Pondering compassion. Weighing the risk. Iowa legislators and officials controlling prescription medications, getting pressure to legalize medical marijuana. We're getting perspective and an update on this edition of Iowa Press.
Borg: For most Iowans, possessing and selling marijuana means prison time. But in 20 states and Washington, D.C., using marijuana as a prescribed medication is legal. Several other states have pending legislation to legalize it. Some want the same for Iowa. They are underscoring those pleas with emotional patient circumstances, including children, claiming medical marijuana would help them. Others say prescription marijuana isn't easily controlled. State Senator Joe Bolkcom of Iowa City introduced legislation that would have permitted prescription marijuana in Iowa. Steve Lukan directs the Governor's Office of Drug Control Policy. And Steve Gaer is a parent advocating for medical marijuana believing it could help his daughter with health challenges. Gentlemen, welcome to Iowa Press.
Thanks for having us.
Borg: We look forward to an insightful discussion here. Across the table, James Lynch who writes for the Gazette published in Cedar Rapids and Radio Iowa News Director Kay Henderson.
Henderson: Gentlemen, let's help the viewers out. Let's start with Mr. Gaer. Explain to viewers why you're here.
Gaer: Well, our daughter Margaret is 24 and she had her first seizure when she was four months old and we have been to the best health care professionals around the country and Margaret has tried 16 different anti-seizure medications and her seizures are still not under control. And we have read about and have talked to families who have children with the same epilepsy Margaret does who have been on medical marijuana that have had just really, really tremendous results, some of whom's children are completely seizure free. So we think this is really kind of the last ditch hope effort to try to help Margaret.
Henderson: Senator Bolkcom, why have you seized upon this issue as something to champion?
Bolkcom: Well, I've met Iowans, people in my district, who are suffering from chronic, debilitating conditions who have been doctored by the best, received the best medications available and still don't have their needs met and would like either to be able to legally have access to cannabis or have actually broken the law to get it to treat their conditions, things like MS, spinal cord injuries, PTSD, epilepsy and I think Iowans are compassionate and there's a way for us to look out at other states that have moved ahead and develop a program to provide safe, legal and controlled access to this, essentially this medicine for people. There's no reason to have people suffer in our state when there's medicine that can help them.
Henderson: Mr. Lukan, what is your perspective?
Lukan: Well, our offices, one of our core missions is trying to keep drugs off the street, trying to make sure that as many Iowans as possible are drug free. We are also a policy advocacy, policy referral organization so our job is to try to help inform policy makers, legislators, the Governor, we certainly communicate with other states. And so one of our jobs here is to try to help get out facts, try to help answer questions, try to be a resource for decision makers who are trying to make this very difficult decision.
Borg: Is your office political?
Lukan: We are not by state code, we are not political. We are a policy organization. We wear several hats. We actually fund a lot of anti-drug task forces, federal funding flows through our offices, we do policy recommendations to try to help update our drug laws here in Iowa. But largely our job is to be policy heavy.
Lynch: Senator Bolkcom, you have already conceded that your proposal to establish medical marijuana here in Iowa isn't going to pass the legislature this year. Is this the end of the road? Is the debate over? Or where do you go from here?
Bolkcom: Well, I think we've had a good discussion this session. Actually I'm optimistic we're going to make some progress. At the beginning of the year there was not bipartisan support to move a bill forward. Obviously this is a controversial topic. There are opinions on both sides of this. And without bipartisan support initially in the session and without a governor, Governor Branstad has been opposed to this, there just wasn't a path forward. This last week there has been a bipartisan resolution introduced to create an interim committee that would come back for the 2015 session with recommendations on how Iowa should create a program and move forward. So I actually feel like we have made progress. Stories like the Gaer's story, Steve and Sally Gaer and other advocates have done a tremendous job educating policy makers about why we need to act.
Lynch: Let me ask you about that interim committee. There's five democrats and five republicans have proposed this and it's the full spectrum, liberals like you, conservatives like Ken Rozenboom and Michael Breitbach. What does that tell you about this issue that you can bring together 10 senators from that spectrum of political beliefs?
