Hawaii has yet to craft a functional law that addresses medical marijuana for chronic disease. Progress to date has been incremental but in the right direction. Last year the platform for medical marijuana moved from the Department of Public Safety to the Department of Health, establishing it as a mainstream medical program. 

SB 2574 SD 1, relating to medical marijuana, permits board-certified pain specialist physicians, oncologists, ophthalmologists and board-certified palliative care physicians to prescribe medical marijuana beginning Jan. 2. Currently, only primary care physicians are authorized to prescribe.

"We are committed to increasing access to medical marijuana for patients who require it for chronic disease," says Sen. Josh Green, chairman of the Senate Committee on Health.

Hawaii is in the middle of the pack. Approximately 20 states have approved legislation for medical marijuana. Several more are on the verge of doing so. Federal law is still at tension with state laws across the country, and federal law enforcement has been inconsistent in its interface with the states. Recent legislation approving recreational use of marijuana in Colorado and Washington has raised many questions about the evolving federal response and how this may affect other states that legally condone the use of medical marijuana.

With few exceptions such as glaucoma, marijuana does not affect the physiology of the chronic diseases it has been approved to treat. Rather, it works primarily by shifting one’s relationship to an illness. The experience of chronic pain, for example, is a combination of the physical inputs from the nervous system and how we react to those inputs plus the personal impact of related disability. It does not block the sensation of pain like opiate analgesics.

For several reasons, however, marijuana is safer than opiates and many other pharmaceuticals. While it can be habit-forming, marijuana does not result in a frank physiological addiction. It is also far safer than virtually any illicit drug and does not come even close to the damaging physical effects wrought by alcohol abuse.

Marijuana use still carries health risks. While it has not been implicated in lung cancer (like tobacco), it can cause asthma, chronic bronchitis and emphysema. Vaporizers do mitigate adverse effects of smoke inhalation and are becoming more widely used.

It also clouds the mind, can be fatiguing and, in the long run, may diminish motivation. As with alcohol, the earlier in the day one starts, the more challenging the drug can be to maintaining a healthy lifestyle. After-work or after-dinner use is better tolerated. In contrast, those who start using in the morning typically need to re-dose several times during the day.  When smoking, the primary effect lasts roughly three hours and results in changing blood sugar levels, leaving one prone to mood swings. Among those most devastated are our youth who start to use regularly in their early teens and then suffer permanent social deficits.

All considered, decriminalizing the use of medical marijuana is wise. In addition to the relative safety and efficacy of medical marijuana, law enforcement and Hawaii’s courts have far more compelling priorities such as diversion of pharmaceuticals, crystal methamphetamine labs and violent crime.

SB 2574 SD 1, which enables selected specialists, in addition to primary care physicians, to prescribe medical marijuana, is a positive step. But the laws on the books for medical marijuana in Hawaii still leave a lot to be desired. With a prescription, patients can possess, smoke and grow marijuana, but there is no way to legally purchase it.

"The Senate Committee on Health intends to continue expanding access to medical marijuana to Hawaii’s patients, including proposals for a pilot dispensary program that will provide safe, quality medicine that meets the standard of medical care," Green says.

To have a functional law for medical marijuana, Hawaii needs to create responsible access via dispensaries.

Note: None of the providers at Manakai o Malama Integrative Healthcare Group and Rehabilitation Center prescribe medical marijuana. 

Ira Zunin, M.D., M.P.H., M.B.A., is medical director of Manakai o Malama Integrative Healthcare Group and Rehabilitation Center and CEO of Global Advisory Services Inc. Please submit your questions to info@manakaiomalama.com.