1. Moral and Legal struggles of Medical Marijuana Melisha Hamm Duncan Ruchisha Patel Sthefany Torres Jessica Miles Minal Gandhi Karolina Lira Vidya Patil Mounia Derkouch

2.  What is the Ethical Dilemma?

3. Should Physicians be allowed to prescribe Medical Marijuana?  Yes and No  For or against?  Journal of Family Practice  Must be medical use only  Patient must be given recommendation  Treats more than just cancer;  Aids/HIV  Anxiety  Pain Management  Glaucoma  Eating Disorders

4. Should patients have a right to request Medical Marijuana?  Public view has always favored the use of medical marijuana  Pros and Cons  Risks  Patient vs. Physician  Right to receive medical information  Qualification process

5. Political Views  Federal Government  For or against ?  Approval of certain states  Republicans  63% in favor  Democrats  77% in favor

6.  Medical Marijuana: The Facts

7.  What is Marijuana?  Cannabis subspecies:  C. sativa, C. indica, C. ruderalis  Cannabinoids:  Tetrahydrocannabinol (THC): psychoactive  Cannabidiol (CBD): non-psychoactive Marijuana: The Facts

8. http://www.21stcentech.com/biomedicine-part-11-curing-technologies-in-the-21st-century-overcoming-addiction/ How does Cannabis work on the human Body?  Endocannabinoid System (ECS)  CB1 (brain) and CB2 receptors (immune system cells)

9. Marijuana: The Facts  Cannabinoid Bioavailability  Methods of administration  Inhalation ( vaporizer, “e-cigs”)  Smoke (“joints”, “blunts”, cigarettes)  Smoking topography  Ingested (edible treats, raw juicing)  FDA-Approved Drugs with synthetic cannabinoid  Marinol (dronabinol)

10.  Risks Associated with Marijuana  Increased heart rate  Changes in blood pressure  Psychosis  Smoking is detrimental to respiratory system  Outdoor vs. Indoor Grows  Contaminants Marijuana: The Facts

11.  Define the Stakeholders

12. Highest level Stakeholder “Government” Federal vs. State vs. Local  Marijuana is classified as a Schedule I substance under the Controlled Substance Act  Marijuana is being shipped to other states (Oklahoma and Nebraska) from Colorado making it harder for officials adding more work.

13. Mid-level Stakeholder “Physician”  First Amendment allows Physician Patient Communication  Physician has to recommend and prescribe the use of Medical Marijuana for its patients

14. Effective Stakeholder “Patients”  Patients must have a qualifying medical condition to obtain state or county issue ID card.  Each state has its own list of specific medical conditions or symptoms in the Medical Marijuana Law  Cancer, AIDS, Multiple Sclerosis, Sever/Debilitating Pain, Sever Nausea  Certain states allows patients to enroll in state- run medical marijuana programs to gain help from caregivers to grow the plant

15.  Options and Alternatives

16. Alternative Treatments for Pain Management  Acupuncture  Exercise  Chiropractic Manipulation  Supplements and Vitamins  Therapy  Stress-reduction techniques  Yoga  Relaxation therapy  Hypnosis  Guided imagery  Music therapy  Biofeedback  Massage

17. Alternative Treatments for HIV/AIDS  More than 25 antiretroviral drugs to treat HIV infections that lower viral load and help fight infections.  Massage  Dietary Supplements  Meditation  Acupuncture  Anxiety  Eating Disorders

18. Alternative Treatments for Epilepsy o Herbal Medicine o Relaxation and biofeedback o Acupuncture o Chiropractic therapy  Charlotte’s Web

19. Alternative Treatments for Cancer  Alternative treatments may not play a direct role in curing cancer, however they do help cope through the signs and symptoms caused by cancer and cancer treatments.

20.  Make a Choice/Decision

21. Lets have a vote in the class? How many of you are for it? How many are against it?

22. Making a Choice Facts of what we gathered  THC and CBD, marijuana’s primary cannabinoids, are both cancer killers.  Suicide rates are lower in areas where medical marijuana is available.  So far there is ZERO evidence that marijuana causes significant damage.  Regulating and taxing will generate revenue and boost economy.

