Bill Could Change How Physicians Practice, Prescribe

TMA Testimony on House Bill 3785

House Public Health Committee
House Bill 3785 by Rep. Marisa Márquez

April 28, 2015

The Texas Medical Association, the Texas Pediatric Society, and the Texas Neurological Society, on behalf of our 48,000-plus physician and medical student members and the millions of Texans that we serve, offers  testimony on House Bill 3785 by Rep. Marisa Márquez. There is a substantial amount of interest among some of our patients and our physicians in the potential use of marijuana to treat the severe symptoms of their chronic conditions. While we are concerned about extensive provisions in HB 3785 that would establish a system to allow for the possession, distribution, and delivery of cannabis for medical use, we are most concerned because of how this could alter how physicians currently practice and prescribe medications for our patients. 

In 2014, TMA completed a review of the most recent research and clinical indications of marijuana and its potential risks and therapeutic benefits. All medical associations agree that we do not have a broadly accepted body of research and practice on marijuana and marijuana compounds to properly inform physicians on the therapeutic effects and risks of marijuana use for specific medical conditions. This research is critical for physicians to be able to inform patients on whether marijuana may provide therapeutic support, for which conditions it may be appropriate, the appropriate dosing levels for different patients, any potential side effects, and if these products are more beneficial than other approved medications with less threat of substance abuse and addiction. 

HB 3785 defines a “bona fide practitioner-patient relationship,” and it dictates what a physician must do with a patient, and it goes further by identifying symptoms and diagnoses that would qualify as a debilitating medical condition. Further determinations of a debilitating condition are assigned to the Texas Department of State Health Services (DSHS) to address by rule. We note that as our state public health agency, with few physicians in the agency, DSHS unlikely would have adequate expertise in identifying medical conditions or symptoms that would qualify as debilitating. 

The public and our patients are greatly encouraged when they learn of the possibilities of having access to a medication or therapy that will address their debilitating symptoms. Physicians make many decisions every day on therapies and medications for their patients. But they make these determinations by taking into consideration the evidence and scientific guidelines that describe the expected effects and side effects of a medication, the interactions with other medications the patient is taking, as well as the other conditions the patient has and the patient’s ability to comply with the prescribed regimen. Physicians cannot make a decision to prescribe a medication or a therapy for a patient without having information from a body of scientific and investigational studies. This is key information and knowledge that every patient would expect for every treatment and regimen their physician prescribes. The medications and treatments we prescribe for our patients cannot be based on anecdotal information or the nonscientific practices that are underway in other states.

While TMA and TPS oppose the unregulated sale and recreational use of marijuana because of its well-identified effects on some populations at risk of abuse and addiction (minors, persons with mental or substance abuse concerns, pregnant women), we are encouraging the U.S. Congress to authorize additional research on marijuana and related cannabinoids for potential medical use. Such research will help to more fully delineate its deleterious effects and any possible beneficial uses, particularly for seriously ill patients who may benefit from alternative treatments. 

While we believe the provisions in HB 3785 will likely increase patient demand for the use of marijuana as treatment, we affirm our right to have a free exchange of information with our patients on the effects and use of marijuana as well as other unapproved complementary therapies. We understand the great interest in addressing requests that will allow chronically ill patients to have access to marijuana products, but HB 3785 is asking physicians to respond to their patients with the still-thin data available on the use of marijuana for therapy. We look forward to working with Representative Márquez and the members of the House Public Health Committee as you consider this and other legislation related to this issue. 

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June 17, 2016

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