Bolkcom: People get sick. The party affiliation has no meaning when people have chronic, debilitating conditions like multiple sclerosis or Dravet Syndrome or a spinal cord injury that somebody doesn’t' get better from. And there's interest beyond party affiliation about trying to provide compassion and medicine to these folks in our communities and I think more members of the legislature are slowly learning more about it and they're hearing from their constituents that this is a real issue they'd like addressed.
Mayor Gaer, the Senator said that he's going to keep working on this issue. I assume that this isn't the end of the road for you, that the lack of legislation this year doesn't stop you from pursuing some sort of medical marijuana legalization?
Gaer: Correct. Yeah, we're going to keep working on it. What we would like to see, there's actually seven states that have interim legislation pending that would allow people that have epilepsy to get access to the liquefied version of the medical marijuana that is so low in THC that you can't get high on it. They have recognized that it is very helpful for these folks. It's not addictive. It can't be abused. And seven states have said, we need to at least pass this for the folks in our state who need access to this medication while we take another year to try to figure out all the nuances of a more comprehensive bill. So we would like to see this interim legislation passed like is being proposed and actually passed in one state and being proposed in six others.
Lynch: Mr. Lukan, your boss has expressed his opposition to this, Governor Branstad has expressed opposition. Can your office ever get beyond just say no?
Lukan: Well, that has not been our position actually. We have supported research. Many people don't know that the FDA actually has clinical trials underway currently on several medications which would have cannabis based, marijuana based medicines. What we have really tried to look at is making sure that we are keeping a very safe, secure health care system. Many of these drugs that are out there, there's been no long-term studies, we don't know the long-term side effects. American Medical Association, American Psychiatric Association have expressed some reservations, there is concern about, there is research that says people who use some of these drugs may actually develop things like schizophrenia. We don't know how these drugs interact with other medications. Many people are taking a lot of other medications. So there's a lot of legitimate policy questions that I think really need answers and that is one of the things we try to do is try to do some research and try to see what we can do to help answer questions.
Borg: We mentioned Governor Branstad being opposed here. And just recently he was asked about this, Senator Bolkcom, in light of what you say is bipartisan support. And Governor Branstad said this, he said, I think we have to be careful about drafting our laws just for a few people that have a particular problem or ailment. Now, in light of that, he's not talking bipartisan here, he is saying I'm opposed because this is a very small segment and in passing a law here there is a lot of unknowns and dangers. How do you respond to that in light of the legislation that you introduced?
Bolkcom: Well, I think the Governor is uninformed, Dean, and I think he needs to do his homework. 20 states have moved ahead, thousands of Americans across this country have access to effective medication that cannabis provides for them. We have a massive amount of abuse of prescription drugs because they're so overprescribed and nobody is having a conversation about taking those drugs away from physicians and pharmacists that provide those to people. I think there is a path forward here in Iowa where we could develop safe, legal access in a restricted way and carve out this legal space where people are not going to lose their homes or face prison time or have a big legal bill because they get arrested for basically trying to improve their quality of life by treating their conditions with a doctor's order with cannabis. I think there is a path forward and I hope that the Governor gets a little bit more engaged and gets a little bit more up to date on this issue.
Borg: Mr. Gaer, I want to ask you also about the Governor's statement and the stand about it is a particularly small group of people and we'd be crafting a law just for them. You're a republican. You are Mayor of West Des Moines. And so you know the politics of all this and we've already heard there's bipartisan support here. So how do you defend what the Governor says that you are a very small group of people who would be helped by this?
Gaer: Well, I wrote my first letter to the editor after I heard those comments and I thought it was very unfair because there are more than a few people. I have heard from families all over Iowa who have challenges medically who have said, my doctor said if I could get access to medical cannabis it would help me. And my position is, is that we shouldn't have to move from Iowa to another state to get the help that we need. I'm a fourth generation West Des Moines resident. My son lives here so he is our fifth generation. Our health care shouldn't be dictated by what zip code we live in. And some of these medical marijuana laws have been passed back in 1998. Alaska and Oregon passed it in 1998. This has been around for 16 years. There's 117 million people in the United States that have had access to this medicine. There are no horror stories coming out of these states that have medical marijuana. The only horror stories that people point to are places like Colorado where it has been legalized. And in fairness to us, it's obvious that it helps. My daughter is on a non-FDA approved drug. Our point is, let us have access to this medicine if our doctor thinks it is going to help my daughter while they go ahead and do studies. She has been on two of those medications already. Don't deny us something that we know and people have testified have had dramatic improvement in people's health care.
