Doctors still wary of risks of medical marijuana

Katherine Ranzenberger

Patients in Pennsylvania who may benefit from medical marijuana are one step closer to getting the help they need after the Pennsylvania House of Representatives passed a bill Wednesday.

However, medical professionals in York County are still wary of taking the leap of prescribing medicinal cannabis to patients without knowing the benefits and risks it.

Cara Salemme, of Spring Grove, whose nine-year-old son Jackson was diagnosed with both encephalitis and epilepsy, speaks in this file photo as supporters gather at the Pennsylvania State Capitol Building to promote the legalization of medical cannabis in Harrisburg, Pa. on Tuesday, Sept. 22, 2015.   Dawn J. Sagert photo

“There is a fair amount of research out there already, but it’s patchwork studies and studies done overseas,” said Dr. D. Scott McCracken, a member of the York County Medical Society. “We’d prefer to see long-term research before we prescribe it. We want to make sure it’s used in a safe and effective way.”

McCracken compared the research out there to the 1990s and the start of opioid prescriptions. Opiates were marketed for chronic pain, he said, but the tests out there were based on three- to six-month trials.

Doctors were prescribing opioids such as oxycodone and morphine to patients for chronic pain, McCracken said. This has ultimately led to the opioid abuse epidemic in Pennsylvania and to heroin abuse, as well.

“If you look at a yearlong trial, there’s almost no benefit of opioid prescriptions for chronic pain,” he said. “We’re being more cautious this time around. That’s the nightmare for marijuana use. We need to find the long-term harms and benefits. We’re talking five, 10 or 15 years out. That’s the data we’re missing.”

Ava's story: 

Michelle Vermeulen, of York Twp., and her daughter Ava, 4,  share a laugh at their home Thursday, March 17, 2016. Ava, who started suffering with epilepsy at four weeks old, had the right side of her brain removed at 7 months old in efforts to control her seizures. Amanda J. Cain photo

Michelle Vermeulen's 4-year-old daughter Ava started suffering from epilepsy at 4 weeks old. The York Township family tried multiple medications to treat the seizures and found a medication that worked for a while.

"Her form of epilepsy does not respond well to medication," Vermeulen said. "The biggest side effect of the medications is that it causes permanent vision loss, causing a kind of tunnel vision. It's irreversible."

After about six months, though, the seizures came back. Then 7-month-old Ava had a hemispherectomy, removing the right side of her brain. Vermeulen said you'd never know because she's walking and talking like other kids.

"The seizures went away for about three years, but they came back again," she said. "We went back to medication. She's on Onfi, a benzine medication like Valium and Xanax, but she's still having seizures."

Vermeulen has talked with her daughter's doctors about medical cannabis to help with her seizures. Vermeulen is a pharmacist and is worried about the stress the side effects of the current medication can have on her daughter.

Ava Vermeulen, 4, smiles Thursday at her York Township home. Ava, who started suffering with epilepsy at four weeks old, had the right side of her brain removed at 7 months old in efforts to control her seizures. Amanda J. Cain photo

"It's hard enough that she's already missing half her brain," she said. "We've done surgery. We've done medication. We've done the Keto diet," referring to the ketogenic diet, which focuses on high-fat, low-carb foods and has helped control seizures in some people.

"We know medical marijuana isn't a miracle drug, but it's hard to ignore the success stories," Vermeulen said.

As a pharmacist, Vermeulen said she can understand how doctors can be wary of a similar situation to the opioid epidemic. However, she said opiates don't treat the underlying condition of people who use them.

"I do agree we need more information and research," she said, "but I do know the options we have now are affecting kids' brains."

Jackson's story: Cara Salemme, whose 9-year-old son Jackson has a rare form of epilepsy resistant to most drug treatments, has been advocating for medical marijuana for years in Pennsylvania. She said it is “ludicrous to compare opioids to medical marijuana.”

“The addiction factor just isn’t there,” Salemme said. “Research is great. We want research. But we need to get these people something that can help their symptoms now.”

The North Codorus Township mother said she has thought about moving her family to another state, like Colorado, where medical marijuana is legal. However, she wants to stay in Pennsylvania to work with her son’s doctors to get access to the medication that could help more than just her son.

“We have resources in Pennsylvania that will help with the research,” Salemme said. ”This would just give those doctors that are out of options another one.”

Studies: There have been studies in recent news touting the benefits of tetrahydrocannabinol, or THC, the active ingredient in marijuana. One study published by the Journal of the American Medical Association found states with medical cannabis laws had nearly 25 percent fewer opioid overdoses than states without those laws.

Even emergency room doctors such as Dr. Tom Kehrl said they have seen other legal substances like alcohol do more damage than marijuana. Kehrl said that on Friday he treated seven patients in a row with alcohol-related injuries.

However, he and others are worried about the longer term effects it can have.

“We don’t know the dosing or the potential side effects,” Kehrl said. “We can all recount failed new drugs, procedures and modality. It’s a tricky balance. We want to be doing the bests for our patients.”

Salemme said she expects it to take 18 to 24 months before the program is fully up and running. She said there have been similar timelines in other states that have legalized medical marijuana.

"Our work isn't done," she said. "If it has to go back to the House again, that'll be a problem."