The Missouri Influencer Series

In their own words: Missouri leaders, including a toxicologist, on medical marijuana

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Missouri Influencer Series

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With three medical marijuana questions on the ballot in Missouri next month, The Star’s readers had a lot of questions about the issue.

The two most popular were:

1. Should marijuana be legal for medical use? Why or why not?

2. Should employers continue to screen for medical marijuana if it is legalized? Why or why not?

Here what our panel of business leaders, policymakers and community catalysts participating in “The Missouri Influencers” series said.

Kay Barnes, former mayor of Kansas City, senior director for university engagement at Park University

1. Yes, a measured approach to this issue is best. Clear guidelines as to appropriate usage will be important.

2. Not certain.

Michael Barrett, Missouri State Public Defender director

1. Yes. If medically trained experts — among whom I am not — say that it can help people who are sick while not harming others, I simply don’t understand why this is the least bit controversial.

2. It should be rationally related to the work being performed. If data suggests that it impairs cognitive function in any way, then I’d say — might be good to know before we let someone, say, land a plane or perform LASIK. I’d be less inclined to support testing when hiring baristas or parking lot attendants.

Brenda Bethman, director of UMKC Women’s Center

1. Yes, because it can help people with chronic illnesses and cancer patients going through chemotherapy. The more treatments available, the better.

2. No, because if it’s legal, it shouldn’t matter to employers.

Jean Paul Bradshaw, lawyer and former U.S. attorney

1. For those situations in which there is truly a medical benefit, there is no reason why it shouldn’t be available like any other beneficial drug. It seems that the problem in many states has been that the medical necessity for use of the drug has been very liberally construed, almost to the point of being a joke. This is unfortunate because it diminishes the importance of the use by those who truly can benefit.

2. Yes. Marijuana is a drug that can affect cognitive ability and therefore employers are justified in making sure employees are not impaired.

Mark Bryant, lawyer and former Kansas City Council member

1. Yes. Some patients have found relief from nausea following chemotherapy, muscles spasms associated with multiple sclerosis, appetite disorders and other diseases and conditions. These are serious conditions and neither health care professionals or patients should be limited in their treatment options.

2. Yes. Employers must prohibit use of marijuana by employees because it affects a person’s mental acuity. Employees who have a prescription for the medical use of marijuana should be an exception.

Mike Burke, lawyer and former Kansas City Council member

1. I believe that in specific circumstances, it is very beneficial for treatment.

2. An exemption for medical use should be allowed like other prescribed drugs.

Woody Cozad, lobbyist and former state GOP chairman

1. No, it should not. First, there are two chemical agents in marijuana that affect pain and some other medical conditions. One of them gets you high, the other does not. Pharmaceutical companies are already running trials, as is the FDA on the agent that relieves pain, helps with epilepsy and does not get you high. These meds will be available soon, some are already on the market. There is no MEDICAL marijuana, no prescription, no dosage. It’s a way for what has become a huge industry to get even bigger. Finally, like the tobacco companies, they are punching up the potency of the drug to make it more addictive.

2. Yes, they should. If a person’s general competence is affected by alcohol, it’s easier to spot than the same condition caused by marijuana. If you care about the quality and safety of the product or service your company provides, you should screen for marijuana.

Thomas Curran, president of Rockhurst University

1. Arguments can be made for and against the use of medical cannabis (marijuana). Arguments against include: the claim that there is high potential for addiction; it’s associated with lowlifes such as hippies and pot-heads; and there is insufficient evidence to demonstrate that it has legitimate medicinal uses.

Supporters for its medical use argue that it can reduce stress level for chronic illness. Additionally, they argue that it is significantly less destructive than either alcohol or tobacco. In essence, there is thoughtful and convincing evidence on both ideas of the issue.

2. If medical marijuana were to become legalized, the testing would need to be connected with work-related reasons such as ability to perform required tasks or causing disruption of work environment and work product. Otherwise, testing for a medical approved remedy could result in a prima facie discrimination claim.

John C. Danforth, former U.S. senator

1. Yes. As the question pertains solely to medical use, I see marijuana as no different from other treatments that would be prescribed by medical professionals.

2. Employers should have the option of screening for marijuana to determine if employees are fully functioning on the job.

Reza Derakhshani, EyeVerify developer

1. Yes. Research has shown certain benefits, so there’s no reason to deny access to patients that need it.

2. No. Employers should not interfere with employees’ treatment plans provided by their doctors.

Jane E. Dueker, lawyer, radio host and former political adviser

1. Yes at a minimum. It is far better to have the growth, processing and sale of marijuana be regulated. Also, Missouri might as well get the revenue from this industry. Missouri does this knowing that federal law could still be enforced against Missourians. A federal change is really the best way to deal with this issue properly. But if the feds refuse, Missourians still need to be on notice that federal law governs where there is a conflict and it can be enforced at any time.