Borg: Mr. Lukan, drug control policy, you have a differing opinion.
Lukan: Well, I think there's some clarifications need to be offered here. First off, unfortunately there have been some very negative side effects that have happened in some of these states that have passed medical marijuana laws. We have actually seen DEA raids happen in some of these states --
Borg: Drug Enforcement Agency.
Lukan: Drug Enforcement Agency has actually gone in and seized firearms in some of these dispensaries, they have seized other drugs in some of these dispensaries. Children have actually been taken out of the homes of medical marijuana families in some of these states because the drug has been abused, it has been misused. So the Governor approaches this with a great deal of caution and really wants to make sure we are ensuring a secure, safe, sound health care system for all Iowans. Everybody I think wants to help people who are in desperate need. But when legislators are crafting policy, and I'm a former legislator and I know how hard this can be, you don't want to pass laws that actually end up allowing harm to happen in the name of doing good. We just recently passed, we have worked hard on the prescription drug front, we recently passed a bill. It took about three years to get it done but we passed a bill unanimously in the legislature this year to help control prescription drug abuse. So good laws take time, good laws take a lot of research and thorough review.
Henderson: Let's talk about the drug or the device which delivers the solace that you and your family seek. You're not talking about something that's a cigarette, right? You're talking about something that is either a pill or an oil, right?
Gaer: Correct. It's an oil form and the version, they call it Charlotte's Web, the version that they grow has virtually no THC in it. So even if a drug person were to get a hold of this and try to smoke it, it doesn't do anything for them. This medication for people with epilepsy has so low THC in it that you can't get high on it and it's in an oil form that they take just like you would cough syrup. So that's I think why these other seven states have said, let's at least pass this for these folks because it's so beneficial and it's not subject to abuse.
Henderson: Mr. Lukan, you have cited a doctor who disagrees with that assessment and makes the assertion that this Charlotte's Web variety that has been discussed causes brain problems. Is that correct?
Lukan: Well, I think there's a lot of unknowns here with this drug. There has been, again, there has been no long-term testing done, there's been no rigorous standards applied. There's a lot of legitimate policy questions I think that legislators and the Governor want to have answered before we move down this path. How do we make sure there are no long-term side effects? And I think, again, pointing to some of the FDA research that is going on today, we want to make sure we are not harming people by passing laws. I know everybody wants to move down the path of helping others. The Governor certainly has compassion and wants to do that as well. But we also want to make sure we aren't putting a medicine out on the street that we don't really know how to --
Henderson: Yeah, but the Governor's point when he spoke with reporters a couple of weeks ago was that this is a prescription and people are going to abuse a prescription like the kids steal the OxyContin that is in the parents' drug case. If someone steals the drug that Mr. Gaer's daughter takes are they going to get high?
Lukan: Well, there's some unknowns here, Kay, and one of those is how you're even going to produce this drug. We don't know where this drug would be produced at in the state. What happens with some of the leftovers? If you are using marijuana to produce this drug, where do the leftovers of the plant go? There's some real policy issues that I think we need to be thoughtful about.
Borg: In light of this, Senator Bolkcom, I'm wondering, when you introduce legislation, in light of these things that we've just heard from Mr. Lukan, were you just saying let's throw this up in the air against the wall to see what sticks?
Bolkcom: No. I mean, I think it's clear that cannabis, marijuana is medicine. People all over the country have access to it. 20 states, District of Columbia today, 15 more states are looking at it. Mr. Lukan I think is trying to confuse the facts around that. 80% of Iowans believe that alcohol is equally as dangerous as cannabis is. We're not talking about something that has all the side effects and all the concerns that he has. I mean, anybody can watch TV this afternoon or this evening and see the news and see the prescription drugs that are marketed to people for depression and anxiety and they say things like, you might want to kill yourself after you take this pill, you may go blind, you may get cancer, there's a lot of things that are marketed as drugs. Cannabis is a relatively safe plant. The side effects of cannabis are falling asleep and having the munchies. We know that this works for people. And I just can't, I don't understand what the state's interest is in preventing people that are suffering from having legal, safe, restricted access to this medicine.
