Take Two (Hits) & Call Me In The Morning: Continuing the Medical Marijuana Conversation
By Sarah Sidlow
It started with survivor’s guilt. Robert Kowalski’s Air Force lieutenant was the first Air Force officer to be killed once Operation Iraqi Freedom had commenced. Kowalski was supposed to be in the truck when it was hit.
In 2010, after two deployments in Iraq, Kowalski returned home. His right meniscus is deteriorating. His right kneecap is twisted sideways. He has two herniated disks and two bulging disks in his lower back. His right rotator cuff is shoved up into his shoulder and doesn’t align with the joint. He should use a cane, but he doesn’t. And along with his physical scars, he has some in his mind as well: a PTSD diagnosis in 2010 and a partial-agoraphobic diagnosis in 2012.
Yet his voice is calm and measured as he recounts this laundry list of ailments. He sounds upbeat. “I’m a functioning member of society,” he says, “and I can’t leave my house unless I use cannabis.”
Medical marijuana wasn’t Kowalski’s first choice. He had tried it as a teenager, but didn’t use it heavily. When he came back from Iraq, he was put on a government-prescribed cocktail: anti-anxiety medication, pain medication, and sleeping medication, in addition to a type of therapy known as prolonged exposure, which is a common recommendation for treating PTSD.
He went almost two full months without sleeping while working at Wright-Patterson Air Force Base. He was hallucinating and losing time—meaning he was technically asleep, but his body was still functioning. Once he woke up driving a car.
“I got tired of being a useless walking being while trying to work for the United States military,” Kowalski says. “So I took some leave of absence from work and I tried cannabis for the first time since high school. By the time I returned back from work, I had made the decision that I wasn’t going to take pharmaceuticals that were going to ruin my career in order to be a functioning member of the military.”
Obviously, Kowalski didn’t go to work under the influence of marijuana. But he did use cannabis to sleep at night.
“They noticed a difference in me,” he recalls, “with my attitude, with my performance, because my performance went from very, very poor to very, very good.”
“My first sergeant walked into the office I was working in and said, ‘I can’t believe you’re still awake,’” Kowalski remembers. “I looked at him and asked, ‘why wouldn’t I be awake? I’m at work.’ He said, ‘Well, I know the medication you’re supposed to be on, and I don’t know how you’re functioning.’”
Marijuana as Medicine
Marijuana’s recorded medical benefits apparently date as far back as 2900 BC, when Chinese Emperor Fu Hsi wrote about its popularity and its possession of both yin and yang. In 1213 BC, Egyptians documented cannabis use as a treatment for glaucoma and inflammation. Other research points to marijuana references as holy anointing oil in the Bible’s Book of Exodus.
“Marijuana has been used for many years for some very common ailments,” says Dayton pain specialist Dr. Suresh Gupta of the Dayton Outpatient Center. “[It] provides great benefit for nausea and vomiting in patients undergoing chemotherapy for cancer, has been used for PTSD in veterans returning from wars, for children suffering from seizures, and in patients with glaucoma to reduce their intraocular pressure, preventing them from going blind.”
Some studies indicate it also may ease multiple sclerosis symptoms like muscle stiffness and spasms, pain, and frequent urination.
Marijuana plants contain hundreds of chemicals, known as cannabinoids. The two you hear most about are THC and CBD. While both chemicals have properties that are helpful in treating various ailments, only one, THC, is associated with the psychoactive “high” effects.
But, like all pharmaceuticals, medical marijuana also comes with adverse side effects.
While it can influence your mood to increase feelings of happiness and relaxation, it can also induce drowsiness and anxiety. It can disrupt your short-term memory and decision-making ability for up to three hours. It has the potential for addiction, in the same way alcohol does (hence the label “gateway drug”).
And because smoking marijuana can exacerbate breathing problems such as bronchitis, doctors advise that patients use medical marijuana as an edible or through a metered inhaler or vapor pen.
Since the 1937 Marijuana Tax Act effectively prohibited the use of all cannabis on a federal level, research and administration regarding medical marijuana has been challenged.
But beginning in the 1970s, individual states have revisited the question of medical marijuana, and in 1996 California became the first to legalize it.
Veteran Kowalski became a medical marijuana patient in Arizona in 2012.
“By the time 2014 rolled around, I was different person,” he says. “I got married. I had a child.”
So how do would-be patients take the first step? Kowalski recommends: start with Google.
“If you type in a simple phrase like ‘cannabis research,’ you’ll find hundreds of thousands of articles and studies that were published on cannabis research. Once you start to have questions, seek out an organization.” Kowalski’s organization, Veterans Ending the Stigma, or V.E.T.S., is designed to bridge the gap between veterans and civilians, and to provide support to veterans returning to civilian life.
