Come January 1st, thousands of Arizona veterans and others suffering from post-traumatic stress disorder will soon be able to obtain marijuana legally.
State Health Director Will Humble decided Wednesday there is at least one study showing the drug can be helpful in treating the symptoms of PTSD. He said that, combined with some anecdotal evidence, provides what he needs under Arizona law to allow doctor with a qualifying patient to recommend the drug.
But Humble said he is approving the drug for use only to help patients deal with the symptoms of PTSD. He said there is no evidence that marijuana can be useful to actually treat or cure the condition.
Humble placed one other limit on doctors: Before they can recommend marijuana to deal with PTSD symptoms, they must first attest that the patient has been undergoing more conventional treatments. That would require doctors to first try something else rather than simply using marijuana as the first choice.
Tucson attorney Ken Sobel, who represents the Arizona Cannabis Nurses Association that petitioned for the change, called Wednesday’s action a “landmark.” He pointed out this is the first time since voters approved the use of medical marijuana in 2010 for certain specified conditions that a new one has been added.
But Sobel said a new legal fight may be brewing. He contends that Humble’s authority under the Arizona Medical Marijuana Act and the rules that implement it is limited to deciding what conditions allow a doctor to recommend the drug to patients.
“There is nothing in the rules that, once a condition is listed, it allows the (health) department to impose conditions,” Sobel said. But Sobel said he has made no decision on whether to take the issue to court.
The voter-approved law allows the use of the drug by patients suffering from a list of several specified medical conditions. These range from glaucoma and AIDS to any chronic or debilitating condition that leads to severe and chronic plan.
So far close to 50,000 people have qualified under the existing list of conditions to purchase up to 2 1/2 ounces of marijuana every two weeks.
But the law also requires Humble to consider requests for expanding the list of conditions for which marijuana can be recommended.
Proponents of adding PTSD to that list tried in 2012 and again last year. That led Humble to contract with the College of Public Health and the University of Arizona UA to examine peer-reviewed studies to determine whether there is any basis for that addition.
Humble said he needs peer-reviewed scientific studies to show any beneficial link between marijuana and PTSD. And Humble pointed out that UA study found only “observational studies of varying quality,” with the conclusion that “the totality of this evidence should be considered very low quality with a high degree of uncertainty.”
That last rejection resulted in an appeal by Sobel’s clients. And last month Thomas Shedden, a state administrative law judge, said Humble should grant their request.
Shedded conceded that lack of those scientific studies. But the judge said the health chief should also have considered the anecdotal testimony of doctors and nurses who said the drug has helped their patients.
Humble, in Wednesday’s order, acknowledged Shedden’s point.
But Humble said that proponents actually had more. He said they presented evidence to Shedden of a manuscript — not yet published at the time — which found “an association between cannabis used and PTSD symptoms in some patients.”
“In other words, the information presented by the petitioners at the hearing and subsequently published study provided evidence that marijuana may be helpful in the palliative care of PTSD in some patients,” Humble wrote. And that, he said, is enough to meet the requirements of the law which require some substantiation between marijuana and helping patients deal with their symptoms.
That still leaves the question of the limits Humble is placing on when doctors can recommend the drug.
Sobel contends that Humble’s authority to limit how marijuana can be recommended ends once he concludes there is medical evidence the drug is useful in the treatment of PTSD. He said it is irrelevant whether either Shedden or Humble believe the drug cannot be used by those who believe it provides an actual cure or treatment, or whether they believe that doctors should first try more conventional approaches.
For example, Sobel said, marijuana can now be recommended for those who are undergoing chemotherapy as part of their treatment for cancer.
“We have no evidence yet that cannabis will cure cancer,” Sobel said.
“But we know it will make them feel a lot better from the chemotherapy,” he continued. “They’re not required to have to prove that they have tried some conventional medicine and they’re not required to jump through other hoops.”
There was no immediate response from the health department to Sobel’s contention.
The number of people who could benefit is unclear.
Sobel said there was testimony by a doctor that perhaps 500,000 Arizonans — close to one out of every 13 — suffers from PTSD. But he said many may not be aware of it.
Vietnam Veterans of America estimates that 30 percent of those who served in that conflict are affected by PTSD, with a likely similar percentage of those who have served more recently in the Middle East.