23. Our Decision Based on the facts, as a group we are pro Marijuana WHY  Legalizing it will give us the opportunity to do more extensive research to create more effective dosages and isolate the ingredients to create more medicine  It will reduce crime, suicide, and DUI’s.  Giving cancer patients an alternative medication besides just using chemo.  Medications like volume and oxytocin are addictive with many side effects, marijuana would not harm patients with such side effects.

24. Since we are talking about Marijuana here are a few pictures form our recent San Diego trip!

25. Justify your Choices

26. Medical/General Justification  Natural Herb  Has a long history of use  FDA has tested and approved certain components

27. Case - Zaki Jackson  Rare form of epilepsy  100s of seizures a day  Tried various medications  Finally marijuana relieved the kid

28. Legal Justification Marijuana  Regulating and taxing will generate revenue  Reduced crime, violence, and corruption due to involvement of international drug markets  Venture capitalists ready to invest will boost economy  Shipped from legalized states to other

29. Political Justification  Increased support for Marijuana  Many states have legalized considering the benefits of the marijuana  Political parties asking for lesser punishments vs. opposing  Various restrictions on the dispensing of marijuana

30.  How can this Ethical Dilemma be prevented?

31. Legal Struggle  Conflicts between local, state, federal to be available to the public:  It is challenging the essential fundamentals of the acknowledged practice in the medical, legal, and ethical societies  The primary antagonist to legalization;  The federal government  Outdo state law rights by frightening patients and physicians with criminal prosecution  Local, state, and federal strongly argue that Schedule I drugs has a high potential for abuse

32. Legal Struggle Cont.  However, is it truly gaining the public support to outlaw it?  Huge public support in some states to ban it  Ex, Montana and California  Is the public fully aware of the advantages and disadvantages of medical marijuana?  The central opposition: the federal government  A national policy of “zero-tolerance” toward illegal drugs

33.  The ethical dilemma:  If banned, will it be violating the physician- patient relationship?  Is it true that, it can be enclosed by the ethical moralities of autonomy and beneficence?  Are not patients having the right to expect full disclosure and discussion of all available treatment options from their physicians?  Is it considered violating the basic duty of a physician, if denying a patient that has a terminal disease? Moral Struggle

35. Practical Consideration  The use of cannabis as a medicine can bring up lots of questions:  Issue with reimbursement – Health Insurance

36. Recap  The Purpose of marijuana  Limited medical researches  The stigma

37. Citations  http://www.whitehouse.gov/ondcp/ondcp-fact-sheets/marijuana- legalization  http://www.pewresearch.org/fact-tank/2015/02/27/63-of-republican- millennials-favor-marijuana-legalization/  http://medicalmarijuana.procon.org/view.answers.php?questionID=1325  http://www.lawteacher.net/free-law-essays/medical-law/outline-is-the- legalization-of-medical-marijuana-morally-sound-law-medical-essay.php  http://www.ncbi.nlm.nih.gov/pubmed/10754797: The ethics of medical marijuana: government restrictions vs. medical necessity.  http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3628147/: Medical marijuana: Medical necessity and political agenda.  http://www.cdph.ca.gov/programs/MMP/Pages/MMPFAQ.aspx  http://www.nytimes.com/2014/12/29/us/pot-pie-redefined-chefs-start-to- experiment-with-cannabis.html?_r=1

38. Citations Cont.  http://www.ncbi.nlm.nih.gov/pubmed/19296351: Medical marijuana: the conflict between scientific evidence and political ideology. Part one of two.  http://www.csatc.org/cellularbiology.html  http://www.mpp.org/search/search.jsp  http://www.ncbi.nlm.nih.gov/pubmed/10754797. The ethics of medical marijuana: government restrictions vs. medical necessity.  http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3628147/: Medical marijuana: Medical necessity and political agenda.  http://www.ncbi.nlm.nih.gov/pubmed/19296351: Medical marijuana: the conflict between scientific evidence and political ideology. Part one of two.  http://www.insurancequotes.org/health-insurance/health- resources/medical-marijuana-coverage/:Medical Marijuana and Your Health Coverage.

39. Questions