Elizabeth Porter, MSSM, GISP, Calls Out Legacy Health, OHSU on Opposition to HB 2687
Elizabeth Porter questions Legacy Health, OHSU on opposition to HB 2687
HB 2687 – Prohibits transplant center from recommending that potential anatomical gift recipient who is
medical marijuana patient be removed from list of potential recipients exclusively based on positive
result of drug test for marijuana use.
To the Members of the House Committee on Healthcare:
I am a public health scientist trained in risk assessment and systems management. During my three
decades of public service, I served as a research and development program manager for a global
surveillance program, an analyst who conducted planning and program evaluation studies for a policy
office of a major public health agency, and a former federal regulator. I support HB 2687, which
removes one area of bias and discrimination against OMMP patients who may need and seek life-saving
organ transplants.
Please also allow me to go on the record to voice my serious concerns with the comments submitted on
behalf of Oregon’s two transplant centers concerning their objections to HB 2687. Both institutions
state they fundamentally object to any measure that would challenge their complete discretionary
control of the organ recipient selection process. That said, the passage of HB 2687, contrary to the fears
voiced by the healthcare institutions, does not eliminate or jeopardize the institutions’ authority to
assess for and use substance misuse disorders and other factors in determining transplant eligibility.
I believe passage of HB 2687 is in the interest of public health. The measure of oversight proposed is
warranted to protect OMMP patients. There is enough evidence of misinformation and bias from the
comments from OHSU and Legacy/ Providence Health to see that the interests of OMMP patients need
legal protection. The OMMP is a state medical and public health program. The state should take every
reasonable measure to protect the civil rights of patients within the context of medical safety and with
every expectation of the best possible outcomes.
I found the comments from Legacy Transplant Services to be particularly troubling. It is off base to
assert, as the Legacy letter did, that HB 2687 “attempts to legislate unsafe standards of care”. Nowhere
in his letter is there any justification of how HB 2687, protecting OMMP patients from removal from
potential organ recipient list based solely on a positive result of drug test for marijuana use, presents an
“unsafe standard of care.” This is inflammatory language and has no place in our community in this
important healthcare dialog. The Legacy Providence Health letter continues by asserting that the
(adverse) consequences of “marijuana in kidney transplant recipients are well-known”. This statement is
also not factual, based on a current review of peer reviewed studies in PubMed. The evidence available
suggests that there is no difference in transplantation patient outcomes when it comes to marijuana
use. Additionally, the Legacy letter directly contradicts guidance concerning marijuana use published in
the American Transplantation Journal (ATJ) Report (2016 16:1-2) when Legacy writes that the alleged
negative consequences of marijuana are “well known” with respect to transplantations. The ATJ Report
states the consequences of marijuana on transplant recipients are not well known; but, to date, the use
of marijuana appears to have little to no impact on survival. The Legacy letter also claims that “Smoking
marijuana carries the same risk as smoking tobacco in terms of cardiovascular risk.” This statement is
also not substantiated and contrary to current evidence.
Furthermore, the Legacy Health letter rejects the medical legitimacy of the OMMP and the associated
cannabis testing program in Oregon. The letter states that “crude marijuana is unregulated” and does
not “meet FDA requirements” for an “approved drug”. If the Oregon testing program for contaminants
is inadequate (for medical patients), perhaps that needs to be addressed as a separate health issue, and
not a basis for the categorical rejection of the use of cannabis, and the systematic discrimination against
patients who use cannabis, even when it is recommended by their physicians. Advancing this letter as
an official medical response from a major Oregon health system is evidence that Providence/Legacy
health system is not in step with current cannabinoid medicine and research. Comments voiced in the
letter repeat myths about marijuana that have no basis in science. This is troubling. Institutions that
oversee the transplant selection process need to continuously re-examine their methods and processes
to ensure decisions are rational and unbiased as possible.
The AJT Report “Transplantation and Marijuana Use” highlights several key points. Most notably, there
is little evidence that shows that marijuana use predicts worse post-transplant outcomes. The report
recommends that, “Transplant professionals should attempt to determine whether marijuana use
negatively impacts a patient’s life and how it may influence behavior or mask mental health issues.”
These AJT recommendations are not consistent with the objections voiced by the Oregon transplant
centers. The Legacy letter asserts that OMMP patients must abstain from using all state regulated
cannabis products when they become transplant candidates, even when the cannabis is physician
ordered, because these products are not FDA approved. This statement is a rejection, without any
supporting evidence, of the OMMP. It does not serve the citizens of Oregon well.
The inflammatory safety language, misstated evidence, and categorical rejection of an entire state
public health program’s validity (OMMP), creates the appearance that stigma and bias are clouding
sound judgment from the leaders of the state’s transplant centers. I advise that any healthcare
institution receiving state funding require physicians and other health institution officers to receive
continuing education and training in the area of physician medical bias and cannabis stigma and how
this impacts healthcare delivery. Knowledge of cannabis science and corresponding policy is rapidly
changing. This is why at least seven states in recent years have banned discriminatory practices against
cannabis patients in need of organ transplants. It is extremely important to ensure that organ recipient
selection is recognized as a fair process. Failure to protect the civil rights of state approved cannabis
patients may cast a poor light on the integrity of the transplantation program, resulting in a significant
drop in organ donor pledges, an unintended negative outcome of allowing systematic bias to become
institutionalized.
I recommend you pass HB 2687 to protect the integrity of the OMMP, to protect the civil rights of
patients, and to ensure the continued success of the national organ transplant program.
Respectfully submitted,
Elizabeth Porter, MSSM, GISP
Health * Environment * Justice
Eugene, OR