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It is now about ten to eleven, and
we're still a little bit of ahead of schedule. Is
Dr. Hertko here?
ED HERTKO: Anyway, my name is
Dr. Edward Hertko, and I've been a physician in the
state of Iowa for the past 50 years. Before I
start my paper -- and I'll read it, and the paper
is called "Deja Vu. Medical Marijuana, Where Are
You?"
Let me explain. Back in 1979, I
appeared before a legislative forum who at that
time then referred the problem of marijuana to the
pharmacists. Now we're doing it in reverse. We're
going to the pharmacists to refer it to the
legislature.
However, being a student of the Bible,
this also brings me to mind in the book of Genesis
where the Jewish nation was going to the promised
land. They wandered around in the desert for
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40 years. And then they got to the promised land.
and they sent 13 spies into the promised land, and
they came back. Eleven people said "Oh, my God.
You cannot go in there. The people are huge.
They're probably over 5 foot 7."
And two people said "Go in. Do it."
And they were Caleb and Joshua. But they went back
out into the wilderness for 40 years, turned around
and came back. When they got there, Moses saw the
promised land. He died, but Caleb and Joshua got
in.
So here we are with this position now
because I'm back here 30 years later with the same
problem. So I don't know whether I'm Moses and
going to die or whether I'm Caleb and Joshua who
are going to be able to see something happen.
And with that, I'll read my paper,
which I called "Deja Vu. Medical Marijuana, Where
Are You?"
Ladies and gentlemen of the Iowa Board
of Pharmacy, thank you for allowing me to address
you regarding this subject. I did the same thing
30 years ago to the Iowa legislature. I will focus
only on the medical use of marijuana, not its
recreational use. The people who need recreational
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marijuana already know how to get it.
A bill was approved on June 1, 1979,
which appropriated $247,000 to the Board of
Pharmacy Examiners which was contingent upon the
Board of Pharmacy Examiners establishing a
therapeutic research program within 90 days of the
effective date of that act.
The board was mandated to organize a
physician advisory group to advise the board on the
structure of the program which was never
operational. Today therapeutic research program
laws are no longer effective because of federal
obstructionism.
The dual scheduling scheme still
exists in the statute. But the language for the
therapeutic research program Administrative Code
620-12 was active October 1, '79, to June 30, 1981.
And then it eventually was removed in 1987, and it
is now currently just symbolic.
Should suffering patients be
criminalized? There were approximately
830,000 arrests, 99 percent by local, not federal,
officials in the United States in 2006. 89 percent
of these were for possession, not sale or
manufacture, of marijuana.
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Even if only 1 percent of those
arrested were using marijuana for medical purposes,
then there are more than 7,000 medical marijuana
arrests every year.
Here we are 30 years later in Iowa,
and the marijuana debate continues unceasing
regarding marijuana and its use in medical spheres.
Since 1979, and especially since the mid-1990s,
there have been numerous studies that have shown
that many patients suffering from AIDS, cancer,
multiple sclerosis, epilepsy, Lou Gehrig's disease,
severe or chronic pain, severe nausea and vomiting
secondary to chemotherapeutic drugs, severe or
persistent muscle spasms, and other debilitating
illnesses that find that marijuana provides some
relief from their symptoms.
Available prescription drugs often
come with far more serious side effects than
marijuana. And many patients -- That doesn't
count, does it? And many patients who find relief
from marijuana simply do not respond to other
prescription medications.
In 1999 the Institute of Medicine,
which you already mentioned, showed there was great
relief for -- for marijuana. In 1988 after
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reviewing volumes of evidence on marijuana's
medical use, the Department of Enforcement Agency
chief administrative law judge, Francis Young,
found that maintaining marijuana as a Schedule
drug would be unreasonable, arbitrary, and
capricous and that marijuana in its natural form
is one of the safest therapeutically active
substances known to man.
Last year in 2008, the American
College of Physicians, of which I am a member -- I
have been a fellow of the American College of
Physicians since 1968 came out with a position
paper on the therapeutic role of marijuana in
certain conditions but also -- came out with a
pardon me. I skipped a line -- which stated the
conclusion evidence not only supports the use of
medical marijuana in certain conditions but also
suggests numerous indications for the cannabinoids.
Additional research is needed to
further clarify the therapeutic value of the
cannabinoids and determine optimal routes of
administration. The science on medical marijuana
should not be obscured or hindered by the debate
surrounding the legalization of marijuana for
general use.
