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House Bill 1317, legislation that is quickly making its way through the Colorado legislature, seeks to make significant changes to the state’s longstanding medical cannabis access program. Many of these proposed changes are not in the best interest of either patients or public safety. Furthermore, some of the advocacy groups pushing this measure are not acting in good faith — as they have publicly stated that their ultimate goal is to roll back legal access altogether.
Specifically, HB 1317 provides new, overly burdensome requirements upon physicians issuing medical cannabis recommendations. It requires physicians to create an explicit dosing regimen for patients, which must include instructions regarding the potency of THC to be used by the patient, the specific type of cannabis formulation to be consumed, and the precise amounts that patients should be taking daily. No other state medical cannabis access program places such explicit requirements upon authorizing physicians. Further, surveys of health professionals consistently report that physicians and nurses are highly uncomfortable counseling patients in this manner. Most will likely not recommend such detailed treatment plans, thereby leaving patients without the access they have grown accustomed to.
In most cases, such a daily dosing plan is neither necessary nor appropriate. Unlike most prescription medicines, cannabis is incapable of causing lethal overdose, and its dependence liability is lower than that of many other commonly prescribed substances, like opioids. Most importantly, most patients consume cannabis ad hoc — ingesting only as much as is needed at that time and doing so only when necessary to mitigate intermittent symptoms, like spasms, nausea, pain or seizures.
House Bill 1317 also places new and inappropriate hurdles for eligible patients ages 18 to 20. Specifically, it requires “two physicians from two different medical practices…to diagnose the patient as having a debilitating or disabling medical condition after an in-person consultation.” This requirement places an undue burden on young adult patients, many of whom may not have access to even one primary care physician, much less two.
Further, proponents’ contention that such stringent requirements are necessary in order to limit potential abuse among this demographic is not persuasive. To date, young adults comprise less than 5 percent of all registered patients in Colorado. This percentage has remained consistent throughout the period of time that regulators have been tracking medical cannabis use by age (2016-2021).
The measure also adds mandates that health-care providers conduct a “full assessment” of patients’ “mental health history.” Such an assessment may be beyond the scope of expertise of many primary-care providers — thus forcing patients to seek multiple doctors and thereby unduly limiting their access. Further, while such a requirement may be reasonable in instances where physicians are recommending cannabis for mental health conditions, such authorizations are rare in Colorado. According to the state statistics, the overwhelming majority of recommendations are made to address patients’ pain (87 percent), followed by muscle spasms (34 percent) and severe nausea (19 percent). It is unreasonable to require that these patients receive a mental health assessment prior to receiving medical cannabis when there is no indication that these patients possess any history of mental health issues, nor are they seeking cannabis to treat a mental health indication.
Finally, it has been well-established by the statements and actions of some of the primary proponents of this bill that their ultimate goal is to re-criminalize certain cannabis products above an arbitrary percentage of THC. That said, at this time there exists no persuasive data indicating that these products pose such a unique and significant danger to public health that they warrant being banned from the market. Proponents know this, which is why they have left this specific mandate out of this bill, and instead have proposed the creation of a scientific review council to further look into the issue.
In reality, more potent varieties of cannabis, such as hashish, have existed for decades, and many patients enrolled in medical access programs have grown to rely on these higher-potency products to treat their medical conditions. Prohibiting patients from accessing these products at legal dispensaries will only push these patients to seek out similar products in the unregulated illicit market.
Finally, it needs to be emphasized that these amendments were proposed without best interests of the patient community in mind. In fact, this bill was drafted without proper input from this community or from other important stakeholders, who have largely been left out of this process. For these reasons, lawmakers should approach HB 1317 with a healthy dose of cynicism and skepticism.
Paul Armentano is the deputy director of the National Organization for the Reform of Marijuana Laws (NORML), one of the nation’s older marijuana advocacy organizations. He is the co-author of the book Marijuana Is Safer: So Why Are We Driving People to Drink.
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