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4th Quarter 2014
RETURN TO MAIN PAGE | FORWARD TO A FRIEND
Preston’s Hope: An Introduction to the Medical Marijuana Debate
The journey will not be easy, but the potential payoff for a North Carolina family could be immeasurable.
Ana Watson of Greensboro is in the process of packing her family’s possessions for the upcoming move
to Colorado. The purpose of relocating to the Centennial State is not for an employment opportunity or a
"change of scenery"; instead the goal is to save her son’s life. Preston Watson is a happy 12-year-old with
the neurodevelopment of a 2- to 3-year-old. He does not read or write and cannot even draw a circle.
Preston suffers from Dravet Syndrome, a severe form of epilepsy that produces dozens – even hundreds
– of seizures a day. This condition hampers Preston’s neural development. Preston’s doctor at the
University of North Carolina School of Medicine has treated him with every anti-convulsive available, and
not one has been successful in controlling the seizures. A possible treatment for Preston is a medicine
called Charlotte’s Web, which is made from marijuana and has showed positive results in children with
severe forms of epilepsy. The drug was developed in 2011 by the Stanley brothers (Joel, Jesse, Jon,
Jordan, Jared and Josh) and The Realm of Caring Foundation, a nonprofit organization, was set up by the
Stanley brothers to assist patients who cannot afford the treatment. Ana Watson realizes that Charlotte’s
Web is not a miracle drug or cure, but to save Preston’s life (mortality rate for Dravet’s is 15-20%), Ana
and her family are willing to take a chance on this experimental treatment. Preston is not alone, as many
other people in the U.S. are now viewing medical marijuana as a viable alternative to traditional medicine
to address their pain and suffering. Making it easier is the fact that medical marijuana is now legal in 23
states (this includes two states, Colorado and Washington, where it is now legal for recreational use)
along with the District of Columbia.
Before members of the medical community begin promoting medical cannabis as a wonder drug, they
should determine if the overall rewards outweigh the risks. Should doctors and their patients latch on to an
experimental drug before they truly comprehend the long-term consequences to the patient and society as
a whole?
A Brief History
The use of marijuana for medical purposes is documented as far back as ancient Chinese emperors,
around 2700 B.C., when it was prescribed to treat gout, rheumatism, malaria and poor memory. Other
ancient civilizations such as the Egyptians, Greeks, Romans and Hindus also relied on cannabis to
address a number of maladies. The Egyptians used it for glaucoma and inflammation and in enemas, the
Greeks prescribed it for earaches and edema as well as inflammation, the Romans alleviated joint pain
and gout with it, and the Hindus administered it to those with leprosy. By the mid-19th century the United
States Pharmacopeia, a still-active organization that sets standards for medicine and food, had
recognized marijuana as accepted treatment for typhus, cholera, rabies, dysentery, alcoholism, opiate
addiction, anthrax, leprosy, incontinence, gout, convulsive disorders, tonsillitis, excessive menstrual
bleeding and uterine bleeding, among other conditions.
A morphine addiction epidemic in the late 19th century was a significant factor in the formation of the
Food and Drug Administration (FDA) in 1906 and the passage of the Pure Food and Drug Act the same
year. This legislation required that particular drugs, including marijuana, be accurately labeled with
Page 1 of 3RGA Group Insurance INSIGHT
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contents. Not stopping there, in 1910 states passed numerous bills to limit the distribution of narcotics,
including marijuana, to pharmacies and to require a prescription. The Pure Food and Drug Act was
strengthened in 1938 with the passage of the Federal Pure Food, Drug, and Cosmetics Act, which directs
federal enforcement and prosecution for all products that fall into any one of these categories, including
marijuana, which is recognized as a dangerous drug under this legislation. A provision in the 1938 law
identifies marijuana as a dangerous narcotic with no medical benefits, though it lacked the proper
research to support this position.
Breaking Down Marijuana
Cannabis is quite the complex plant. Depending upon the study, 400 to 500 chemical compounds have
been identified in marijuana, but only around 60 of the components are unique to the cannabis plant.
These are referred to as cannabinoids. The cannabinoids are the elements of marijuana that can be
utilized for medical purposes. Research experts have narrowed down two main cannabinoids, delta-9-
tetrahydrocannabinol (THC) and cannabidiol (CBD), as beneficial. THC and CDB have very similar
properties; the only difference is that THC can produce a "high", or, medically speaking, a psychoactive
effect. Marinol, a capsule taken orally, is a synthetic version of THC that was approved by the FDA in
1985 to treat nausea and vomiting associated with chemotherapy and to increase appetite and address
weight loss in AIDS patients. Even though it is a synthetic version of THC, Marinol users can also
experience a THC-type psychoactive effect.
