Sunday, November 18News That Matters

A look at Missouri's 3 medical marijuana ballot questions and lessons from Colorado


The question of whether Missouri should legalize medical marijuana is personal for Pam Whiting.

Whiting, the vice president of communications for the Greater Kansas City Chamber of Commerce, had a sister who was diagnosed with epilepsy at a young age. Traditional medicine failed her.

“Her seizures were uncontrolled throughout her life despite a whole series of different medication regimes,” Whiting said. “The medicines she was given turned her from a bright and curious child to dull, listless, and unable to achieve in school. She was unable to hold a job and unable to drive.”

Whiting said she often wonders now what kind of life her sister might have had if she could have tried using marijuana to quell her seizures.

With three medical marijuana questions on the ballot in Missouri next month, The Star’s readers wanted to know whether the 51 influential Missourians participating in the Missouri Influencers project think marijuana should be legal for medical use. Readers also wanted to know whether employers should continue to screen for marijuana if it is legalized.

Whiting, an Influencer, was part of the majority in favor of Missouri joining 30 other states that have legalized marijuana for medical use. The group included two former Missouri governors, Democrats Jay Nixon and Bob Holden.

“If we allow alcohol, we should allow marijuana,” Holden said.

But the dissenting voices included Children’s Mercy Hospital chief toxicologist Jennifer Lowry, the Influencer with the deepest knowledge of cannabis’ effects on the human body.

“Currently, cannabinoid biology is poorly understood,” Lowry said. “Research has identified areas of therapeutic potential for these molecules, including analgesia in chronic neuropathic pain, appetite stimulation in debilitating disease, and spasticity in multiple sclerosis. However, adverse effects can also occur, ranging from benign (tachycardia and palpitations) to serious (mood, anxiety, and thought disorders).”

Doctors’ orders

Marijuana has been a feature of folk medicine for thousands of years, but modern research studies are complicated in the United States by the drug’s status as a Schedule 1 controlled substance at the federal level.

Some research shows chemical compounds found in marijuana can be effective for treating certain conditions. The Food and Drug Administration has actually approved medications based on synthetic or natural versions of those compounds, like a drug called Epidiolex for persistent seizures and Marinol for nausea and appetite loss.

But when it comes to using “whole plant” cannabis to treat disease, Lowry’s opinion is not an outlier among physicians. Doctors would be the gatekeepers to medical marijuana if Missouri voters approve it, but all three ballot measures are opposed by several major medical groups in Missouri, including the ones that represent physicians in Kansas City, St. Louis and statewide.

They say that although certain parts of the cannabis plant have legitimate medical uses, broad-based medical marijuana programs like the ones proposed in Missouri provide access to products that aren’t sold in standard dosages or purities.

Essentially, patients don’t know what they’re getting, so it’s impossible for doctors to gauge the risks versus the benefits.

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John Hagan, an ophthalmologist and past president of the Kansas City Medical Society, said cannabis-based treatments should come in standardized products tested by the FDA, just like other drugs.

“Approving medical treatments by ballot initiatives sets a dangerous precedent for public health,” Hagan said.

But if results in other states are any indication, Missourians will probably opt to approve medical marijuana, which would raise new questions about how to regulate it.

The 3 ballot questions

Nine marijuana initiatives appeared on statewide ballots in 2016 and all but one was approved. While the measures used to pop up mainly in Democratic-leaning states, they’ve since become bipartisan. Earlier this year voters in Oklahoma, arguably the reddest state in the union, overwhelmingly passed a broad-based medical marijuana program, sending regulators scrambling to create rules for implementing it.

Ironically, legalization efforts in Missouri could be thwarted because there are so many on the ballot. It’s highly unusual, if not unprecedented, to have voters evaluating three separate questions at the same time. If they split votes, it’s possible none of them will pass.

The three proposals are:

Amendment 2: a change to the state constitution that would allow doctors to prescribe cannabis for a slate of 10 medical conditions.

Amendment 3: a change to the state constitution proposed by Springfield physician/lawyer Brad Bradshaw that would create a medical marijuana research institution that Bradshaw would lead, at least temporarily. Bradshaw recently came under fire for having about $100,000 in unpaid state and federal taxes, which he said stem from a mistake by the IRS and his accountant.