2. I don’t think most employers should screen. I am not, however, convinced that testing should be banned. I believe employers should retain the right to test but they need to inform employees and prospective employees of their decision to test and under what circumstances they could be tested.

Pat “Duke” Dujakovich, president of the Greater Kansas City AFL-CIO

1. Marijuana should be legal for medical use. Medical professionals should be given as many tools as possible to treat patients.

2. Employees with a valid prescription for marijuana should be exempt from testing or immune from punishment for a positive test.

John Fierro, Kansas City Public Schools board member

1. Yes, proven research indicates that marijuana can help alleviate various medical conditions and allow individuals to live a more comfortable and pain-free life while battling various health conditions; whole-plant marijuana can slow the growth of cancer cells from one of the most serious types of brain tumors and marijuana has been found to reduce pain and inflammation, controlling epileptic seizures, and possibly even treating mental illness and addictions.

2. Yes, and employees testing positive for using marijuana to treat medical conditions should be required to provide proper documentation from their doctor. And individuals should not be terminated for medical marijuana use.

Gwen Grant, president and CEO of the Urban League of Greater Kansas City

1. I support the legalization of marijuana for medical use by patients suffering with cancer, epilepsy, HIV/AIDS, glaucoma, intractable migraines, and a variety of other chronic illnesses. Simply put, it is the humane thing to do. Opponents fear that legalizing medical marijuana is the gateway to full legalization. It may well be, but we need to cross that bridge when we get to it. In the meantime, it is inhumane to force people who are suffering with chronic and debilitating illnesses to choose between breaking the law or getting treatment.

2. While my first inclination is to say that employers should not screen for legalized marijuana, I realize that this is not a black or white situation. There is a huge gray area that must be taken into consideration. For instance, how do employers comply with federal and state regulations at the same time? In several states where medical marijuana use is legal, some state courts have ruled that employers cannot discipline workers based on medical marijuana use. As we venture out into this new frontier, employers and HR professionals will need to figure out how to comply with the law, protect the rights of medical marijuana cardholders, and maintain a safe work environment.

Jason Grill, media, public affairs and crisis communications consultant

1. I think the tide has already turned on this issue throughout the country and medical marijuana will continue to become legal in more states.

2. If something is legal, don’t believe it should be mandatory to screen for it. I believe as it becomes legal more and more throughout the country, we will begin to see screening for it dissipate.

Heather Hall, Kansas City Council member

1. No

2. Yes.

John Hancock, consultant and former chair of the Missouri Republican Party

1. If physicians and their patients agree that marijuana could have positive medical benefits, then I see no reason for it to be illegal.

2. Employers have a right to screen employees or potential employees in a number of areas, marijuana use being one of them.

James Harris, political strategist

1. CBD oil, which is already legal in Missouri, has proven potential to help children with epilepsy. However, for broader legalization of medical marijuana, I think it would be best for Missouri to wait on the federal government to act.

Legalizing medical marijuana at the state level does nothing to change its federal status, and that can lead to problems. Federal authorities could very easily come in and shut down medical marijuana dispensaries. Many doctors avoid writing prescriptions for medical marijuana because of concerns about FDA regulations. And the businesses involved in the industry have to operate as cash businesses, because banks will not allow them to set up accounts due to federal regulations. A high-volume cash industry has the potential to be a magnet for crime.

Furthermore, because of its federal status, not enough research has been done into the long-term effects of marijuana use. For these reasons, I think state-level legalization of medical marijuana is a flawed idea.

2. Absolutely, and I believe that those who use medical marijuana should be asked to disclose that information to their employers if they are going to be operating heavy equipment or doing anything else that could be problematic if impaired. This can cause serious liability issues for employers.

Deb Hermann, CEO of Northland Neighborhoods Inc. and former Kansas City Council member

1. Yes. It has been proven to reduce symptoms, including pain, for people with serious health issues.

2. Yes, if the employer feels it is necessary for a safe work environment. Marijuana shouldn’t be used by those who operate vehicles, use heavy equipment, perform delicate procedures, etc.

Bob Holden, former governor

1. Yes, but regulated. If we allow alcohol we should allow marijuana.

2. The rules should be the same for marijuana and alcohol.

Gregg Keller, principal of Atlas Strategy Group

1. This is an issue that capital “L” Libertarians care about deeply; in fact along with gay marriage it seems to be the only public policy matter they care about. My personal feelings towards Libertarians dictate that I remain studiously noncommittal on any issue of great importance to them, lest I begin to question myself at innermost levels.