When marijuana is smoked, the burning leaves produce hundreds to thousands of byproducts, some of
which are suspected of being carcinogens. Research indicates that marijuana smoke contains 70% more
carcinogens than tobacco smoke. Conversely, studies to prove a connection between marijuana smoke
and lung cancer thus far have been inconclusive. The positive attribute of smoking marijuana is that the
effect is immediate, even within minutes, which is ideal for people who suffer from physical pain or nausea
(e.g., side effect from chemotherapy treatment).
Based on these facts, it would seem that the ideal process for developing a medical cannabis product
would involve extracting the CBD element, which produces little to no side effects for patients. A
counterpoint to this recommendation is that comprehensive, extensive studies to support the use of CBD
are absent thus far. In fact, related to Charlotte’s Web, clinical evidence to support the use of
cannabinoids in the treatment of epilepsy is non-existent. The challenge with executing clinical trials on a
prospective drug containing CBD is the fact that marijuana is illegal in most states, and in the states
where it is legal, federal jurisdiction could conflict with local laws. To make it easier to perform clinical
trials, the makers of Charlotte's Web are planning to move part of their operation to Uruguay, which
legalized marijuana for recreational use in December 2013. Further research is occurring in the United
States as the FDA recently approved a request to trial Epidiolex in children with forms of epilepsy. The
drug contains CBD and is developed by GW Pharmaceuticals, which is based in the United Kingdom.
Groups opposing the use of medical marijuana maintain that this drug can have a harmful effect on
children. Children and adolescents are more susceptible to the mental and physical health consequences
from marijuana use compared to adults. The brain continues to develop until the age of 25, and studies
have shown that marijuana can negatively impact this process. Another theory contends that children and
adolescents are at a greater risk of becoming dependent on the drug and that dependence occurs more
quickly. In addition, a common contention is that marijuana serves as a gateway or a "stepping stone"
drug for young people. In 2003, the Journal of the American Medical Association (JAMA) completed a
study on the topic and concluded that people who used marijuana by the age of 17 were 2.1 to 5.2 times
more likely to use and become dependent on other drugs, including alcohol, than people who did not use
the substance before the age of 17.
Catching Up with Preston
Due to the absence of follow-up information on Preston’s current status, I reached out and was successful
in communicating with Ana Watson. Ana indicated that she and her family have been living in Colorado
since June 2014 but Preston has yet to gain access to Charlotte’s Web even though he has been on a
wait list since April 2014 (October 2014 Time magazine noted a waiting list of 12,000 families for this
Page 2 of 3RGA Group Insurance INSIGHT
2/25/2015http://rga.dmplocal.com/main/index.php?wd=ArticleGateway&article_id=2712&smart_skin_id=4...
drug). He is being treated with Haleigh’s Hope, like Charlotte’s Web, a drug with high CBD content. Oil-
based and given orally, Ana Watson has claimed this treatment can be credited for a 70% seizure
reduction for Preston along with noticeable improvement in his cognitive skills. The drug was inspired by
Haleigh Cox, a 4-year-old from Georgia who has also suffered from severe seizures and whose family
also made the decision to move to Colorado in order to obtain access to this drug. Like Preston, Haleigh
has experienced a material reduction in the number of seizures. Thanks in part to recent legislation in
some states legalizing marijuana, arguments for and against using it to treat illness are becoming more
public and heated, and both sides would benefit from a greater understanding of the positive and negative
attributes of medical cannabis.
ABOUT THE AUTHOR - Richard D. Becchetti
Richard D. Becchetti, Senior Risk Management Analyst at RGA Reinsurance
has over nine years of exposure management and catastrophe modeling
experience along with a Certified Catastrophe Risk Analyst (CCRA)
designation.
RGA Group Insurance Insight is published by the Group Reinsurance Teams of RGA Reinsurance. This publication’s mission is to provide
news and information to group insurance professionals and to support the group insurance market. The information contained in the articles
represents the opinion of the authors and does not necessarily imply or represent the position of the editors or RGA Reinsurance Company.
Articles are not intended to provide legal, consulting or any other form of advice. Any legal or other questions you have regarding your
business should be referred to your attorney or other appropriate advisor.
Copyright ©2014 RGA Reinsurance Company. All rights reserved. No portion of this publication may be reproduced without permission from
the publisher.
MANAGE YOUR SUBSCRIPTION PREFERENCES | FORWARD TO A FRIEND | PRIVACY STATEMENT
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GroupInsInsight-MedicalMarijuana_4Q2014

  • 1. www.rgare.com 4th Quarter 2014 RETURN TO MAIN PAGE | FORWARD TO A FRIEND Preston’s Hope: An Introduction to the Medical Marijuana Debate The journey will not be easy, but the potential payoff for a North Carolina family could be immeasurable. Ana Watson of Greensboro is in the process of packing her family’s possessions for the upcoming move to Colorado. The purpose of relocating to the Centennial State is not for an employment opportunity or a "change of scenery"; instead the goal is to save her son’s life. Preston Watson is a happy 12-year-old with the neurodevelopment of a 2- to 3-year-old. He does not read or write and cannot even draw a circle. Preston suffers from Dravet Syndrome, a severe form of epilepsy that produces dozens – even hundreds – of seizures a day. This condition hampers Preston’s neural development. Preston’s doctor at the University of North Carolina School of Medicine has treated him with every anti-convulsive available, and not one has been successful in controlling the seizures. A possible treatment for Preston is a medicine called Charlotte’s Web, which is made from marijuana and has showed positive results in children with severe forms of epilepsy. The drug was developed in 2011 by the Stanley brothers (Joel, Jesse, Jon, Jordan, Jared and Josh) and The Realm of Caring Foundation, a nonprofit organization, was set up by the Stanley brothers to assist patients who cannot afford the treatment. Ana Watson realizes that Charlotte’s Web is not a miracle drug or cure, but to save Preston’s life (mortality rate for Dravet’s is 15-20%), Ana and her family are willing to take a chance on this experimental treatment. Preston is not alone, as many other people in the U.S. are now viewing medical marijuana as a viable alternative to traditional medicine to address their pain and suffering. Making it easier is the fact that medical marijuana is now legal in 23 states (this includes two states, Colorado and Washington, where it is now legal for recreational use) along with the District of Columbia. Before members of the medical community begin promoting medical cannabis as a wonder drug, they should determine if the overall rewards outweigh the risks. Should doctors and their patients latch on to an experimental drug before they truly comprehend the long-term consequences to the patient and society as a whole? A Brief History The use of marijuana for medical purposes is documented as far back as ancient Chinese emperors, around 2700 B.C., when it was prescribed to treat gout, rheumatism, malaria and poor memory. Other ancient civilizations such as the Egyptians, Greeks, Romans and Hindus also relied on cannabis to address a number of maladies. The Egyptians used it for glaucoma and inflammation and in enemas, the Greeks prescribed it for earaches and edema as well as inflammation, the Romans alleviated joint pain and gout with it, and the Hindus administered it to those with leprosy. By the mid-19th century the United States Pharmacopeia, a still-active organization that sets standards for medicine and food, had recognized marijuana as accepted treatment for typhus, cholera, rabies, dysentery, alcoholism, opiate addiction, anthrax, leprosy, incontinence, gout, convulsive disorders, tonsillitis, excessive menstrual bleeding and uterine bleeding, among other conditions. A morphine addiction epidemic in the late 19th century was a significant factor in the formation of the Food and Drug Administration (FDA) in 1906 and the passage of the Pure Food and Drug Act the same year. This legislation required that particular drugs, including marijuana, be accurately labeled with Page 1 of 3RGA Group Insurance INSIGHT 2/25/2015http://rga.dmplocal.com/main/index.php?wd=ArticleGateway&article_id=2712&smart_skin_id=4...
