supports medical marijuana, has said that federal law trumps the state’s program, effectively tying his hands.

In a move that patients’ rights advocates and proponents of legalization find inexplicable, the Obama administration has shown a new willingness to prosecute should states open medical marijuana dispensaries.

Dr. Seth Bock is one of many Rhode Islanders who thinks Governor Chafee is making the wrong decision. Dr. Bock’s own Greenleaf Compassionate Care Center was approved by the health department, but has now been left in the lurch by the political chess match currently underway all over the United States. Dr. Bock owns the Newport Acupuncture & Wellness Spa.

In a wide-ranging conversation, Dr. Bock told New England Post all about his side of this contentious issue.

NEP: Where does the medical marijuana movement stand in RI as of right now?

SB: The Medical Marijuana Program in Rhode Island is at a crossroads. Governor Chafee has pulled the plug on the state Compassion Center law, citing his concern for the safety of the compassion centers and the patients in several quotes. He asserts that the federal government will shut the centers down and that federal law trumps state law with respect to the Controlled Substances Act (CSA). What is important to know is that the federal government has waged a 40-year war on marijuana and has violated its own drug rescheduling procedures to keep marijuana listed as a schedule one narcotic. For those who don’t know, all drugs, including prescription drugs are scheduled between one and five. Schedule five is the least restricted for use whereas schedule one drugs cannot be prescribed or possessed by individuals or institutional bodies, such as universities. The risks to individuals and society are thought to be so great that a physician cannot even prescribe a schedule one drug to a dying patient. Cocaine and opium, for example, are schedule two drugs. So, according to the federal government, marijuana is less safe than cocaine or opium, the precursor to heroin. Schedule one also states that the substance has no proven medicinal benefits.

So, here’s the catch-22: marijuana is so harmful that researchers cannot possess it to determine whether it has medicinal value, yet, the Drug Enforcement Agency has determined that marijuana has no medicinal value. The fact of the matter is that marijuana has indeed been rigorously studied, mostly in foreign countries such as Canada and Israel whose policy is based on science. Peer-reviewed papers supporting its use have been published in numerous medical journals. Even the American Medical Association calls for marijuana to be rescheduled. To bolster the fact that marijuana does indeed have medical purposes, the Food and Drug Administration has approved pure THC, in pill form, as a schedule three drug. THC stands for Tetrahydrocannabinol and it is the substance that produces marijuana’s euphoric effect. So clearly the Federal government does not really believe marijuana has no medicinal effect, or that it is too harmful for society to use medicinally. I can only guess that their main concern is individuals being able to use THC in its natural form as opposed to a pharmaceutically produced alternative. The herbal consumption of marijuana allows consumers to bypass the FDA approval process which would create an unwelcome precedent from the perspective of the pharmaceutical giants. The resurgence of “folk medicines,” such as acupuncture, chiropractic, massage and herbalism, threatens an industry that wants to do it all.

NEP: What do you tell people who believe they’d benefit from the medicinal properties of marijuana?

SB: Well, as a Doctor of Acupuncture I am not allowed to sign the Department of Health form for a prospective medical marijuana patient. Therefore, all I can do is talk to them about the pros and cons of this substance. I personally do not believe marijuana is a panacea for all conditions. I believe acupuncture, and hundreds of other Chinese herbs can be just as powerful. Nor am I against modern conventional medicine. Quite the contrary; modern medicine can be life-saving. That said, many people are being mismanaged by the health care system and conventional medicine. People are being prescribed drugs when they should be receiving acupuncture, chiropractic and massage, to name a few. Pharmaceutical drugs are the eighth largest cause of death in the United States. People need to take a step back and really consider the implications of this statistic! So when talking to patients about the benefits of marijuana I try first to put it into context. Many people have fears about taking a psychoactive, medicinal plant, and those fears are justified. People should understand the risks associated with marijuana, such as euphoria or increased anxiety. It works both ways, and people need to know how best how to avoid unwanted symptoms. I also talk about known, research-based, effects, such as appetite stimulation and nausea suppression. It is worth mentioning the research that shows positive anti-cancer effects, painkilling effects, anti-spasm effects and several additional possible uses. Unfortunately, physicians are not generally trained in the use of marijuana. They are not trained in the endocannabinoid receptor system that mediates much of marijuana’s physiological effects. Lastly, people need to know the facts about marijuana’s toxicity. Marijuana is one of the least toxic substances on the planet. Researchers cannot determine how much marijuana it takes to kill a laboratory animal because they cannot administer enough in a short enough period of time to produce death. It is estimated that the lethal dose is 40,000 doses. The lethal dose of aspirin is approximate 12 doses. People die from aspirin overdoses. There has never been a single reported death from a marijuana overdose. That we are arresting hundreds of thousands of people a year for possession of a substance with this track record is mind-boggling.