Jennifer Lowry, MD, chief toxicologist at Children’s Mercy Hospital

1. No.

Cannabinoids are biologically active molecules that bind to receptors in the human body. Humans produce endocannabinoids, including anandamide and 2-arachidonoylglycerol, which bind the receptors known as CB1 and CB2. Both naturally occurring and synthetic cannabinoid molecules can bind these human endocannabinoid receptors and have biologic activity.

Currently, cannabinoid biology is poorly understood. 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 (e.g., tachycardia and palpitations) to serious (e.g., mood, anxiety, and thought disorders).

There are 2 cannabinoid pharmaceutical products approved by the U.S. Food and Drug Administration. Controlled studies suggest that pharmaceutical preparations that combine cannabinoids with varying affinities for the CB1 and CB2 receptors appear to be able to deliver therapeutic effects while protecting against adverse effects.

Marijuana refers to the dried leaves and flowers of the cannabis plant, which contains a large number of biologically active cannabinoids. There are numerous species and subspecies of cannabis. Leaves of the plant are smoked, vaporized, or cooked to extract cannabinoids, which can then be ingested for their pleasurable psychoactive effects. Cannabinoids from marijuana may also produce therapeutic benefits, which has led to the use of marijuana as a medication.

However, marijuana is a complex mixture of cannibinoids (more than 200 have been identified) and other molecules, and the risk — benefit ratio of this mixture has not been well defined. Over the past several decades, selective breeding of marijuana species has resulted in higher concentrations of cannabinoids in the plant, resulting in a more potent psychotropic effect and possible increased risk of adverse effects. Any product that requires smoking to release the desired effects cannot be recommended by physicians, because smoke contains tar and other harmful chemicals.

Tetrahydrocannabinol (THC) is the primary psychoactive cannabinoid in the marijuana plant. The amount of THC in a given plant varies widely, depending on the species and subspecies of marijuana used in breeding the plant. A low-THC strain of Cannabis sativa, hemp, is not used for psychoactive effects. Rather, hemp is used to make a variety of consumer products, including paper, textiles, clothing, health food, and biofuel. Commercially available hemp products (e.g., hemp milk) are devoid of cannabinoids. Hemp is legally grown in a number of countries, including Spain, China, Japan, Korea, France, and Ireland.

Marijuana is the most commonly used illicit substance among adolescents. Youth substance use rates depend on a number of factors, including legal status, availability and ease of access of the substance, and perception of harm. Specific to marijuana, it has been the most widely used illicit drug in adolescents for over 40 years.

In a national study performed annually by the University of Michigan, 8th, 10th and 12th graders are surveyed on their illicit drug use. Daily prevalence rates in 2015 were 1.1, 3 and 6 percent, respectively, with one in 17 12th graders smoking daily. In fact, almost 40 percent of 12th graders state that they have smoked marijuana in the past year. Additionally, 80 percent of 12th graders state that is fairly easy to get with a perceived risk at an all time low with only 35 percent of high school seniors stating that it is a great risk to use it regularly.

Substance abuse by adolescents is an ongoing health concern. Marijuana remains classified in the Controlled Substances Act as a Schedule I drug. This classification implies that it has a high potential for abuse, has no currently accepted medical use in the United States, and lacks accepted safety for use under supervision by a physician. Despite this classification by the federal government, marijuana has been legalized for medical purposes in a number of states, in direct opposition to federal law.

The adverse effects of marijuana have been well documented, and studies have demonstrated the potential negative consequences of short- and long-term recreational use of marijuana in adolescents. These consequences include impaired short-term memory and decreased concentration, attention span, and problem solving, which clearly interfere with learning.

Alterations in motor control, coordination, judgment, reaction time, and tracking ability have also been documented; these may contribute to unintentional deaths and injuries among adolescents especially those associated with motor vehicles if adolescents drive while intoxicated by marijuana). Negative health effects on lung function associated with smoking marijuana have also been documented, and studies linking marijuana use with higher rates of psychosis in patients with a predisposition to schizophrenia have recently been published, raising concerns about longer-term psychiatric effects.

New research has also demonstrated that the adolescent brain, particularly the prefrontal cortex areas controlling judgment and decision-making, is not fully developed until the mid-20s, raising questions about how any substance use may affect the developing brain. Research has shown that the younger an adolescent begins using drugs, including marijuana, the more likely it is that drug dependence or addiction will develop in adulthood. A recent analysis of 4 large epidemiologic trials found that marijuana use during adolescence is associated with reductions in the odds of high school completion and degree attainment and increases in the use of other illicit drugs and suicide attempts in a dose dependent fashion that suggests that marijuana use is causative.

