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Would You Prescribe Medical Marijuana?

Newkendra_2Kendra Campbell -- I recently watched a video of presidential candidate Mike Huckabee responding to a question on whether or not he would support medical marijuana. In his response, he mentioned that narcotics could potentially be an alternative to medical marijuana for the relief of pain. This really got me thinking.

Before I delve into the subject, I’d like to say that I’m not necessarily for or against legalizing marijuana across the board, or even just for medical use. However, I am definitely for the relief of others’ suffering, and I also believe in anecdotal evidence, as well as findings from clinical research.

I can’t claim to be an expert on the subject of medical marijuana. But from what I’ve read, there seems to be a lot of research that suports the claim that marijuana can be effective in treating chronic pain, nausea, increased interlobular pressure, and a variety of other symptoms. It has been promoted in the treatment of diseases such as AIDS, cancer, glaucoma, and multiple sclerosis. Of course, on the other side of the coin, there has been research that supports the notion that marijuana can have some long-term negative effects. I could go on to list all the research for and against the use of medical marijuana, but that would require a much longer post, and it wouldn't prove anything in the end.

The statement that Huckabee made regarding narcotics (and by narcotics, I’m guessing he meant opioids) really fascinated me. His comment would mean that morphine, for example, is a viable alternative to marijuana for the treatment of chronic pain. Any physician, or medical student for that matter, can testify to the fact that morphine is effective in relieving short-term pain, and some research supports its use in the treatment of chronic pain. However, if you’ve ever seen the consequences of the administration of morphine long-term, you can guess why I have a problem with this argument. There is no debate that morphine is physically addictive. I’ve seen it with my own eyes, and the drug seekers who show up in clinics and hospitals are first-hand evidence of the addictive potential of this drug.

Is marijuana also a physically addictive drug? Well, this seems to be a highly debated topic. I’ve seen evidence for both sides, but I think the preponderance of evidence favors the fact that it’s not physically addictive. Even if there is an addictive component, however, could it ever be as strong as the addiction to opioids? I guess that’s for all of you to answer.

Currently, federal law prohibits a doctor from prescribing medical marijuana to their patients. However, certain states have passed laws that allow doctors to prescribe marijuana for various medical reasons. I’m curious as to why certain doctors believe in prescribing marijuana for their patients, and how they would feel if they lived in a state (or country) where its use is prohibited. I also know very little about its use internationally. Do other countries have similar laws about the use of marijuana? I have years before I’ll be able to use a prescription pad, so I have plenty of time to think about this subject. But I wonder what I would do if I had a patient who clearly benefited from the use of medical marijuana. Would I prescribe marijuana if I knew it would relieve their suffering, and even aid in their healing? What would you do?

January 9, 2008 in Kendra Campbell | Permalink

Comments

In Israel, marijuana is approved by the health ministry for AIDS, cancer, and dying patients. Some physicians disapprove, but most are willing to "give it a try".
There is a medical laboratory in a Jerusalem hospital which supplies THC pills for patients. It is still considered an experimental treatment.

Posted by: Omer Moussaffi | Jan 10, 2008 12:58:41 AM

Well, let's also get one thing straight, marijuana when used medicinally, should not be smoked, as it is as bad as unfiltered cigarettes, and possibly even worse. Simply due to the damage that the smoke does to your lungs. Depending on the condition marijuana is being used to treat, this should not be discounted.

However, as a whole, I tend to believe that the US's war on drugs has been a failure as a social experiment, but there are no options being given to change marijuana's status, or any other illicit drug currently.

Posted by: Jared | Jan 10, 2008 5:40:59 AM

Marijuana is not "as bad" as unfiltered cigarettes, in that the average dose is way less. I would estimate 10x less. People don't smoke joint after joint, and many people wouldn't even finish one joint if they were smoking it solo.

Smoking anything is bad for your lungs, but people simply do not and never have smoked marijuana with the same frequency as those who use tobacco.

As far as prescribing Mary Jane - you better not do so unless you're willing to forget about your medical career in the U.S. The California docs who do prescribe it simply charge folks $250 a visit and then the "patient" gets a Dr.'s note for use in the cannabis clubs. Doctors prescribe it to anyone who has a reason and cash, and that's all they do.

So if your idea of being a Physician is selling pot to people, then fine. But if you want to practice medicine, it's nothing you should consider, at least in the present or near future.

