The detractors of State Question 788 argued that the ballot initiative was not aimed at creating a medical program. Were they correct?
Even among conservative Okla-homans, cannabis has overwhelmingly come to be recognized as having medical benefits. Hence, the entities that sought to defeat State Question 788 last year understood that their best strategy was to go after the state question itself, painting it as a recreational measure in disguise. To that end, they received over a million dollars in donations from chambers of commerce and businesses around the state, outspending the Yes On 788 campaign by nearly 10 to 1, yet still losing at the polls by a margin of 57 to 43 percent.
But now, with nearly a year and a half to look back upon, let us ask, Were they right? Do we, in truth, have a medical program in name only? Behind the veneer of a physician recommendation, is our program ultimately recreational?
It can hardly be denied that many people enjoy the psychoactive effects of cannabis. It makes them feel good. It relaxes them. It can also bring inspiration. Hence, notwithstanding all its medical benefits, many enjoy cannabis just as they might enjoy listening to music, walking in the park or having a drink to relax after a hard day at work. Moreover, when we look around the state and see dispensaries with names evoking getting “baked,” social events centered on getting high and a mélange of Facebook personalities who brazenly smoke on camera, it hardly seems that this is a program whose public face reflects the needs of individuals with multiple sclerosis, lupus, Crohn’s disease, neuropathic pain, epilepsy and the host of other medical conditions that drove a significant share of the 57 percent to the polls.
So, again, was the 788 Is Not Medical campaign right? Is our program less medical than what many who voted for SQ788 anticipated? My suspicion is that most Oklahomans, including those who actively campaigned on behalf of its medical mission, would agree that we don’t have anywhere close to the program that most of the 57 percent expected.
The question now is, Who is to blame? Is the recreational appeal of cannabis such that it will inevitably overtake its medical use? Given that many other states have been able to realize a more medical program than what we have here, I think the answer is no. Further, I do not think that the blame lies ultimately with the state question itself. While its lack of regulations might appear at first to be the culprit, most of those who went to the polls saw it as little more than a referendum on medical cannabis with its details to be ultimately worked out by the lawmakers and regulators (something that the 788 Is Not Medical campaign actually acknowledged as well in press conferences).
So what then happened? First, the Legislature failed to enact laws before the vote (House Bill 3468 or Senate Bill 1120). Second, both the Senate and the Fallin administration refused a special session after the election. Third, the Board of Health (and those who colluded with them in late June/early July 2018) undermined the normal rule-making process. Fourth, state chambers of commerce lobbied our Legislature to undo the language in SQ788 that would have had cannabis treated as any regular prescribed medicine. Fifth, most of the hospitals and medical networks prohibited their physicians from signing recommendation forms. And sixth, pain management doctors (as well as oncologists and other specialists) refused to allow their patients to use cannabis.
The significance of such actions by the state’s institutions of power should not be underestimated. Because individuals could not rely upon their existing physician-patient relationships to get their recommendation forms signed or receive any guidance in the use of cannabis, an industry of “marijuana doctors” grew around the state and did little (or nothing) beyond receive payment for their signatures. Because tens of thousands of pain management patients around the state were effectively locked out of the program, the cannabis marketplace was not shaped to address their pain and improve their daily functioning but instead catered mainly to those looking for high-THC products. Because industry groups, employers and chambers of commerce painted our program, even before it got off the ground, as essentially recreational, they were able to move the Legislature to undo the protections of SQ788, effectively knocking out individuals who, again, would have sought out less psychoactive products.
In short, 788 Is Not Medical turned out to be right. We have ended up with a program that is far less medical than anticipated. But again, this is not because of the intrinsic character of cannabis or the deficiencies of the state question. Rather, it is because those who opposed the program, in a manner similar to a self-fulfilling prophecy, made sure they were right.