NEP: What are the medical uses of the plant?

SB: Marijuana has numerous medicinal uses. Marijuana is a superb appetite stimulant and anti-nausea herb. There are many conditions where these effects can be beneficial including anorexia, a number of digestive disorders and helping people cope with the side effects of chemotherapeutic agents during cancer treatment. I lost two very close aunts to cancer and the aunt that used marijuana medicinally was able to eat during her chemo treatments. The ability to eat allows people to keep their strength and weight up which helps them complete their chemo regimen. When people lose their appetites and weight this can limit their ability to take sufficient chemo. Finally, the chemo they manage to take in this anorexic state tends to have a more lethal effect. In my experience working with cancer patients, marijuana has the ability to significantly improve quality of life as well as help them live longer. AIDS and HIV patients report similar findings.

On an entirely different level, research is showing that marijuana has a neuroprotective effect. This particular line of research is really exciting. People with multiple sclerosis, ALS (Lou Gehrig’s Disease) and several other neurodegenerative diseases have reported significant improvement in symptoms and a few ALS patients appear to have halted their disease with medical marijuana. There is a growing body of research to back up these claims that explains the mechanism of action of these success stories. I think it’s very clear at this point that medical marijuana can be very effective for patients with seizures as well. Marijuana is successful for a larger variety of less life-threatening diseases and conditions as well. It works very well for some people with musculoskeletal pain, migraine headaches, menstrual cramps and a number of other common neuromuscular or hormonal conditions. Veterans regularly describe benefiting from its use in treating Post Traumatic Stress Disorder (PTSD). I am probably leaving out several conditions without even getting into the spiritual or relaxation-oriented uses of the herb. I highly suggest that physicians take the time to read the research on this topic, since it is likely to come-up more and more in clinical practice. There are books such as Mitch Earleywine’s Understanding Marijuana that cover much of the recent research on marijuana. Of course the PubMed online research database contains a lot of material in this regard as does the non-profit online group at drugscience.org.

NEP: What evidence, scientific or otherwise, should people consider when forming an opinion about an issue like medical marijuana?

SB: I think people need to use caution with any substance and opinions should be formulated with fact, not hyperbole. That said, the fight to reschedule marijuana is symbolic of how Federal regulatory bodies need to be restructured to meet the needs of people not corporations. If there’s any truth in the assertions I have been making, and I believe there is, the pharmaceutical industry should be frightened by the notion that an easy to grow plant can possibly offer so many beneficial healing properties. Plants cannot be patented so there is very little money to be made by the pharmaceutical industry in producing medical marijuana. There is a lot of money to be lost however, since people might find relief in a plant and not the pills they might otherwise take.