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The position paper of the American
College of Physicians also stated, quote, given
marijuana's proven efficacy at treating certain
symptoms and its relatively low toxicity,
reclassification would reduce barriers to research
and increase availability of cannabinoid drugs to
patients who have failed to respond to other
treatments.
Since 1996, 13 states have enacted
laws that effectively allow patients to use medical
marijuana despite federal law. Those state laws
have removed criminal penalties for patients who
use and possess medical marijuana with their
doctor's approval or certification. These laws are
working well, enjoy popular support, and are
protecting patients.
Data have shown that any concerns
about these laws increasing youth marijuana use are
unfounded. Eleven of the thirteen medical
marijuana approved states that have produced before
and after data have reported overall decreases in
teen marijuana use exceeding 50 percent in some age
groups. It has been said that it is easier for a
teenager to buy pot than a six-pack of Coors.
Right now under Iowa law, it's illegal
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for seriously ill patients to use medical marijuana
under the supervision of their physician. If the
patient with one of the devastating diseases stated
earlier desires the use of marijuana, they then
must grow it illegally or buy it on the criminal
market.
Therefore, cash goes into the purses
of drug dealers or drug gangs instead of into the
coffers of the State through manufacture,
distribution, registration, and taxation of
marijuana which could add up to hundreds of
thousands of dollars yearly.
If a patient is charged with a
possession of marijuana, is it possible to use
medical necessity as a defense? Yes. It is
possible for -- it was possible for a judge to
allow an individual to raise a medical necessity
defense based on the state having a symbolic
medical marijuana law, and in Iowa, that happened.
An Iowa judge ruled that a medical marijuana user's
probation could not be revoked for using marijuana
because the Iowa legislature had defined marijuana
as a Schedule II drug with, quote, currently
accepted medical use, unquote.
Of note, Iowa moved marijuana into
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Schedule II in 1979 when it enacted a therapeutic
research program. The research program expired in
1981, bue marijuana schedule remains in place. A
2005 national Gallup poll found that 78 percent of
Americans support making marijuana legally
available for doctors to prescribe in order to
relieve pain and suffering.
For over a decade, polls have
consistently shown that 60 to 80 percent support
for legal access to medical marijuana. Prominent
health and medical organizations including the
American Academy of HIV Medicine, the American
Nurses Association backed it in 2003, American
Public Health Association, Leukemia/Lymphoma
Society, Lymphoma Foundation, and like I stated
earlier, American College of Physicians.
At the present time, marijuana is a
Schedule I drug which means A, the drug has a high
potential for abuse. This is not true when
compared to other drugs such as Valium, Xanax,
sleeping pills, and other opiates which are much
more addictive and are not Schedule I drugs. Beer
and tobacco are much more addictive.
The drug has no currently accepted
medical use in treatment in the United States.
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This is not true. Just read the medical
literature.
There is lack oE safecy for the use of
the drug under medical supervision. This is not
true. Francis T. Young, chief administrative law
judge, said on September 6, 1988, quote, marijuana
in its natural form is one of the safest
therapeutically active substances known, unquote.
It is time to legalize the passage of
a law in Iowa allowing doctor-advised medical use
of marijuana. Let physicians certify deserving
patients with debilitating conditions which have
been previously mentioned to receive the medical
benefits of marijuana which likely outweighs the
risks. Drug abuse is bad. But drug wars are
worse.
One thing that I have also is where is
the harm in drugs? And one of the things you have
to do is when you talk about a drug, you have to
bear in mind, what is the harm? Reducing the harm
of marijuana is a public health philosophy that
seeks to lessen the dangers that marijuana abuse
and policy causes to society.
Reduction in the harm policy is a
comprehensive approach to drug abuse and drug
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policy. Harm reduction's complexity lends to its
misperception as a drug legalization tool.
Reduction in the harm of marijuana rests on several
basic assumptions.
A basic tenet of harm reduction is
that there never has been, is not now, and never
will be a drug-free society. A reduction in harm
strategy seeks pragmatic solutions to the harm that
a drug -- in a drug policy causes. It has been
said that harm reduction is not what's nice, but
it's what works.
What does that say on that?
ED HERTKO: Five minutes. Good.
A
harm reduction approach acknowledges there is no
ultimate solution to the problems of drugs in a
free Society and that many different interventions
may work. These interventions should be based on
science, compassion, health, and human rights.
A harm reduction strategy demands new
outcome measurements whereas the success of current
drug policies is primarily measured by the changes
in use rates. The success of a harm reduction
strategy is measured by the changes in rates of
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death, disease, crime, and suffering.
