Nevada’s medical marijuana study stalled

In 2001, after Nevadans twice voted to support medical uses for marijuana, the Nevada Legislature codified their decision in the state’s statutes.

“Every legislator had to grapple with this,” Senate Human Resources Chairman Ray Rawson said at the time. “The people put this in the constitution and asked us to do it.”

But the lawmakers did not stop there. At the time, simple marijuana possession in Nevada was a felony offense, though it was often plea bargained. The legislators reduced the penalties to misdemeanor levels. And they set up a state program to research the medical uses of marijuana, housed in the Nevada School of Medicine.

The research language was inserted in the legislation by Rawson, then a highly regarded moderate GOP senator and forensic dentist, and was enacted into law. But it has never resulted in actual research because, well, George W. Bush was president.

The Nevada statute reads, “The University of Nevada School of Medicine shall establish a program for the evaluation and research of the medical use of marijuana in the care and treatment of persons who have been diagnosed with a chronic or debilitating medical condition. … A research program established pursuant to this section must include residents of this state who volunteer to act as participants and subjects, as determined by the School of Medicine.”

But there is also another provision in the law requiring the school to get federal approval for the program.

Legislators decided they would not wait on research to approve health care uses of marijuana or to reduce the punitiveness of the law, but they did retain the provision for a Nevada research program.

Some suspected Rawson of adding the research provision to the bill in order to kill it, and he does say he’s not really an advocate of medical marijuana use.

“I thought we should research it first,” he said this week, “that if there is a therapeutic use for it, it ought to be used for it. … I’m not trying to lead the fight on this at all. I was just trying to give it a reasoned approach. If they’re going to open it up, it ought to be studied.”

In fact, it was the Nevada Medical Marijuana Initiative Work Group—formed after final approval of medical marijuana by the voters in 1998—that recommended the research program. The group’s report said marijuana should be “subjected to rigorous and exacting medical and scientific research. Only through such rigor could folk remedies and traditional cures be proven or disproven and outright charlatanry be weeded out.”

But that kind of research raised issues of purity of supply and the safety of research subjects. Buying on the street wouldn’t work.

“[A supply of] marijuana would be purchased by the research study through federally approved providers,” the group’s report recommended. “Marijuana would not be grown, processed or manufactured in Nevada. The federally approved provider would provide uniform, predictable and uncontaminated marijuana, thus protecting patients from the vagaries of illegal or homegrown marijuana.”

That made federal approval even more essential. And that’s where things came to a halt, because the Bush administration was unremittingly opposed to marijuana use, medical or otherwise. Not only was there vigorous enforcement of federal anti-marijuana laws, but there were no federal research dollars available.

Last year, a School of Medicine associate dean, Dave Lupan, said the program had never been launched and would not be launched unless there was a different president.

Now, there is a different president.

Democrat Chris Giunchigliani, in 2001 a state legislator and now a Clark County commissioner, sponsored the marijuana bill that Rawson amended. She said she expects the new administration to make a difference.

“I think both not only with the new president but with the new attorney general’s stance of looking realistically at how our drug policy is failed and whether they should spend time and taxpayer money on it, yes, it would make sense” for them to take a new attitude toward research, she said.

“This president has been setting a different tone on this issue, and I would think there would be more chance of getting approval now,” Rawson said this week. “That was always the concern, that if a program was begun, the ATF [Bureau of Alcohol, Tobacco, and Firearms] would come in and bust it.”

In July, Dean Lupan submitted a periodic update report to the legislature’s Interim Finance Committee.

“I anticipate there will be a change in philosophy or interest in the development of new treatment regimes for medicinal marijuana at the National Institutes of Health (NIH) during the coming years,” Lupan wrote. “However, the new presidential administration has yet to make investment in new commitments to this area of medical research. The NIH continues to face considerable challenge in funding established biomedical research and training programs. The prospect for a near term turnaround seems unlikely. In addition, the Supreme Court ruling of June 6, 2005, allowing the prosecution of individuals who smoke marijuana for medicinal purposes, though prescribed by personal physicians, poses a major impediment to prospective development.”

This last point has been ameliorated at least for the time being by U.S. Attorney General Eric Holder’s announcement on Oct. 19 that federal agents will not try to arrest medical marijuana users and suppliers as long as they are acting under state laws. Thirteen states permit medical marijuana use.

But other obstacles remain. The legislature has allocated no money for the study, leaving the Medical School dependent on grants. The statute says the School “may apply for or accept any gifts, grants, donations or contributions from any source” to carry out the study. But the federal government has offered no research grants in this field, and the feds set the research agenda except in states—California is the only example—willing to pony up for their own research.

Lupan said, “I’ve had a few physicians of our faculty say that if there’s money available that we’d be interested in looking at it or interested in applying for it.”

In general, the situation seems to be yeastier for serious research than it was a year ago, but it is likely to take some time yet for the Nevada program to get a launch.

But advocates of medical marijuana quickly point out that more research, while welcome, is not necessary to make the case. During the ballot campaigns on the issue in Nevada, a three-inch-thick volume of previous studies of marijuana’s use in treating everything from cancer to cholera was distributed around the state. The year after voters approved the Nevada law, a federal study was commissioned from the Institute of Medicine in D.C. and part of its executive summary is frequently quoted by advocates of marijuana use:

“The accumulated data indicate a potential therapeutic value for cannabinoid drugs, particularly for symptoms such as pain relief, control of nausea and vomiting, and appetite stimulation. The therapeutic effects of cannabinoids are best established for THC, which is generally one of the two most abundant of the cannabinoids in marijuana. (Cannabidiol is generally the other most abundant cannabinoid.)”

The subsequent sentences, however, are less often quoted by advocates. They touch on the problem of pills versus smoking to physically deliver marijuana’s active ingredients:

“The effects of cannabinoids on the symptoms studied are generally modest, and in most cases there are more effective medications. However, people vary in their responses to medications, and there will likely always be a subpopulation of patients who do not respond well to other medications. The combination of cannabinoid drug effects (anxiety reduction, appetite stimulation, nausea reduction, and pain relief) suggests that cannabinoids would be moderately well suited for particular conditions, such as chemotherapy-induced nausea and vomiting and AIDS wasting.”

What this means is that some patients have difficulty taking pills. In addition, medical users have said that smoking delivers the effect gradually while pills deliver with a bang.