Marlene Busko

October 05, 2015

DENVER — Family physicians voted to support the "decriminalization of the possession of marijuana for personal use" here at the American Academy of Family Physicians (AAFP) 2015 Congress of Delegates, but stopped short of supporting legalization; they want solid evidence on its effect on health first.

"With decriminalization, you will give a person penalties in terms of a civil offense — referral to treatment and maybe some fines — and control the behavior," Jose David, MD, from Albany, New York, explained to Medscape Medical News.

The American Society of Addiction Medicine also favors decriminalization over legalization, he added.

Delegates also reaffirmed that they are in favor of reclassifying marijuana from a schedule 1 drug, meaning it has no medical use, to a schedule 2 drug, suggesting it is medically effective but has a high potential for abuse. The reclassification "will facilitate further research on the potential medical uses of pharmaceutical cannabinoids."

"We've been advocating for some time to get marijuana moved from schedule 1 to schedule 2" to allow scientifically valid research to be conducted, said incoming AAFP President Wanda Filer, MD, from York, Pennsylvania.

Decriminalization, Not Legalization

"We haven't felt comfortable supporting legalization because we don't feel that we have enough valid research," she told Medscape Medical News. The proposal to support the decriminalization of marijuana had not been suggested until now.

The advocacy committee recommended decriminalization (resolution 503) and reclassification (resolution 504) after considering lively testimony on the topic.

According to federal law, marijuana is an illegal narcotic. However, medical marijuana is legal in 23 states and the District of Columbia, and cannabis is legal for recreational use in Alaska, Colorado, Oregon, Washington state, and Washington, DC.

During the hearing of the reference committee on advocacy, delegates from New York proposed that the AAFP reclassify marijuana to a schedule 2 drug, support the legalization of marijuana for adults for personal use, and support the use of some of the taxes collected from the sale of marijuana for educational programs.

According to background material presented with the original proposal, most arrests in the United States in 2013 were for drug-related crimes, more than 40% of these arrests were for marijuana possession, and most of the people arrested were black or Latino.

Several delegates testified about the social injustice of American's war on drugs, which disproportionately affects black people.

"We want it legalized," a delegate from California said. "We are not only subjecting people to the horrors of prison system, we are also subjecting a disproportionate number of minorities to the underbelly of the illegal drug trade."

A delegate from Colorado cautioned that legalizing marijuana is not simple. "A common opinion is that if you legalize marijuana, the criminal activity will disappear; that's not what happened" in Colorado, he reported.

Several delegates explained that they favor the decriminalization of marijuana, meaning that people who possess small amounts for personal use will not be sent to jail, but will instead be referred for treatment.

Refer for Treatment, Instead of Incarcerating

However, most delegates oppose the legalization of marijuana until there is solid evidence about its effect on health.

After hearing a lot of testimony, the committee changed the wording from "legalization" to "decriminalization." And after delegates testified that the AAFP should not be deciding how funds should be dedicated to substance abuse programs, the committee dropped that part of the proposal before it was put to a vote.

Julie Anderson, MD, from St. Cloud, Minnesota, was part of the group that put forward the reclassification proposal, which would "allow research to understand the health implication for our patients."

 
It is clear that federally funded research would be difficult if marijuana remains a schedule 1 drug.
 

"Currently, as physicians, we don't have that information to allow patients to make an informed choice," said a resident delegate, who agreed with the proposal.

"We've never had overdose deaths from cannabis," said another delegate. And for many chronic pain patients, the oral or vaporized forms of cannabis "can make a dramatic difference in their quality of life, so let's support that research," he added.

The AAFP reference committee on advocacy recommended that delegates vote to reclassify marijuana, because "it is clear that federally funded research would be difficult if marijuana remains a schedule 1 drug," and ongoing studies funded by the National Institutes of Health are proceeding slowly.

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