All that being said - it's ridiculous that marijuana is illegal. It protects no one, and probably even encourages people to try it more by making it that forbidden fruit.

Posted by: David | Jan 11, 2008 9:01:07 PM

No medical marijuana for me, people have it every where here and it may be less addictive than opioids, but it has more worse side effects including dementia besides, pain can be handled by our current drugs, why opt to marijuana?

Posted by: | Jan 12, 2008 3:21:09 PM

David, I really don't know where you're getting your data on marijuana joints being less damaging than unfiltered cigarettes. The studies I have seen that support this fall into the trap of having people self-report how many joints they smoke on average which generally lowers the reported amount by 50% or more compared to what they actually smoked.

Posted by: Jared | Jan 13, 2008 1:09:47 PM

Who cares if marijuana is more or less damaging than unfiltered cigarettes?! That is a moot point because the alternative is clearly more damaging than either one. Suggesting that people with chronic pain just be placed on long term opiates is ludicrous.

Posted by: | Jan 15, 2008 3:28:28 PM

The extent to which marijuana is dangerous depends, like any other drug, on dosage and delivery. Water pipes can reduce a lot of tar from the smoke, and eating it completely eliminates the smoke hazards.

In determining marijuana's safety, you must remember to compare it to other meds that you might prescribe instead, especially in measuring long-term effects. Ms. Campbell makes a great point when comparing it to opioids.

Posted by: James Ian McCrackan | Jan 15, 2008 3:31:01 PM

I am opposed to medical marijuana because I believe that it is poor practice for physicians to prescribe an agent that is not standardized and regulated. Marijuana can have pesticide residues (some of which can be quite toxic, due to government eradication programs) and other illicit additives like PCP. In addition, I find it the height of hypocracy for physicians to prescribe something that is smoked.

By contrast, I am strongly in favor of oral THC preparations and I would also like to see a THC metered-dose inhaler made available to patients.

From a prohibition standpoint, I also oppose the prohibition of marijuana. I think that draconian drug policies do more to harm our patients than they do to help them. I daresay I have seen a lot less marijuana-related pathology than I have seen alcohol- or tobacco-related pathology.

Posted by: Mike | Jan 15, 2008 3:31:40 PM

My opinion no. They need to work the bug's out. Because this sustance is not allowed in the country. It's also get's the patient in trouble with thw law. Even though It has some value to help the patient with an illness.There are some effect's in the long run may not be good eighter.The FDA AND DEA and other's in the get it approved by all side's before continue this on.

Posted by: Annette | Jan 15, 2008 3:43:24 PM

Everyone who has commented seems to be viewing this strategy from a primary perspective without looking at non-medical sides of the story. For instance, I have seen the performance, whether at a job, driving, and even speaking, of those on marijuana. It is poor at best. Don't believe those people who say that they are actually "Better workers" or "Better drivers." On top of that, the use of medical marijuana could be widely abused and overused, such as testosterone treatments for older males. However, if the marijuana was administered in low enough amounts, moderated (such as adderall) by pharmacies, and only administered when absolutely needed, it may become a viable option. However, this seems very unlikely. I suggest we keep looking, and waiting, for another idea or breakthrough to help us solve this problem.

Posted by: Cody | Jan 15, 2008 4:18:51 PM

Marijuana isn't being discussed for pain management, it is being discussed for treatment of the side effects of pain management, especially nausea. To this end, just like we have many, many choices for treatment of pain, we also have many, many choices for treatment of nausea. We also have dronabinol, which is a synthetic version of THC and isn't very useful (because marijuana isn't very useful) although it works exactly the same way. If you check Micromedex, or perhaps any medical reference, you will find that marijuana and agonists of the THC receptor are allowed by the DEA for last resort treatment. Don't kid yourself, though, this push for "medical marijuana" is about getting it legal for recreational use and that is all.

Posted by: Justin | Jan 15, 2008 4:30:17 PM

Potential for abuse should not be reason enough for baning a drug that could benefit some a great deal. We give out drugs all the time that could be abused...or impair function, etc. If benefit outweighs risk, and the patient can be safely monitored for complications, let them get the pot. For most people dying with pain and wasting away, driving and poor performance are not issues. We need more tools in our arsenal, not less. That said, any drug should be demonstrated safe and efficacious in controled trials.