Legalization of medical marijuana is allowing the use of marijuana to treat a medical condition or symptom with a recommendation from a physician. The current introduced house bill allows for medical marijuana for all ages with those over 18 years of age not required to have a parent or caregiver overseeing the care of this prescription. It also allows for use of a medical cannabis infused product that is intended for use other than by smoking. This may include edibles. The new edibles raise public health concerns, including a risk of consumption by children.

Marijuana is associated with a long history of public misinformation and anxiety, and many observers will therefore view concerns about edibles with skepticism. Still, edibles that resemble sugary snacks pose several clear risks. One is overintoxication. Whereas consumers commonly assume that a candy bar constitutes a single serving, some of these products contain four or more times the level of tetrahydrocannabinol (THC) that is considered to be a safe dose. This problem is augmented by differences in the pharmacokinetic and metabolic effects of marijuana when it is ingested rather than smoked. In addition, case reports document respiratory insufficiency in young children who have ingested marijuana.

Thus, there are certain recommendations that must be considered before any bill or ballot initiative is passed.

Given the data supporting negative health and brain development effects of marijuana in children and adolescents, ages 0 through 21, marijuana should not be used in this population. Additionally, it should not be used by parents as increase abuse and neglect can occur when adults are high.

“Medical marijuana” should not be used outside the regulatory process of the U.S. Food and Drug Administration. Although, it is recognized that cannibidiol administration for children with life-limiting or severely debilitating conditions and for whom current therapies are inadequate may be an option. However, please remember that cannibidiol is one component of the plant and not what is limited to in medical marijuana.

Marijuana is associated with adverse health effects such as lung damage and addiction. Treatment facilities are needed to focus on adolescent use.

Medical marijuana provides levels of THC that can cause seizures. Thus, laws that aim to help intractable seizures should not include the use of medical marijuana as this drug may worsen the effects. The hemp laws maintain low levels of THC. Thus, these terms are not interchangeable and should be accounted for in any discussion regarding their use for serious health conditions.

2. Yes. Employees may become intoxicated and unable to perform their jobs. This may put them and others at risk for harm.

Dianne Lynch, president of Stephens College

1. Yes. Marijuana has proven to be a highly effective pain reliever, is clearly safer than opiates, and helps patients manage such debilitating illnesses as multiple sclerosis, and Parkinson’s disease — benefits that have prompted 29 states to legalize it. More than 85 percent of Americans are in favor of legalization. It’s time for Missouri to put its patients over its politics.

2. Yes, when and if the employee’s job responsibilities require activities that could be impaired by its use — just as they screen for any substance that could endanger the workplace or jeopardize its efficient function. The laws are evolving around the rights of medical marijuana users, and until they are clarified by the courts, businesses should continue to take the appropriate steps to protect and ensure the safety of all of their employees. And that includes screening for those who may be coming to work under the influence of alcohol, other drugs, and yes, medical marijuana.

Chris Maples, interim chancellor at Missouri University of Science and Technology

1. I believe marijuana should be legal for medical use because it seems to be effective in some instances with certain segments of the population. That said, I also believe that research is lagging in this area, and would require a lot of catching up in a short amount of time to fully understand the potential and limits.

2. 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/action. Until we actually conduct appropriate research on the effects of medical marijuana, including potential side effects, it would be prudent to continue screening.

John F. Murphy, Shook, Hardy & Bacon and co-chair of KC Rising

1. At this point in time, while it is a close question, I lean slightly toward no. There certainly are a number of positives associated with the use of medical marijuana. Studies have shown that medical marijuana is effective in reducing the nausea and vomiting associated with chemotherapy treatments. Another potential favorable use is in regard to pain management. If medical marijuana proves to be a suitable replacement to opioids in that regard, it would be a positive result.

On the negative side, the federal government still classifies medical marijuana as a Schedule I controlled substance. There also continues to be a legitimate debate about the medical benefits associated with the use of medical marijuana. For example, while some have argued that medical marijuana is useful in the treatment of glaucoma, the American Academy of Ophthalmology does not recommend it for such treatment. Similarly, many medical professionals point out that for nearly every condition where medical marijuana may be of some benefit, there are existing medications which provide equal or better value without the risks associated with medical marijuana use. Such risks potentially include addictive disease, deterioration of cognitive function, and psychosis. I would like to see more robust medical evidence detailing the benefits of medical marijuana before advocating that it be legalized.

