The myths, the reality, the progress
Photo of Dr. Lazslo Mechtler by kc kratt
In the year 2018, it might be fair to say that a majority of adults have experience—either firsthand or through a friend, family member, or coworker—with the use of cannabis for medical purposes. My own list over recent years includes those who have used cannabis to help tolerate the effects of chemotherapy, mitigate the symptoms of glaucoma, reduce anxiety and insomnia, and ease chronic pain without the use of opioids. By all accounts, this use of cannabis has yielded overwhelmingly positive results without significant negative side effects. But, in all cases, the users were violating arcane and draconian federal/New York state laws. In light of this real world experience, it’s a sobering thought—and beyond ridiculous—that the federal government still considers cannabis to be a Schedule One narcotic on par with heroin and LSD, a substance having no legitimate application.
Any rational observer will conclude that those who use cannabis for medical reasons aren’t stoners out to get baked before a Phish concert. They are people desperately looking to improve quality of life, usually after exhausting the alternatives provided by mainstream pharmaceuticals. With the availability of cannabis for medical purposes for approved conditions in January, 2016, New York became one of twenty-nine states where patients can have at least some access without delving into the black market. But, the headwinds against wider-spread usage—from political, business, and cultural forces—remain strong. Looking ahead, it’s useful to consider how we got to a point—to use a well-known local example—where Buffalo Bills lineman Seantrel Henderson risks the loss of his livelihood by using cannabis to deal with the debilitating symptoms of Crohn’s disease.
In a word: nuts.
The legacy of Henry Anslinger
Henry Anslinger is a virtually unknown name today, but his legacy looms large in the history of medical cannabis. Prior to the early 1900s, cannabis was among the most widely prescribed drugs in the United States. Most Americans living any distance from the Mexican border were unaware that cannabis could even be smoked. But law officials and politicians in border states determined that cracking down on cannabis—rebranded as marijuana to associate it with (portrayed as undesirable) Mexican-Americans—would give them a potent weapon in their efforts to tamp down labor unrest in the region. As a result, prohibitive laws were passed and cannabis was put on the track to being Public Enemy Number One, a blunt object that could be used to scapegoat and harass minority groups and bohemians (with their affinity for “jazz cigarettes”) alike.
Enter Henry Anslinger, the first commissioner of the Federal Bureau of Narcotics (FBN). A veteran of the failed war on alcohol with a reputation of relentless zeal for enforcing the law (think J. Edgar Hoover), Anslinger moved over to the FBN after the repeal of Prohibition. When dwindling tax revenues in the early 1930s threatened the very existence of the FBN, Anslinger determined that demonizing cannabis was his ticket to increased funding and power. Thus a massive campaign of disinformation began. The late night cinema favorite, Reefer Madness, might seem like a giant goof today, but it was indicative of how cannabis was portrayed: a dangerous drug that would drive you to madness, mayhem, and murder (or, apparently just as bad in Anslinger’s mind, playing jazz).
As it became apparent over time that cannabis did anything but trigger violent behavior, Anslinger took a different tack in the 1950s, asserting that Americans couldn’t fight off the oncoming Communist invasion if they were too stoned to get up off their couches. Working overtime in his disinformation efforts, Anslinger made sure that blue-ribbon panels that contradicted his narrative were discredited, and even arm-twisted the American Medical Association.
Even after Anslinger was forced out of his position at the FBN by President Kennedy, the growth of the baby boomer-led sixties counterculture (and the accompanying widespread increase in recreational cannabis use) shook the foundations of the political establishment across the ideological spectrum, leading politicians and law officials to fight back with more stringent laws and enforcement (liberal Republican Governor Nelson Rockefeller oversaw the passing of particularly draconian laws in New York). Seeing a political opportunity in using cannabis as a “wedge issue” to rally voters in the fight against the growing tide of hippies and freaks who seemingly threatened the American Way of Life, President Nixon approved legislation in 1970 that labeled cannabis as a Schedule One narcotic, effectively shutting down the window for medical research going forward. Out of this pit of misconception and legal prejudice, we’ve been on slow climb over the past half-century, back to the early stages of a rational assessment of cannabis.
Dr. Laszlo Mechtler, head of the Dent Neurological Institute (the largest neurological institute in the country), and the Dent Cannabis Clinic, as well as neurological oncologist at Roswell Park Cancer Institute, is one of the most vocal proponents of medical cannabis in the United States. For Mechtler, his advocacy did not come from personal leanings. “I don’t drink or smoke at all,” he explains. “Putting any foreign substance in my body is unusual for me to embrace.” Dr. Mechtler’s interest in cannabis was driven by two factors. “As an oncologist and neurologist, patients were asking me about it on a daily basis and my reply was, ‘It’s illegal and I can’t prescribe it.’ Medical cannabis is a patient-driven phenomenon. It was not ever driven by the medical community. The second thing that has driven me into medical cannabis is research. I sat down and studied the history. What happened after 1910 was purely political. I realized that medical cannabis had a dirty taste to it. The federal government threatened prosecution over it. Physicians became scared of it. But we have every reason to embrace medical cannabis in a professional manner and we will legitimize it.”