Posted by: Jane | Jan 15, 2008 4:35:04 PM

Since when are glaucoma patients in agony and dying? Yes, other drugs CAN impair function as well, but does that make them ok to hand out to anyone? As i stated, it may be a viable option if it can be controlled. However, do you think that is possible. I don't understand why someone would want to throw another addictive, performance altering drug into the mix when there are other drugs that can do the exact same thing. If you would like more drug seekers, more abuse, and maybe even a family of 5 being killed by a high driver, just to get one more non-breakthrough drug out there, then you should try and rethink your stance.

Posted by: Cody | Jan 15, 2008 4:56:51 PM

If the pt. was elderly and wanted the marijuana, then yes I would prescribe it to them. To a young person, no I would not, unless it is for certain that they are dying. (and who really knows for sure)But yes, to the elderly, because they have lived their life and if that is what makes them happy in life, then why not? Let the elderly die happy.

Posted by: Darli | Jan 15, 2008 5:50:35 PM

I had to undergo chemotherapy almost two years ago. The nausea and vomiting I experienced was horiffic. I had Zofran and Phenergan avaiable to me, but there were many times when even taking them in combo produced little to no relief. I was able to obtain marijuana and smoked it when prescribed antiemetics failed. Smoking the marijuana helped me remain free from vomiting much of the time and allowed me to enjoy eating, and had I not smoked the marijuana, I believe I would have lost much more weight without it.

Posted by: Paula | Jan 15, 2008 5:51:20 PM

A natural substance vs. something man made is the real question at hand. I think it also might be a personal choice, but if you can prescribe it to others accross the board how will insurance companies get there cut?

Posted by: Lesley | Jan 15, 2008 8:20:06 PM

The reason smoked marijuana (and possible an inhaled metered dose if made available) is better than marinol is because the patient doesn't get overdosed so easily. The patient knows how much they need, and going overboard is a waste of pot. Smoking pot isn't a pleasant experience for most people, unless they are in some kind of distress (such as nausea, extreme boredom, frustrated anger, etc.) that the THC helps alleviate. Most people find the side effects of smoking pot to be quite uncomfortable. Confusion, paranoia, etc.. It is only as popular as it is because it is illegal.

When taken every day for at least two weeks, marijuana's antidepressant effect kicks in, and the brain adjusts neurotransmitter levels somewhat so that it isn't so impaired. It isn't worth the memory problems and other cognitive impairment for most people, but for many it is. We'd have a big uprising among professional burger-flippers in this country if the supply of marijuana were somehow interrupted. How would they deal with life? They'd get angry, drink, get more angry, and it would be a bad scene for all. Good thing that the marijuana supply is far from the reach of our government.

The USA was founded on self-evident truths, such as the individual's right to Life, Liberty, and the Pursuit of Happiness. The founders of the declaration of independence would be, I believe, saddened by the authoritarian disaster that has cost countless lives and greatly exacerbated the drug problem in this country. The doctors that hand out prescriptions for marijuana take personal risk in order to stand up for the rights of others, and are heroes in my book.

I say that all money spent on enforcement of a horribly misguided drug policy could be better spent on treatment for the victims of drug addiction. Refocus those DEA agents on violent crime and crime against property....oh wait, real crime would decrease dramatically with a sane drug policy. (All those heroin addicts not needing to constantly support an insanely expensive habit. Look up the numbers yourself.) OK then, send the DEA agents to nursing school. Maybe a few could even make it into medical school. God knows we need more health care professionals, soon.

Posted by: Kiraly | Jan 15, 2008 8:21:21 PM

I believe that drugs should be treated the same as cigarettes and alcohol. For a physician, prescribing these substances should be a matter of preference and ethics. If these drugs were not illegal they would be so cheap that no one would bother peddling. The war on drugs is as stupid and fraudulent as the war on terrorism. All about expanding bureaucracy.

Posted by: Dorothy | Jan 15, 2008 9:07:13 PM

Peer reviewed publications indicate that marijuana may not be efficacious for many patients as the process of smoking it often leads to coughing, throat and sinus irritation. However, administering THC in either pill of suppository form is a viable and legal option here in the U.S.

In Europe, there are numerous pharmaceutical options for THC administration. Sadly, the FDA does not approve these here in the U.S.

Posted by: TC | Jan 16, 2008 11:12:28 AM

Each time a politician begins talking about some medical topic, in this case medical marijuana, causes the thought to arise that they are trained mostly as lawyers and not physicians. As such they are wholey unqualified to render an informed position with respect to any topic relating to pharmacology.

Posted by: Craig M. