Virginia bill sprouts greater discussion on medical marijuana

A bill that passed the Virginia House of Delegates this week will allow the use of medical marijuana for patients suffering from epilepsy.

The bill, approved unanimously Tuesday by all 98 of the delegates who voted, proposed the use of cannabis oil for medical purposes in treatment of epilepsy, the commonwealth reported through its online information system at http://lis.virginia.gov. The drug would be administered in liquid form and not contain portions of the cannabis plant that produce the psychoactive ingredient tetrahydrocannabinol (THC) in marijuana.

Present but not voting was Delegate Mark Berg, R-29th. Delegate Robert G. Marshall, R-13th, was absent from the vote.

The approval is a step in the right direction, said Dr. Paul Lyons, medical director of the Virginia Comprehensive Epilepsy Program and attending physician at Winchester Medical Center, who called the decision “encouraging.”

“I think this is an exciting thing for Virginia,” he said. “And I look forward to being part of a broad discussion … to make this as encouraging and promising as can be.”

But he said its impact won’t be felt by the health community until Virginia legislation can answer all the questions that arise from the possibility of a new treatment.

“What does this mean for the how and the who and the when and the why?” Lyons said.

Marijuana, which comes from the cannabis plant, is classified as a Schedule 1 controlled substance. Lyons recently acquired Federal Drug Administration approval to use the drug in the treatment of two young epilepsy patients participating in a study, but only after he endured 13 months of phone calls, background checks and certifications to legally be able to possess and administer a version of the drug called Epidiolex.

The first drug approved by the FDA for medical research in epilepsy, Epidiolex is distributed by GW Pharmaceuticals in the United Kingdom.

“Presently, pharmacies are not allowed to dispense Schedule 1 drugs,” Lyons said.

If that changes, he wondered, how will they be prescribed or distributed? Will third parties become involved, and how will Virginia’s decision affect the drug’s movement across state lines or through the mail?

How will the drug be produced, and who will grow the plants? Will the transfer of seeds be allowed, and what kind of security would companies or health care facilities need for protecting the drug from theft or misuse?

Will dosage be standardized or adjusted per patient? Which type of epilepsy will this drug treat, and where in the sequence of treatment attempts should it be used?

“Will insurance pay for it?” Lyons wondered. Will it be taxed?

“I guess I’m excited, I’m optimistic,” Lyons said. “But there are a lot of details between here and there.”

It will take a lot of homework to do this safely, he said. But he pointed out that GW Pharmaceuticals has operated under the authority of the British government to produce Epidiolex in “a very formal, scientific and authoritative way.”

He would suggest Virginia legislators contact GW for advice on how to proceed.

Also hoping Virginia will find research partners in states like New York, Maryland, North Carolina that have already crafted legislation for use beyond medical situations, Lyons described this new frontier in modern medicine as a sort of Wild West in the world of health care.

“It’s one experiment after another,” he said.

For his own part, he said he hopes to be successful in reaching out to legislators to share what he’s learned about medical marijuana during the last year, and in working with patients in his epilepsy study.

His two young patients, 9-year-old Courtney Iser, of Gore, and 12-year-old Caleb Thomas, of Virginia Beach, found no success in managing their epilepsy using other treatments, but over the last two months have had good results on Epidiolex.

Their parents and teachers say the children are more alert and more academically engaged, said Lyons, who plans to begin another, larger study on epilepsy this spring once he receives approval from the FDA.

So far, Lyons said, “[The children] are having a robust response to this novel medication.”

Contact staff writer Josette Keelor at 540-465-5137 ext. 176, or jkeelor@nvdaily.com