I have heard critics of the medical marijuana industry say that medical marijuana legalization by the states for medicinal purposes “sullies the medical profession” and “threatens the sanctity of the drug approval process.” Bear in mind that the FDA is allowing pharmaceutical companies to export clinical trials to foreign countries via companies that promise results regardless of efficacy. I would argue that the sanctity of the drug approval process is innately very questionable to begin with. Having worked in clinical trial research ethics at the Brigham and Women’s Hospital and the Dana-Farber Cancer Institute I saw very clearly how the pharmaceutical industry is driven by money and not some highly ethical, benevolent group of regulators. I think this is evident in the fact that pharmaceuticals are the eighth largest cause of morbidity in this country. Very few pharmaceuticals are adequately tracked for long-term outcomes and we all pay the price.
NEP: How did you become involved in the fight to bring dispensaries to Rhode Island?

SB: I have been interested in alternative modes of healing for two decades. I am not, underscore not, someone who got into this because I believe it’s the best path to overall marijuana legalization. Although I question the rationale for and viability of the “war on drugs,” I believe sobriety is a good baseline state of being. I have practiced martial arts and yoga for years and believe we can strengthen our minds naturally and that we should not be reliant on substances or vices to regulate our sense of well-being. That said, I just don’t see what role the government has in telling us how to behave, as long as that behavior does not cause anyone else harm. I guess I’m a libertarian in that regard. So, getting back to your question, my involvement actually began with a dream. I don’t typically consider myself psychic, but I actually awoke one morning after having a dream about opening a “compassion center.” I had never heard this term before, nor did I know that Rhode Island was working on a compassion center program under state law. But as fate would have it, when I opened the paper that morning the headline read something like “Department of Health announces Compassion Center Meeting This Week…” I immediately got interested and started looking into it. One thing led to another and here I am. I am not typically the “activist” type, but after really diving into this topic I am just blown away by how the government can fight wars against ill citizens. My guess is the government will eventually reschedule marijuana and then I can go back to my normal existence.

NEP: Does it surprise you that Chis Christie, Republican governor of New Jersey, is willing to force a confrontation with the Obama administration about this issue, while Rhode Island governor Lincoln Chafee, an independent, is unwilling to take any stand on the issue perhaps due to his cordial relationship with Obama?

SB: Yes, I guess it was a little surprising. I am well aware of the stereotypes pertaining to marijuana being a “hippie” or “liberal” drug of choice, so to have a republican governor support small scale compassion centers shows that people are starting to see that there are indeed medical properties to this herb and that good people need this medicine. It’s important to note that governor Christie was a U.S. Attorney prior becoming governor. My guess is that he looked at the New Jersey medical marijuana program and realized that it would not turn New Jersey into California, the wild west of medical marijuana. When you think about it, people are either going to procure this medicine on the streets from illicit and sometimes dangerous sources or they’re going to get it from a highly regulated and strictly controlled source. What’s safer, what’s better for society? Making marijuana illegal has done nothing but create a black market for it. People haven’t stopped using it under the “war on drugs.” In fact, legalizing it for medicinal purposes with state-licensed dispensaries, as several states have done, actually decreases that black market demand and leads to a decrease in crime in the vicinity of the dispensary, as the now famous Rand study has shown. I think Governor Christie has taken a compassionate and common sense approach to dealing with something that’s not going away. I don’t believe governor Christie did this to spite President Obama. I just don’t see it. He could have run for president instead.

NEP: Without naming names, can you provide me with some anecdotal evidence, people you know of who use marijuana for medical purposes and what people have to go through to obtain the drug and how they take it?

SB: I mentioned my aunt’s story previously. Her story has repeated itself with numerous cancer patients I’ve treated over the years. When people take a few puffs and instantly have an appetite, it does not take a clinical trial to determine efficacy. Look at coffee, for example. Would anyone waste money on proving that coffee wakes you up. This is a priori knowledge. These are the results marijuana has on numerous people for numerous conditions. I have approximately 30 to 40 acupuncture patients that use medical marijuana and ironically, not a single one is someone I would classify as the stereotypical hippie pothead. The majority are successful professionals and retired folk that simply do not fill that stereotype. They are people who have not found relief from conventional options and who, often in fear of being negatively typecast by friends and family, very slowly and very cautiously pursue the medical marijuana option. As residents of Rhode Island they have access to a well-constructed state marijuana program. If their doctor agrees that their medical condition meets the criteria of the marijuana program, that doctor may choose to sign-off on their marijuana application. If their doctor is agreeable to that, and many are unfortunately not, they can purchase the medicine on the street, they can grow it or appoint a primary caregiver to grow it for them. Most people are not comfortable purchasing it on the street so they look for someone else to grow it.