Because incarceration does little to
reduce the harm that any ever-present drug causes
to our society, a harm reduction approach favors
treatment of a drug addiction by health-care
professionals over incarcecation in the penal
system.
Because some drugs such as marijuana
have proven medicinal uses, a harm reduction
strategy not only seeks to reduce the harm that
drugs cause but also to maximize their potential
benefits. A harm reduction strategy recognizes
that some drugs such as marijuana are less harmful
than tobacco, cocaine, alcohol, methamphetamines,
and many others.
Harm reduction mandates that the
emphasis on intervention should be based on
relative harmfulness of the drug to society, a harm
reduction approach that advocates lessening the
harms of drugs through education, prevention, and
treatment.
Harm reduction seeks to reduce the
harms of drug policies, dependent on an
overemphasis on interdiction such as arrest,
incarceration, establishment of a felony record,
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lack of treatment, lack of adequate information
about drugs, the expansion of military source
control intervention efforts in other countries,
and an intrusion on personal freedoms.
Harm reduction also seeks to reduce
the harms caused by an overemphasis on prohibition
such as increased purity, black market adulterants,
black market sale to minors, and black market
crime.
A harm reduction strategy seeks to
protect youth from the dangers of drugs by offering
factual science-based education and eliminating
youth black market exposure to drugs.
Finally, harm reductlon seeks to
restore basic human dignity to dealing with the
disease of addiction. Thank you.
LLOYD JESSEN: Thank you, Dr. Hertko.
And thank you for summarizing the history that this
board has had with this issue, which I think is
something the public is not generally aware of.
I do have a couple questions for you.
The board has been following what's happening in
other states that have medical marijuana such as
California and Colorado. I assume you follow that
as well?
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ED HERTKO: Oh, yes. I followed
this
last week in the paper. The amount of money that
they're going to gain, and I'm thinking Iowa needs
money. Why don't we legalize it and tax it? Like
one guy says, legalize it and tax the hell out of
it.
LLOYD JESSEN: The question I have
for
you is, if medical marijuana was approved in Iowa,
would you have a recommendation on how distribution
of marijuana occurred here given the fact that it
happens in different ways in different states?
ED HERTKO: The only way that I would
be in favor of it is the same way when I was in
practice. I would write prescriptions for
Phenergan, for morphine, for codeine, for any of
the drugs and so forth, and I would do the same
thing here, that I would write a prescription,
which is a legal document which then would take it
to a legal dispensary for a pharmacist who has been
brought up to date on how to fill that thing so
that you have some idea of who is getting it, and
it all has to be legal.
LLOYD JESSEN: Thank you. Some states
use what they call a compassionate care center, and
another alternative would be to have licensed
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pharmacies dispense the marijuana. How do you feel
about that?
ED HERTKO: If I were going to do
that, the first place I would do is I would go to
California because they're the ones whose law
when you're dealing with 13 states, like I've read
the articles from every one of the states, and some
of them are really to the -- far to the left or
whatever you want to call it, and over in
California, I think they've gone a little bit too
far, and some of the stuff they're doing, it almost
sounds like they're doing like a Neverland. You
can just walk down the street and buy marijuana and
hashish and so forth, and you buy it just the same
as cigarettes. But I think that's a little much.
I think at this point in time I don't
think we're quite ready for that sort of a
situation to arise. I would be favor of legalizing
it, but it has to be legally dispensed through a
prescription from a practicing physician or
practicing health physician. I don't know what the
law would be.
But hopefully, though, we will take
this and just add it to the aramatarium that
physicians and other people and health
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professionals can go ahead and use it because I
personally think that marijuana does have a place
and a legal place. As far as the recreational, as
I said earlier, those people already know how to
get it.
LLOYD JESSEN: So in your opinion,
would you favor dispensing by a pharmacy rather
than what other states call compassionate care
centers?
ED HERTKO: No. I would first
go with
that. I don't think -- I don't think -- that came
later because they've been doing that for years in
California. I don't think they did all that
compassion centers -- I don't think that was Day 1.
I think that came later.
I would go with the legal part
through -- legally dispensing it through a pharmacy
and go with that, see how it runs, and then if you
want to change it later to something else or add
something else, but I'd first -- I'd go out to
California and find out how they're doing it and
figure out "Oh, I ain't going to do that to start
with."
LLOYD JESSEN: Any other questions
from board members? Thank you, Dr. Hertko.