2. If medical marijuana is legalized, I do not believe employers should continue to screen for its use. Employers have the right to continue to ban alcohol and drug use in the workplace itself but what an employee does after hours or on weekends should not impact an employee’s work opportunities. That would hold true assuming the use of medical marijuana outside the work environment does not otherwise impact productivity or safety. We need to keep in mind that byproducts of marijuana can be detected in an individual’s system for weeks after use so screening for marijuana would seem to be unfair to employees. While I am not familiar with the specifics of various state laws, I know a number of states that allow the use of medical marijuana have passed legislation prohibiting employers from discriminating against workers solely for reasons related to marijuana use. That appears to be a sensible approach and would render screening of employees unnecessary.

Jay Nixon, former governor

1. Yes. Under the care of medical professionals. It is time to provide this option for patients in need.

2. Employers should desist from screening for a legal treatment.

Ken Novak, UMKC professor of criminal justice and criminology

1. Missouri should follow the majority of other states, as well as the sentiment of nearly 3/4 of Americans surveyed, and legalize medical marijuana. There is strong evidence indicating cannabinoids provide significant relief from chronic pain and symptoms associated with multiple sclerosis, and additional evidence suggesting positive effects on conditions including Parkinson’s, PTSD, and epilepsy — without significant side effects.

2. Employers should not screen when medical marijuana is legalized. The reason is patient privacy — if employers were able to screen for medical use then they may then be able to logically assume the employee is being treated for some disease (e.g., PTSD, epilepsy, multiple sclerosis, etc.). Assuming the employer has no business determining whether employees have these afflictions, then screening for drugs associated with alleviating the symptoms is legally problematic.

CiCi Rojas, partner and president of Tico Productions and Tico Sports

1. Yes, as someone who experienced a significant health issue recently, the ability to access medical marijuana may have been very helpful in my recovery.

2. Yes, but they would need to be thoughtful and review all options for how to screen for medical condition usage vs. recreational.

Ryan Silvey, Missouri Public Service commissioner and former state senator

1. Yes. We’ve learned a lot about the medical benefits in the last several years, including the potential to stem the opioid epidemic. The legislature has begun to recognize this by taking steps to provide access to CBD treatments.

2. Insofar as there are federal or state safety regulations regarding the performance of their duties, employers should not be prohibited from testing. However, for the vast number of jobs, I would see no need to test outside of the suspicion that the employee was actually impaired at work.

Jeff Simon, managing partner, Husch Blackwell

1. Yes. If it is proven to alleviate pain and suffering, there is no reason it should not be allowed to do so.

2. No. This is too intrusive in the employee’s privacy. If the employee is impaired at work, or if the job description is one in which drug screening is a necessary safety measure (i.e., airline pilots or OTR truck drivers), then screening is acceptable.

David L. Steelman, chairman of the University of Missouri Board of Curators and former state legislator

1. Yes. In full disclosure, although I do not and have never used marijuana, either inhaled, or digested, and I would never recommend recreational use, I don’t believe the law should be hypocritical and should legalize marijuana in keeping with prevailing societal thought. I am also convinced that marijuana does have legitimate medical uses. However, if medical marijuana is to be a sham for recreational use, the state should go ahead and legalize its use.

2. I believe employers should be able to screen for whatever substance usage they believe is important for their business operations.

Mike Talboy, director of government affairs for Burns & McDonnell and former state legislator

1. Absolutely it should be legal. The medical benefits have shown tremendous value to patients across several diagnoses and the rehabilitation impact and alternative to overuse of opioids is actually life-saving. We have seen it have a positive impact on people from all walks of life. Medicinal use is a great first step for Missouri to help the citizens.

2. There will be jobs that will need to have testing due to the work being done and the regulations those come with. That said, it should be treated the same as alcohol or prescriptions. If you do it inside the workplace then it could entail reprimanding or consequences. However, if done on the individual’s own time outside of work it should be treated the same as alcohol or prescription medications and leave them alone.

Scott Wagner, Kansas City mayor pro tem

1. Legal as it seems to be a viable alternative for some medical issues.

2. It depends on the occupation. I would have a concern with heavy machinery and construction environments.

Pam Whiting, vice president for communications, Greater Kansas City Chamber of Commerce

1. Yes, it should definitely be legalized. My youngest sister was diagnosed with epilepsy at a young age. Her seizures were uncontrolled throughout her life despite a whole series of different medication regimes. 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. Given the remarkable results medical marijuana has shown in controlling epilepsy, I often wonder what her life would have been like had she been able to access that kind of treatment. And, with additional research, who knows what kind of applications medical marijuana can have for other diseases and conditions.

2. The question is difficult to answer — how would an employer know whether use was medical or recreational? Not sure I want my employer to know what prescriptions I have.

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