Proposition C: a change to state law that is similar to Amendment 2, but with different taxation levels and, because it’s a statute rather than a constitutional amendment, the legislature would be able to change it.

If both of the constitutional amendments pass, the one with more votes will be enacted. The amendments would supercede Proposition C if it and either amendment pass or all three pass.

If medical marijuana passes

If any of the measures pass, regulators will face new questions about who should be able to use medical marijuana and in what settings.

Lowry said it shouldn’t be used by anyone under 21 because marijuana can impair brain development.

Colorado Springs doctor Kenn Finn said Missourians should be aware that marijuana-related traffic deaths are rising in his state, which has also legalized the drug for recreational use.

Finn said “it’s very tricky” to determine when someone has consumed too much THC — the compound in marijuana that causes a high — to safely drive. There’s no breath test for it. Colorado uses a blood test and has set a legal limit of 5 nanograms per milliliter of blood.

“Which is difficult to rely on because that doesn’t necessarily mean somebody is impaired,” Finn said.

Finn said Colorado has also learned that the environmental costs of legalization can be high, because marijuana is an energy- and water-intensive crop.

Some of the Influencers identified other challenges the state will face if the ballot initiatives pass.

Political strategist James Harris said the continued federal prohibition of marijuana poses several potential problems.

“The businesses involved in the (marijuana) industry have to operate as cash businesses, because banks will not allow them to set up accounts due to federal regulations,” Harris said. “A high-volume cash industry has the potential to be a magnet for crime.”

There are also questions about how federal law enforcement would handle those who use or sell legal medical marijuana.

William Callahan, the head of the Drug Enforcement Administration’s regional office in St. Louis, said the agency doesn’t prioritize arresting people who sell medical marijuana as long as they’re following state laws and not letting their products flood into other states. And it’s not interested in cracking down on simple possession.

“DEA does not target the user, and that cuts across all sorts of drugs,” Callahan said. “The DEA targets those organizations, those individuals that choose to sell illegal drugs, that choose to prey on those who are addicted.”

But Callahan, like Hagan, said people should only use cannabis compounds in FDA-approved medications. He said the DEA has approved more than 700 marijuana-related research studies to determine potential health risks and benefits.

Employer drug screening

The Influencers were split on whether employers should continue to screen for marijuana if it’s legalized for medical use.

Chris Maples, interim chancellor at Missouri University of Science and Technology, said medical marijuana should be legal because it shows promise in treating certain conditions, but more research is needed.

“I believe some employers should continue to screen for medical marijuana if it is legalized, especially if there is the possibility of any impaired judgment or action,” Maples said. “Until we actually conduct appropriate research on the effects of medical marijuana, including potential side effects, it would be prudent to continue screening.”

But Ken Novak, a professor of criminal justice and criminology at the University of Missouri-Kansas City, said it wouldn’t be appropriate for employers to test for marijuana if their workers might be using it legally for medical purposes.

“The reason is patient privacy — if employers were able to screen for medical use, then they may be able to logically assume the employee is being treated for some disease,” Novak said, citing epilepsy and post-traumatic stress disorder as potential examples. “Assuming the employer has no business determining whether employees have these afflictions, then screening for drugs associated with alleviating the symptoms is legally problematic.”

Last week’s Influencer topic: Redistricting

Next week’s topic: Courts and judges

We want to hear from you

Missouri lawmakers have slowly but surely stripped all local authority to regulate guns, culminating when the legislature voted to void any local ordinance restricting the open carry of a firearm.

In recent years, lawmakers have voted to overturn local minimum wage hikes and undo local regulations on vehicle-for-hire companies like Uber and Lyft. They’ve debated eliminating the earnings tax, which funds a huge portion of Kansas City’s budget, and over the years have introduced bills prohibiting cities from banning disposable plastic grocery bags and gutting local ordinances aimed at preventing discrimination against LGBTQ Missourians.

Local leaders balk at what they see as “one size fits all” proposals, saying they are far more attuned to their constituents than the GOP-led legislature that is far more dominated by rural interests than urban populations.

What questions do you have about local control in Missouri? Tell us at Kansascity.com/influencers to help shape our future coverage.

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