COLUMBUS – Two medical marijuana conditions – anxiety and autism – are one step closer to being added to Ohio's list of qualifying conditions.

A state medical board committee on Wednesday recommended adding those two and rejecting three others: depression, insomnia and opioid addiction.

The full board will vote on the conditions in June.

Experts consulted by the board agreed evidence supported marijuana use for anxiety and autism spectrum disorder but split on the other three conditions. Generally, they supported marijuana when it was a safer and effective alternative to how the conditions are treated now.

An estimated 3.5 million Ohioans are eligible to obtain a medical marijuana card under the 21 qualifying medical conditions set in state law, according to an Enquirer analysis.

It’s not known how many Ohio adults live with autism, but an estimated 44,000 Ohio children do. Children can use medical marijuana under the supervision of a parent or guardian.

An estimated 1.6 million Ohioans have anxiety.

The medical board accepted petitions for new conditions for the first time in November and December 2018. The board received 110 petitions that were narrowed to proposals for five conditions.

Petitions included evidence, anedotal and data-based, to support adding the conditions. Clinical research on medical marijuana use is hard to find in the U.S. because marijuana is still classified as a dangerous, illegal substance with no medical value.

The board asked doctors and researchers with experience in medical marijuana or the proposed conditions to review the proposals. The committee asked some of the experts questions by phone during Wednesday's meeting.

Board member Dr. Michael Schottenstein, a psychiatrist, said he didn't vote lightly to reject petitions because he knows patients have held out hope that medical marijuana is the solution they've been searching for.

“For me, the benefits of medical marijuana for an indication need to outweigh the risks and it needs to be as good or better than the conventional therapies that are out there,” Schottenstein said before the panel voted on conditions.

Thomas Rosenberger, associate director of the Ohio Medical Cannabis Cultivators Association, was among those who submitted petitions for the five conditions reviewed Wednesday. Rosenberger said he hopes the full board votes to add opioid use disorder.

"The reality is Ohio is at the forefront of the opioid crisis and we should be offering physicians every tool available to address that," Rosenberger said.

Additional conditions take effect immediately after they are approved by the state medical board.

Autism spectrum disorder

Several states allow marijuana to treat symptoms of autism spectrum disorder: Colorado, Delaware, Iowa, Louisiana, Michigan, Minnesota, Pennsylvania, Puerto Rico, South Carolina and Utah.

Research reviewed by experts showed THC and non-intoxicating compound cannabidiol reduced behavioral problems including self-harm.

Gary Wenk, an Ohio State University professor and researcher, said cannabis can calm down children with autism. But there are concerns with recommending children use marijuana because there is research showing marijuana can harm youth brain development.

Few drugs have been federally approved to treat autism symptoms, and their side effects include diabetes and sudden cardiac arrest. Wenk said cannabis is the better option and "way safer."

“It is going to be better, which in this world means less harmful, less negative and potentially beneficial for the caregivers,” Wenk told panel members Wednesday.

Anxiety

Ohio would join two other states that have approved marijuana to treat anxiety: New Jersey and West Virginia. West Virginia's program isn't up and running yet.

Anxiety is a side effect of marijuana. Board members questioned how it could alleviate the condition.

Dr. Solomon Zaraa, a Cleveland-area psychiatrist, told them low doses of marijuana can be beneficial in treating anxiety, but even moderate doses of THC can make the condition worse. Zaraa, who is certified to recommend medical marijuana in Ohio, said anxiety patients are best using cannabidol, or CBD, and low-THC products.

Dr. Mark Woyshville, a Cleveland-area psychiatrist, said anxiety patients often turn to benzodiazepines, which can cause side effects and painful withdrawal symptoms.

“The use of marijuana for medicinal purposes is unlike the development of any modern chemotherapeutic agent for any disease,” Woyshville wrote in his analysis recommending the board add anxiety.

Rejected conditions

The board voted to reject insomnia, opioid use disorder and depression. At least one expert consulted by the board objected to those conditions. No other state includes insomnia or depression on their qualifying conditions lists.

For insomnia, the experts concluded marijuana has the same problem as existing treatments: it might help for a few days but it doesn't produce normal sleep patterns.

For depression, experts said there weren't high-quality studies supporting treatment with marijuana.

Four states include opioid addiction as a condition. Dr. Ted Parran, an addiction expert at Case Western Reserve University, said there's "zero evidence people" using cannabis to treat opioid addiction use fewer opioids.

"Even if they did, a person using less heroin laced with fentanyl isn't really any kind of treatment goal especially when we have good evidence-based treatment like buprenorphine, methadone and naltrexone," Parran told the panel.

But other experts disagreed with Parran's take. They noted studies showing THC reduced withdrawal symptoms in the early stages of detox. and opioid overdose death rates dropped in states that implemented medical marijuana programs.

Dr. David Bearman, a California physician specializing in pain management and medical marijuana, wrote in his analysis that marijuana could help meet the increased need for treatment options for opiate addiction. In 2017, 4,293 people died in Ohio from opioid drug overdoses.

"Cannabis has been used for years by patients both as an illicit and as a licit substance to routinely, safely and successfully reduce, if not eliminate, opioid use," Bearman wrote.

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