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Should mob rule be the litmus test in legalizing marijuana?

December 22, 2018

Marijuana is becoming a popular ballot measure in many states in an effort to legalize it. Ardent advocates of legal marijuana claim that marijuana is safe and effective in treating a number of illnesses.

Their claim is that it is, after all, a “natural” product. And if they “feel” it is effective and safe, then why not let citizens decide its fate? The nightshade berry (Atropa belladonna) is also natural. Eat three to five of these, and you will die — naturally, of course!

At the federal level, marijuana remains classified as a Schedule I substance under the Controlled Substances Act. Schedule I substances are considered to have a high potential for dependency and no accepted medical use, making the distribution of marijuana a federal offense.

The challenge is that while marijuana remains a Schedule 1 substance, the law was signed in 1970. Since then, a lot of studies have been done about marijuana, some of which are legitimate while others should never have been considered a “study” given their poor design.

The question we should all ask ourselves is whether drug policy should be decided based on mob rule or through the oversight of the Federal Drug Administration. Many states have allowed voters to determine whether marijuana should be approved for medical and recreational use. If a majority of voters decide that marijuana is appropriate, they can legalize marijuana through a process I call “mob rule.”

I am not convinced this is an appropriate way to legalize a Schedule 1 substance.

If I were to take at face value all the positive claims of medical marijuana, there would be a plethora of benefits. In 2017, the National Academies of Sciences, Engineering, and Medicine issued a report on the benefits and detriments of marijuana based on the review of more than 10,000 scientific abstracts from marijuana health research. It also made 100 conclusions related to the health effects of cannabis and cannabinoid use.

One would believe based simply on 10,000-plus abstracts of marijuana use that marijuana is a miracle drug that cures almost all ailments, including chemotherapy-induced nausea and vomiting, that it improves patient-reported multiple sclerosis spasticity symptoms and short-term sleep outcomes in individuals with sleep disturbance associated with obstructive sleep apnea syndrome. One would believe it cures fibromyalgia and chronic pain; improves appetite and decreases weight loss associated with HIV/AIDS; improves symptoms of Tourette’s syndrome; helps individuals with social anxiety disorders; eases symptoms of post-traumatic stress disorder; treats traumatic brain injury and intracranial hemorrhages; aids cancer patients, including those with glioma; and helps patients suffering from anorexia nervosa.

And this is by no means a complete list of all the beneficial “claims” of medical marijuana.

But anecdotal evidence is a long way from empirical scientific evidence. That is not to suggest we should dismiss anecdotal evidence. There may be some empirical evidence of the benefits made in some of these claims.

Regardless, science must play a role in concluding the effectiveness and safety of any drug. And as every clinical drug trial has taught us, there are always side effects with every approved drug, and we need to understand the side effects of marijuana even if it has a true medical benefit. We also need proper labeling of the detriments and limitations of any FDA-approved drug.

When a pharmaceutical company applies for FDA approval of a particular drug, it must conduct a number of double-blinded clinical drug trials in a very controlled manner to assure the safety of patients while determining whether the drug actually performs as alleged. Double-blinded studies are the gold standard of statistical studies — neither the investigator nor the subject knows who is receiving a placebo and who receives the active ingredient. Objective tests are then performed to determine the effect of the drug in treating the underlying condition.

And even if a drug has some moderate success in the treatment of a particular condition, the question is whether the drug is also safe and statistically significant in its efficacy. The FDA has high standards, and it is not easy for pharmaceutical companies to obtain approval given these. Why would we want to substitute the FDA process for a ballot measure of approval of a Substance 1 drug based on majority rule?

The proponents of legalization often state that there is no harm by using marijuana and those who use it “feel better.”

I do not doubt the claim of feeling better. However, if that becomes the new standard, we should legalize heroin given the tremendous “good feeling” it produces. Clearly, there is a big difference between heroin and marijuana; nevertheless, having average citizens legalize a drug through a ballot measure is not wise drug policy.

There are reasons we have a federal government to help standardize and manage certain aspects of our civil society. States have separate rights, as enumerated in the Constitution.

As much as I believe in individual freedom and liberty, I do believe there are times when it is necessary to centralize policymaking. The Constitution gives broad enumerated power to the federal government to regulate commerce (i.e., the Commerce Clause).

Though there have been a number of challenges to the Commerce Clause in the overreach of the federal government, there has not been a challenge per se as to whether the federal government has the authority to determine which “drug” is legal and how to legalize drugs under the agency of the Federal Drug Administration. The FDA has a long history of advocating for the safety of public health that began in the 1930s. To abandon the role of the FDA in favor of a majority-rule ballot measure is neither wise or prudent when there may be a risk to the public.

We are witnessing increasing nullification of federal laws by states and cities throughout the country. Our country was founded on the principles of law and order, and the nullification of federal law is a disturbing trend.

What is the message to the average American when a city or state decides unilaterally not to obey a federal law? We have a process in place, and if one does not like the current state of affairs, there is a proper way to make a change, and that is through the legislative process. If there is a consensus, then change will take place.

But mob rule is the opposite of a civil society.

Alan Preston has been a professor for five years in San Antonio specializing in epidemiology, biostatistics and health care policy. Most of his career has been spent as a CEO for managed care companies and physician organizations.

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