Dr. Lazslo Mechtler
The Dent Cannabis Clinic currently has more than 2,500 patients with an additional waiting list in the hundreds. Mechtler relates his experience to date: “As a physician, I have two types of experience, scientific studies and personal experience. Personal experience I can’t present at a national level. But, from my thirty years of personal experience, medical cannabis has changed people’s lives. In an anecdotal manner, reviewing these cases, I’ve never seen anything like this with any other medications I’ve used and researched. Some of these patients just come back and embrace you with tears in their eyes because of how their lives have been changed. Everyone here at the Dent is so encouraged. Let’s now do the research and legitimize it.”
One huge stumbling block to legitimization and acceptance is the Schedule One classification. “Right now, we have so many medical cannabis patients; I would love to do perspective research. But, because it’s a Schedule One drug, that is nearly impossible. And though I have seventy-five ongoing studies at the Dent Institute, I cannot do a research study perspectively, because I can’t get federal approval. The federal government won’t allow us to do research.”
The conflating of medical cannabis with recreational usage and the patchwork of laws in each of the twenty-nine states where at least some use is legal further complicates legitimization. “I use the term 'legitimize' often, because I feel that what's been done in California and Colorado is not legitimizing medical cannabis, and, because of that, it feels dirty among physicians. The politicians bypassed us and suppressed our ability to do research.” Although perhaps frustrating to potential recreational users, the laws in states like New York that approve cannabis for medical use only make it easier for medical cannabis advocates to make their case free from the additional issues associated with recreational use.
With the opiate crisis currently at the forefront, Mechtler emphasizes, “It’s been proven that medical cannabis is not a gateway drug, and it’s about the safest, least addictive drug out there. It causes zero deaths a year. I have no concerns [about side effects] other than with patients with strong histories or family histories of schizophrenia and kids under the age of twenty-three, unless they have cancer or epilepsy. Otherwise, I’m not astonished about my comfort level because I see the response. Of all my patients, less than one-tenth of one percent come back and say ‘I got a buzz.’ They don’t get high. In today’s world, with the opiate epidemic, people who don’t embrace medical cannabis are doing a disservice to the community and the individual patients who are addicted to opiates.
“I work with national medical societies making the case that legitimization should be their number one priority. People who are voting against it don’t have family members who have tried it. There’s an artificial fear factor from our culture. But if people question the efficacy of medical cannabis, I know that they don’t have any experience or know anyone who has.”
Headquartered in Illinois, PharmaCannis operates medical cannabis dispensaries across New York State, including its Amherst location. According to chief legal counsel Jeremy Unruh, the company saw an opportunity in highly regulated states “to bring a mainstream business and science background into a space that really cried for it historically and culturally. In order to be attractive to the more conservative members of Congress, there has to be a more sophisticated mainstream oriented approach.” Regional manager and lead pharmacist Rachel Schepart looks back on the opening day of the Amherst dispensary in January 2016: “There were more television reporters than patients.” When chronic pain was added to the approved list of symptoms in March, 2017, prescriptions increased dramatically.
There’s no doubt that the current federal classification of cannabis is probably the main barrier to wider acceptance. The situation is like the quandary of a recent college graduate looking for a good job—you need experience to get a job but can’t get the experience you need without first having a job. Schepart notes, “The most common pushback from physicians is that they need to see more data. Over time, the reclassification of the drug would debunk a lot of the myths and validate the place of this plant in medicine. What has driven this program is people. It will be very difficult for our policy makers to ignore this over time.”
With recent polls showing ever-rising public support for medical cannabis and research, Unruh acknowledges that there’s usually a lag time of three to four years between public acceptance and appropriate legislation. That said, the time to let your doctor and legislators know you are fully behind the reclassification of medical cannabis at the federal level is right now, not when you or a loved one is in a dire position of possible need.
For more information, the New York State website health.ny.gov/regulations/medical_marijuana/ is a great place to start.
Medical Cannabis By The Numbers
There has been no measured level of lethal toxicity in humans for cannabis. It’s been estimated that a 154-pound human could ingest forty-six pounds or smoke three pounds of cannabis in a short period without reaching toxic levels.
An October 2017 Gallup poll showed widespread public support for legalizing cannabis—sixty-four percent—including, for the first time, a majority of Republicans. The support for medical cannabis has been tracked by Quinnipiac at ninety percent.
Given his usage of recreational cannabis in his youth, President Obama’s failure to reclassify cannabis from its Schedule One narcotic status was a major disappointment for advocates. There is presently little hope for change under the current administration, especially given Attorney General Jeff Sessions’ Rockefeller-era attitudes, without a dramatic increase in vocal public support.
In states where cannabis is legal in some form, the death rate from opiate overdoses has dropped by approximately twenty-five percent. According to one recent study, annual prescription drug usage across a wide range of categories dropped significantly—ten percent or more in most cases—in states with legal cannabis.
The Buzz Factor
There are two main chemical components (or at least the two main components of interest for this purpose) of cannabis: CDB (cannibidiol) and THC (tetrahydrocannabinol). CDB has a lot of the medicinal qualities. THC is what gets people high, which is actually beneficial in cases of nausea and loss of appetite. The key is for pharmacists is to figure out which ratio between CBD and THC is ideal for the patients, so that symptoms can be treated without patients getting unnecessarily blasted (not necessarily a concern in end of life situations). There are over 113 active cannabinoids in cannabis but THC and CDB are the main focus right now. There’s a lot of research to be done—but only if cannabis can be moved out of Schedule 1.
Bruce Eaton is a longtime writer for Spree.