Richard Feldman: Marijuana should be treated more like alcohol

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Dr. Richard FeldmanMarijuana, despite some recognized adverse effects, is progressively gaining acceptance by the public and lawmakers for both medical and recreational uses. In Pew and Gallup polls, approximately 65% of Americans favor legalization, and in one study, nearly 70% of physicians believed medical marijuana should be available while over half believed it should be legalized.

Marijuana has demonstrated therapeutic benefits for a number of conditions, including chronic pain, recalcitrant epilepsy, nausea and spasticity in multiple sclerosis. There are probable benefits in inflammatory bowel disease, fibromyalgia and glaucoma and in the stimulation of appetite in cancer patients. Much more research is needed.

Adverse effects include some risk of psychological addiction and mild physical addiction with withdrawal symptoms similar to nicotine. There can be emotional disturbances, some driving impairments, and cognitive and memory difficulties with heavy use, but these are largely reversible.

A major concern is adverse effects on adolescent brain development and, although there is some observational evidence, it is principally based on non-clinical indications of brain physiology changes. There is no evidence that marijuana is a gateway drug, any more than alcohol can be considered so.

Thirty-three states, the District of Columbia, Guam, Puerto Rico and the U.S. Virgin Islands have legalized medical marijuana. Eleven states (including Michigan and Illinois) and D.C. have legalized recreational use. Ohio approved medical marijuana in 2016.

The acceptance clearly crosses political party lines, evidenced by the states that have passed legalization statutes and referendums. Voters in Florida approved a medical marijuana referendum with a 71% majority.

As one might expect, Indiana is not politically ready at this moment for the legalization of medical marijuana. But in one recent poll, 73% of Indiana voters favored legalization for medical purposes. Accordingly, one would predict that legalization of medical marijuana is inevitable. An Indiana law should include strict regulation, meaningful medical supervision, limitations on quantities, and formation of a state commission of medical professionals that would issue legitimate evidence-based indications for medical use.

Legalization of recreational use is also currently unrealistic in Indiana. Decriminalization is. Note that the Marian County prosecutor has ended prosecution for possession of small quantities of marijuana. Fifteen additional non-marijuana states have decriminalized marijuana. Decriminalization generally involves reducing the offense of personal-use possession of small quantities from a felony or misdemeanor to an infraction. There would be no arrest, prison time or criminal record, much like minor traffic violations.

Marijuana is not heroin, cocaine or methamphetamine. It’s not a narcotic and is probably safer than alcohol; it should be legally treated as such. Convictions and imprisonment and the resulting marginalization and negative consequences to future employment, educational and other opportunities are not justified from either a moral or cost-to-society standpoint. Resources can be saved in law enforcement, corrections and judicial systems and spent fighting more serious drugs and crimes. Decriminalization has not resulted in increased use.

Both the American Academies of Family Physicians and Pediatrics have recommended decriminalization of marijuana. As more states embrace both medical and recreational uses, federal illegality and treatment as a Schedule I controlled substance (like heroin) will increasingly become untenable.

Much like the forbearance for tobacco and alcohol or the repeal of Prohibition, the public is willing to accept marijuana as a legal substance and tolerate its untoward effects.•

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Feldman is a family physician, author, lecturer and former Indiana State Department of Health commissioner for Gov. Frank O’Bannon. Send comments to ibjedit@ibj.com.


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