Gaer: And I think you should put this in the context of what legally they have given my daughter and what it has done to her. When she was eight months old we were at the University of Iowa Hospital and the neurologist said, Steve, once we start putting Margaret on this medication it will stunt her mental growth. She's 24 years old and she's five years old mentally. That has occurred because of the legal medications that we said we need to give your daughter to preserve her life. She's on four anti-seizure medications right now, she's on two more medications to counteract the side effects of the four that she's on. Medical cannabis cannot have any worse side effects than what this little girl has already suffered from legal medications that have been available to her.
Lynch: I want to ask you about that because a lot of what we hear, you have firsthand knowledge of this, but a lot of what we hear is anecdotal evidence, that it's not coming out of research institutions, it's people saying I find that marijuana helps me with my anxiety, with some chronic pain, that sort of thing. But do you feel safe, do you feel like you know enough to give medicinal marijuana to your daughter for years, possibly for life? Do you know enough about the effects?
Gaer: I feel like we do, especially in light of families that have taken it for a long time. You take Charlotte Figi who Charlotte's Web is named after, she was having 300 seizures a week and she's down to a couple. There's a mother who lived in Waterloo who took her daughter out to Colorado in November. She's going to come back to the Capitol on Monday and testify that 30%, she has reduced her daughter's seizures by 30%. This medication cannot have any worse side effects than what Margaret has been on for 24 years already, especially in light of the families and how much help it has given her. And isn't that our decision to make? If her doctor says, we think Margaret would do well on this, isn't that our decision to make with our doctor and not the government's?
Henderson: Mr. Lukan, you have argued that, you and others have argued that marijuana is a "gateway" drug. Is medical marijuana a gateway drug?
Lukan: Therein is a very important question. Man of the medical marijuana strains that are available out in many of these other states is simply the same street drug that is actually much more potent in many cases. I have been to drug treatment programs, I have been to drug treatment centers and I have talked to young people and I do believe it's a gateway drug. I have talked to a lot of young Iowans who have said, this was the first drug I experimented with, this is what I thought was safe, it's not going to cause that much harm to me. We today here in Iowa have almost 2,900 young people who are in drug treatment programs because of marijuana. It has seriously ruined many people's lives --
Borg: Are you saying that these other states then are in risky territory, that they're ahead of the curve? They're ahead of proven scientific evidence?
Lukan: I believe that we really want to make sure we're putting safe, secure medicines out on the street. There's a lot of research that needs to be done with marijuana. To the Senator's point, there has been a lot of research that suggest it can exacerbate current problems, people who are potentially using it for PTSD have actually reported worsening their problems, there's a lot of self-medication that happens. We want to make sure we have a safe, secure health care system here in Iowa.
Henderson: Let's talk about New Mexico, which a lot of people refer to who would like the state of Iowa to enact a law. How does the New Mexico law work, Senator Bolkcom?
Bolkcom: Yeah, in 2010 our Iowa Board of Pharmacy, after an exhaustive review looking around the country at the programs made the suggestion that New Mexico would be a good model. They also reviewed all the scientific literature that was available, the University of Iowa College of Pharmacy reported on that and said, indeed, cannabis will work as a medicine. The New Mexico law defines a set of conditions that one could get cannabis under, requires a doctor to basically testify that you as a patient have had all the treatments that are available, all the powerful drugs that are available without relief. Then that application for cannabis approval would go to the State Department of Public Health where a doctor, a medical director of the New Mexico cannabis program would essentially approve it or not approve it, need more information, no this makes sense, the card is issued and then in New Mexico they have developed a set of non-profit dispensaries where the cannabis is grown and it is also dispensed. In states around the country, all of this cannabis is grown inside, it is regulated, it is monitored by the state and people that get a card have to have that renewed every year. It prevents doctor shopping because at the state level they review, we asked, do people go doctor shopping? Of course, they do. But the medical director at the state department is able to weed out those doctors that simply willy-nilly give prescriptions. So we think it's a very restrictive program. There are other models. This interim committee will look to find the best approach for Iowa.