“Veterans are constantly looking for that brotherhood they had in service,” Kowalski says, “someone that’s always got your six.”
HB523: Medical Marijuana in Ohio
In September 2016, the state of Ohio officially legalized medical marijuana with the passage of HB523. But since then, determining how Ohio’s medical marijuana landscape will look—who can grow it, who can sell it, and who can use it—is still a work in progress.
Here’s what we know:
Government-certified physicians may recommend medical marijuana only for the treatment of a qualifying medical condition. The list includes AIDS, ALS (amyotrophic lateral sclerosis), Alzheimer’s disease, cancer, chronic traumatic encephalopathy, Crohn’s disease, epilepsy or other seizure disorder, fibromyalgia, glaucoma, hepatitis C, inflammatory bowel disease, multiple sclerosis, pain that is either chronic and severe or intractable, Parkinson’s disease, positive status for HIV, post-traumatic stress disorder, sickle cell anemia, spinal cord disease or injury, Tourette’s syndrome, traumatic brain injury, and ulcerative colitis.
Now there’s a push to add one of the state’s most chronic problems to the list: opiate addiction.
“We have an opiate crisis here in Ohio—there’s no doubt about that,” says Ohio Patient Network (OPN) Executive Director and Blue Ash City Councilman Rob Ryan. “Pain patients have called me up and said, ‘the more marijuana I have, the less of the opiates I need, and the more functional I am with my family.’”
Ryan says OPN—a coalition of Ohio patients, caregivers, activists, and medical professionals who support marijuana for medical use—intends to petition the Ohio Medical Board to add opiate addiction to the list of qualifying conditions.
He refers to a handful of peer-reviewed studies about the connection between marijuana use and opiate addiction recovery.
One, published by The Journal of the American Medical Association, discovered that states with the oldest medical marijuana laws had the deepest reduction in opiate overdoses. Another discovered a significant reduction in prescriptions per patient per doctor for pain control in states with medical marijuana, compared to those without.
And a third, published by The National Academy of Medicine, confirms conclusive positive effects of marijuana in the treatment of three conditions: pain, nausea, and spasms—three of the most common symptoms of opiate withdrawal.
For now, doctors in Ohio can recommend medical marijuana to patients with one of the qualifying conditions mentioned above. But recommending isn’t the same as prescribing.
“[Marijuana] cannot be prescribed by doctors on a prescription pad until it becomes federally legalized,” Dr. Gupta explains. “I can recommend my patients use marijuana, but they will have the choice to use prescription pain medication or marijuana—they cannot use both at the same time.”
While doctors can’t use a prescription pad to provide patients with marijuana, they can now use a recommendation form found on the O.P.N. website.
The Conversation Continues
Ohio’s 2016 medical marijuana bill came on the heels of a statewide effort in 2015 by Responsible Ohio, an advocacy group that proposed a business-focused plan to legalize marijuana, medicinal and otherwise. The push put the marijuana conversation on the table for Ohio legislators and voters, but ultimately failed to garner enough support. However, Ryan believes HB523 owes its success, at least in part, to the road paved by the Responsible Ohio initiative.
“The legislators moved at legislative light speed,” he says of HB523. “Nothing else has moved so quickly from when it was introduced to when it was signed.”
But fast-forwarding the legislation has left some holes. Some nearby cities, like Kettering, Oakwood, and Beavercreek, have even passed ordinances to ban the growth and related sale of marijuana. And time for public participation is far from over.
“There’re rules to making rules,” Ryan jokes. “People need to get engaged in this. People need to get engaged and call in on these rules.”
As an example, Ryan points to the conversation of cost. He rattles off the proposed price sheet for various levels of involvement in Ohio’s new marijuana industry: $200,000 for a small cultivation site, plus an additional $750,000 in bond money; $100,000 to become a processor; $70,000 to open a pharmacy.
“I have no real issue with getting involved in the business, but corporations and companies have to make a profit,” Ryan says. “And if they don’t make a profit, there will be no supplies for the patients.” And these start-up costs may be prohibitive.
These are the things, he continues, that are up for public debate right now before the program is fully operational September 2018.
“We’re moving in the right direction,” he says, “but people shouldn’t be sitting back and just letting it happen.”
For more information about medical marijuana in Ohio, please visit MedicalMarijuana.Ohio.gov. For a complete list of pending rules and deadlines related to medical marijuana, please visit OhioPatientsNetwork.org and search ‘OARO.’ For more information about Veterans Ending the Stigma (V.E.T.S.) or to get involved, please visit VeteransEndingTheStigma.org.
For more information on how to talk to your doctor about medical marijuana, please go to page 27.