A handful of South Carolina legislators have made it clear they intend to again push for legalized marijuana in South Carolina. They have also made it clear they intend to have this debate as though it were a medical issue by making physicians the singular access point for the ”marijuana drug.” There is one substantial problem; none of them have bothered to ask physicians if we support such measures. We do not.
The South Carolina Medical Association is the state’s largest voice for physicians, representing thousands of physicians in South Carolina. Every year, we set our association policy at our House of Delegates meeting and have done so for more than 100 years. The physicians in attendance, representing all corners of the state and every medical specialty, are unanimous in their opposition to forcing physicians to decide who can and cannot have access to marijuana. To date, medical studies have failed to make it clear what medical benefits there are in using marijuana. As we all know, if a physician does not have clarity, then it is impossible to “first do no harm.”
In the United States, we schedule substances in categories based on their potential for abuse, medical usefulness, safety of use, and propensity for addiction. Marijuana, along with most every other known compound, was scheduled by an act of Congress in 1971 and the powers to regulate the schedule have been largely delegated jointly to both the Drug Enforcement Administration (DEA) and the Food and Drug Administration (FDA).
For nearly 50 years, marijuana has been a Schedule I drug, a schedule reserved for substances that have the highest potential for abuse, lack known medical value, and high potential for addiction. Marijuana proponents, including those who believe marijuana has theoretical medical value, have long desired the DEA change marijuana to Schedule II, which would dramatically improve the availability of marijuana for scientific testing. We are not opposed to this.
As physicians, our main concern is medical safety and efficacy, which can only be clearly determined for marijuana after controlled scientific testing on a widespread peer-reviewed basis. For decades, the DEA, FDA, and National Institutes of Health have all agreed on this same process. Until such wide-scale testing occurs, it remains dangerous for our legislative body to ask physicians to be the gatekeepers for marijuana in our state.
Indeed, there exists a process to conduct the studies necessary to understand the indication and dosage for marijuana and its compounds: reschedule marijuana allowing for significant, controlled, and replicable scientific testing. However, this can only occur on the federal level, through either an act of Congress which some view as the most expeditious method, or through more cumbersome and time-consuming actions taken by the DEA and FDA.
This safe and reasonable process is not the solution sought by marijuana proponents, however. In fact, their bill would circumvent this process entirely and put our patients’ health at risk.
Sacrificing patient safety, alone, causes me to pause as a physician and examine the individual and population health risks posed by such a radical policy proposal. While in the midst of an ongoing and deeply tragic opioid crisis, itself full of unintended consequences that affect us all, we would do well to avoid another substance crisis. We have a chance to prevent poor legislation from passing and to work on real, safe, and reasonable solutions now. The physicians of South Carolina stand ready to help—we’re always on call.