Henderson: Mr. Lukan, as you're putting your policy hat on, what are the strengths and weaknesses of the New Mexico law?
Lukan: This I think is one of the real questions we have to look at as well as policy makers, the future, what happens down the road. I understand there are several states who are actually facing lawsuits over their medical cannabis programs, people are seeking to expand them. New Mexico, one of my concerns with the program is the number one condition that people qualify for was PTSD. I'm a veteran, I have very deep sympathy for veterans coming back who suffer from PTSD --
Borg: Post Traumatic --
Lukan: Stress Disorder, exactly. I'm also encouraged though that the University of Arizona has just been approved for a study on the effects of medical cannabis on PTSD and I think that is, again, our point is we need to do a lot of research with this drug to make sure we aren't causing long-term, unintended side effects. And New Mexico I think has some positives to it if I had to look at all the particulars. But there's a lot of unknowns out there. Again, nationwide we actually only see about 10% of the people that, states that have reported the numbers we've only seen about 10% of the people actually using medical cannabis for some of these well-known conditions like cancer, like glaucoma, in many states it has actually just been people claiming chronic pain that have used it and that is one of our big concerns is kind of the bleeding into the youth population.
Henderson: Mr. Gaer, Mr. Bolkcom had cited some public opinion research on this. A recent poll showed that eight out of ten Iowans support medical marijuana. But it also showed that support was far weaker among republicans. As you go up to the Statehouse do you find a republican, your fellow republicans receptive? And if they aren't, what is your message to them?
Gaer: Well, clearly the ones that I have worked with over my local political career are because they know us personally. Many of them have met Margaret so they all have said, look Steve, we need to figure out a way to make this available to help folks like you, we have to make sure that we have parameters around it so we can express to our voters that this is not something that's going to get out of hand. But they all are very, very understanding of it and said, Steve, it's not a matter of if, it's when, we just need to figure out how to do it right.
Borg: Okay. Jim?
Lynch: I just wanted to jump in and say, would this be different if it wasn't an election year? Would this issue have moved faster or farther if this wasn't an election year and people had to worry about what might come back to bite them in November?
Bolkcom: I think there's two things. I think there's a level of awareness that has not been reached here by members. Members of the legislature try to do their best to do what people back home talk to them about and they haven't heard enough -- and it's an election year and because they haven't heard enough people aren't ready to take a risk in an election year around a topic that has obviously got some controversy to it.
Borg: Because of what Senator Bolkcom has just said, it's an election year and people don't have enough information right now, I'm wondering, five years from now, Steve Lukan, where are we going to be? Will we be back at this same table or are we going to see some movement? And what are you predicting?
Lukan: Well, I'm hopeful that some of these FDA trials can produce clear evidence, pro or con, to help really guide some of these decisions in the health care format. There are clinical trials undergoing right now. There's actually some possibility of expanded access to those clinical trials and that's what we really believe we need research to make sure that we are producing sound medicine that is tested, that actually has dosage requirements attached to it --
Borg: Let me be more precise for an answer from you. Are you thinking that Iowa eventually will legalize medical marijuana given where we are right now in the momentum and these scientific tests that are undergoing?
Lukan: I think there's a lot of legislators who have deep empathy for people who are suffering. There's a lot of policy makers who have deep empathy. But policy makers in Iowa I think generally want to make sure they are passing sound policy and there's a lot of unanswered questions today. I think that answer, Dean, will depend on some of the unanswered questions.
Borg: What is your personal feeling? Yes or no?
Lukan: Well, if it was up to me I think we would make sure we're putting sound, safe medicine out on the street.
Borg: Alright. Thank you gentlemen for being here today. We're out of time. And we'll be back with another edition of Iowa Press next weekend, same times, 7:30 Friday night, noon on Sunday. I'm Dean Borg. Thanks for joining us today.