Growing marijuana indoors is often expensive and very time consuming. You have to build a totally controlled environment and control for humidity, temperature, soil conditions, pest management and nutrients to name a few. It is simply to challenging for many of the patients or their caregivers to produce it effectively. This is why so many patients in the state do not have access to marijuana and why the General Assembly passed legislation for compassion centers. Many people feel it’s a shame our governor chose to repeal this state law and question his legal authority to do so.

NEP: Patients generally smoke medicinal marijuana so do you think the political stigma would be lessened if supporters of medical marijuana advocated for the THC pill?

SB: I think a lot of people would respond better to the stigma if people only required a pill such as Marinol, the THC pill. I think the image of people smoking joints evokes so much political history, especially for older generations, that it has become a very volatile cultural and political symbol. However, after painfully watching close family members use this medicine in end-of-life situations, I just think there’s nothing you wouldn’t do to ease ones suffering. I think there’s a point where our common humanity has to override unfounded cultural stigmas. The fact of the matter is that Marinol is unpopular with medical marijuana patients. It’s a powerful pill, almost too powerful for some. Also, THC is metabolized differently when it’s digested. It is much easier to control the dose with smoking or vaporizing since its effects take place almost immediately. Many people report that the pill does not have the same medicinal effect as the whole herb product. Research over the past several decades has revealed that the THC is just one of numerous cannabinoid compounds that have a medicinal effect in this plant. There are over 60 cannabinoids that seem to work together to produce the effects of the whole plant, so it’s really hard to say that THC alone is the way to go. It should also be noted that long-term epidemiological studies have failed to find a single incident of smoked marijuana causing lung cancer! I think we need to really rethink our policies as well as our taboos if all of this is true.

NEP: As you see it, how does the drug industry help and/or hinder progress on the issue?

SB: The drug industry is the most profitable industry in the world. Profits equal power. Many politicians take large sums of money to help ensure policies, programs and laws that support the industrialization of medicine. What I mean by industrialization of medicine is the control of our healthcare has been turned over to industry and the criminal justice system. Just look at how courts are starting to mandate that people take immunizations. To me, that is scary! The same thing has happened with the food industry. It is sometimes illegal for people to control what they put into their bodies, just look at the Department of Agriculture’s attack on the raw milk movement. Over the past several decades we’ve seen a diminishing interaction with the forces and processes that dictate our health and wellbeing. We don’t grow our own medicine and we don’t grow our own food because we have handed the reins of production over to gigantic companies that dictate the terms of how these substances are made and packaged. Ironically, as we are separated from the production process we become less healthy. If only people knew the full extent of how corporations have discovered novel ways to tinker with our physiological chemistry to make us sick, there would be a food revolution. The level of chronic illness in this country is exponential and I often question to what degree giant agribusiness is in cahoots with the pharmaceutical industry to create health problems that need a fix. This is why so many people are choosing locally grown foods and using alternative medicine. By controlling, or at least being closely connected to the means of production, we are healthier and will live longer. The separation might not be an issue if the related federal regulatory bodies were not closely tied to the industries they regulate, unfortunately, they are. So, to answer your question, I can only imagine that the state sanctioned medical marijuana programs are creating quite a stir in the industry. In ending, I guess the pertinent question is, who should the government work for, the corporations or the people?

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Posted by Soren Sorensen on Oct 23 2011. Filed under Politics. You can follow any responses to this entry through the RSS 2.0. You can leave a response or trackback to this entry