Iowan Dr. Ed Hertko: “Available Prescription Drugs Often Come With Far More Serious Side Effects Than Marijuana”

The following speech was given by Dr. Ed Hertko at the 2009 Iowa Board of Pharmacy hearing on medical cannabis in Des Moines, Iowa. Transcript of speech available here on page 37 – 48.

Dr. Edward Hertko

Dr. Edward Hertko

“I’ll read my paper, which I called “Déjà 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 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 the 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, ’70, 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.

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 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 I drug would be unreasonable, arbitrary, and capricious 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.
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 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 moved marijuana into Schedule II in 1979 when it enacted a therapeutic research program. The research program expired in 1981, but 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. This is not true. Just read the medical literature.

There is lack of safety for the use of the drug under medical supervision. This is not true. Francis 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 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.

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 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 incarceration 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, 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 reduction seeks to restore basic human dignity to dealing with the disease of addiction. Thank you.”

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Here’s video of Dr. Hertko’s speech courtesy of Jimmy Morrison:



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