To the Members of the Arkansas Legislature, regarding medical marijuana:

I am a full time internist with a hospice program in northwest Arkansas, board certified in both internal medicine and in hospice/palliative care. I have worked with hospice either part time or full time for ten years now.

Over these ten years, our hospice team has encountered patients with intractable nausea and vomiting, for whom oral medications cannot work. If a patient's stomach lining is irritated to the degree that the person is throwing up, a pill won't a) remain in her/his stomach long enough for absorption, or b) be absorbed effectively. Certainly, the well-known active ingredient in cannabis (THC) is available in an oral preparation, called Marinol; however, this cannot be absorbed well by an irritated stomach lining.

Other medications are available for administration by the rectal suppository route or by the injectable route, and these can be powerful, useful adjuncts to control intractable nausea and vomiting; however, they do not work universally. Having the ability legally to recommend inhaled cannabis would augment our options for quelling intractable symptoms in the terminally ill.

You are likely aware that the end of life provides tremendous opportunity for spiritual growth. It is very difficult for human beings to work on their spiritual issues when their physical issues are overwhelming them. That is why our team works so diligently to address physical symptoms.

We safely use legal opioid preparations to address pain; these agents are as addictive (if not more so) than cannabis. It is imperative for our team members to be vigilant for side effects of ALL medications we prescribe for our patients, whether the medication is a controlled substance or not. This would apply to cannabis as well, of course. (In fact, the side effects of medications that are not controlled substances can be worse than those of many controlled substances.)

Thank you for giving me the opportunity to address this question. I encourage you to consider expanding the medical options for the patients in Arkansas, admittedly very few, who could benefit from inhaled cannabis.

endorsements

Yours truly,

Leslie G. Landrum, M.D.