Consider this: While national trends clearly support the legalization of medical cannabis (if not “adult use” as well), in our conservative state, a significant share of the 57 percent voted for 788 as a means to address the opioid crisis. Their hope was that the tens of thousands of chronic pain patients as well as those who have become dependent upon opioids would have access to this dramatically safer alternative. But instead, pain management doctors were made to be terrified of the prospect of allowing their patients to use cannabis.
They were told that they could lose their license for prescribing scheduled drugs to a patient who uses cannabis, even though such treatment protocols have been in place in other states for decades, and Conant v. Walters (2002) prohibited the DEA from threatening or punishing a doctor for recommending or condoning the medical use of cannabis.
They were told that in this climate where opioid prescribers are seen by some as drug dealers, this would further paint a target on their back for the Attorney General’s office. Yet Section 10.C. of HB 2612 reads, “No physician shall be subject to arrest, prosecution or penalty in any manner or denied any right or privilege under Oklahoma state, municipal or county statute, ordinance or resolution, including without limitation a civil penalty or disciplinary action by the State Board of Medical Licensure and Supervision or the State Board of Osteopathic Examiners or by any other business, occupation or professional licensing board or bureau, solely for providing a medical marijuana recommendation for a patient or for monitoring, treating or prescribing scheduled medication to patients who are medical marijuana licensees.” In fact, I supplied this very language to House Bill 2612 after discussing with pain management doctors what they needed to have in the law for them to feel safe.
Doctors were also told that if their patient gets into a car accident and is under the influence of both cannabis and a prescribed narcotic, the prescribing physician can also be held liable. While we are in a highly litigious society and anyone can be sued for just about anything, this is hardly a likely scenario, especially unlikely given warnings on prescription bottles and medical records advising patients to not drive under the influence. Nevertheless, such fears seemed to have been so beaten into the medical community that they decided it was better to protect themselves from frivolous litigation than let their patients use a plant that can reduce the risk of death from the medications they’re prescribing.
The primary acute danger from opioids is due to them being respiratory depressants. Under their influence, breathing slows and becomes more shallow, and patients can, as a result, turn hypoxic and die. Yet cannabis can reduce this risk, not only by making it possible to take fewer opioids, but because THC is a respiratory stimulant (it increases both volume and rate of respiration), it can counteract the respiratory effects of opioid therapy. Cannabis, in short, could have prevented or at least reduced the death toll from opioids, a death toll that in the past 20 years alone exceeds 1 million Americans.
Surely the people of Oklahoma should find this extremely troubling. Advocates for medical cannabis and opponents alike should be up in arms that this is happening. Fighting the “opioid crisis” was among the main catalysts for why SQ788 passed in our very conservative state, yet despite the explicit legal protections in HB2612, physicians were made (through medical seminars and whisper campaigns) to be so afraid of letting patients use cannabis concurrently with opioids that they are not allowing a course of treatment that reduces the risk of death.
While in other states opioid-dependent pain patients have been able to substantially drop their doses through titration periods as long as they need (one year is not uncommon for long-time opioid dependence), here, our program has gone so awry that perhaps the most pressing reason in many people’s minds for legalizing cannabis has been scuttled by forces that instilled outright terror in the minds of our doctors.
So what are we left with in the state? What has become of the medical program intended by SQ788? Regrettably, from the workplace to the medical office, cannabis continues to be treated as an illicit substance. Cannabis patients are treated like social pariahs, denied the same employment opportunities, medical care, public assistance and other rights and benefits afforded to those who have (by choice or by force) remained within the boundaries of establishment medicine. As such, and as I argued in my Extract column last month, 788 Is Not Medical ultimately won. For while it couldn’t stop cannabis from being legalized, it nevertheless did all that was in its power to ensure that it would never become medical.
Lawrence Pasternack, Ph.D.
Lawrence Pasternack, Ph.D., is a patient advocate and one of the founders of Oklahoma Cannabis Liberty Alliance (okcla.org). He is also among the world’s leading specialists in Immanuel Kant’s philosophy of religion. Dr. Pasternack is a professor of philosophy and the director of religious studies at Oklahoma State University. The views here do not necessarily represent those of OSU.