  • 2. contents. Not stopping there, in 1910 states passed numerous bills to limit the distribution of narcotics, including marijuana, to pharmacies and to require a prescription. The Pure Food and Drug Act was strengthened in 1938 with the passage of the Federal Pure Food, Drug, and Cosmetics Act, which directs federal enforcement and prosecution for all products that fall into any one of these categories, including marijuana, which is recognized as a dangerous drug under this legislation. A provision in the 1938 law identifies marijuana as a dangerous narcotic with no medical benefits, though it lacked the proper research to support this position. Breaking Down Marijuana Cannabis is quite the complex plant. Depending upon the study, 400 to 500 chemical compounds have been identified in marijuana, but only around 60 of the components are unique to the cannabis plant. These are referred to as cannabinoids. The cannabinoids are the elements of marijuana that can be utilized for medical purposes. Research experts have narrowed down two main cannabinoids, delta-9- tetrahydrocannabinol (THC) and cannabidiol (CBD), as beneficial. THC and CDB have very similar properties; the only difference is that THC can produce a "high", or, medically speaking, a psychoactive effect. Marinol, a capsule taken orally, is a synthetic version of THC that was approved by the FDA in 1985 to treat nausea and vomiting associated with chemotherapy and to increase appetite and address weight loss in AIDS patients. Even though it is a synthetic version of THC, Marinol users can also experience a THC-type psychoactive effect. When marijuana is smoked, the burning leaves produce hundreds to thousands of byproducts, some of which are suspected of being carcinogens. Research indicates that marijuana smoke contains 70% more carcinogens than tobacco smoke. Conversely, studies to prove a connection between marijuana smoke and lung cancer thus far have been inconclusive. The positive attribute of smoking marijuana is that the effect is immediate, even within minutes, which is ideal for people who suffer from physical pain or nausea (e.g., side effect from chemotherapy treatment). Based on these facts, it would seem that the ideal process for developing a medical cannabis product would involve extracting the CBD element, which produces little to no side effects for patients. A counterpoint to this recommendation is that comprehensive, extensive studies to support the use of CBD are absent thus far. In fact, related to Charlotte’s Web, clinical evidence to support the use of cannabinoids in the treatment of epilepsy is non-existent. The challenge with executing clinical trials on a prospective drug containing CBD is the fact that marijuana is illegal in most states, and in the states where it is legal, federal jurisdiction could conflict with local laws. To make it easier to perform clinical trials, the makers of Charlotte's Web are planning to move part of their operation to Uruguay, which legalized marijuana for recreational use in December 2013. Further research is occurring in the United States as the FDA recently approved a request to trial Epidiolex in children with forms of epilepsy. The drug contains CBD and is developed by GW Pharmaceuticals, which is based in the United Kingdom. Groups opposing the use of medical marijuana maintain that this drug can have a harmful effect on children. Children and adolescents are more susceptible to the mental and physical health consequences from marijuana use compared to adults. The brain continues to develop until the age of 25, and studies have shown that marijuana can negatively impact this process. Another theory contends that children and adolescents are at a greater risk of becoming dependent on the drug and that dependence occurs more quickly. In addition, a common contention is that marijuana serves as a gateway or a "stepping stone" drug for young people. In 2003, the Journal of the American Medical Association (JAMA) completed a study on the topic and concluded that people who used marijuana by the age of 17 were 2.1 to 5.2 times more likely to use and become dependent on other drugs, including alcohol, than people who did not use the substance before the age of 17. Catching Up with Preston Due to the absence of follow-up information on Preston’s current status, I reached out and was successful in communicating with Ana Watson. Ana indicated that she and her family have been living in Colorado since June 2014 but Preston has yet to gain access to Charlotte’s Web even though he has been on a wait list since April 2014 (October 2014 Time magazine noted a waiting list of 12,000 families for this Page 2 of 3RGA Group Insurance INSIGHT 2/25/2015http://rga.dmplocal.com/main/index.php?wd=ArticleGateway&article_id=2712&smart_skin_id=4...
  • 3. drug). He is being treated with Haleigh’s Hope, like Charlotte’s Web, a drug with high CBD content. Oil- based and given orally, Ana Watson has claimed this treatment can be credited for a 70% seizure reduction for Preston along with noticeable improvement in his cognitive skills. The drug was inspired by Haleigh Cox, a 4-year-old from Georgia who has also suffered from severe seizures and whose family also made the decision to move to Colorado in order to obtain access to this drug. Like Preston, Haleigh has experienced a material reduction in the number of seizures. Thanks in part to recent legislation in some states legalizing marijuana, arguments for and against using it to treat illness are becoming more public and heated, and both sides would benefit from a greater understanding of the positive and negative attributes of medical cannabis. ABOUT THE AUTHOR - Richard D. Becchetti Richard D. Becchetti, Senior Risk Management Analyst at RGA Reinsurance has over nine years of exposure management and catastrophe modeling experience along with a Certified Catastrophe Risk Analyst (CCRA) designation. RGA Group Insurance Insight is published by the Group Reinsurance Teams of RGA Reinsurance. This publication’s mission is to provide news and information to group insurance professionals and to support the group insurance market. The information contained in the articles represents the opinion of the authors and does not necessarily imply or represent the position of the editors or RGA Reinsurance Company. Articles are not intended to provide legal, consulting or any other form of advice. Any legal or other questions you have regarding your business should be referred to your attorney or other appropriate advisor. Copyright ©2014 RGA Reinsurance Company. All rights reserved. No portion of this publication may be reproduced without permission from the publisher. MANAGE YOUR SUBSCRIPTION PREFERENCES | FORWARD TO A FRIEND | PRIVACY STATEMENT Page 3 of 3RGA Group Insurance INSIGHT 2/25/2015http://rga.dmplocal.com/main/index.php?wd=ArticleGateway&article_id=2712&smart_skin_id=4...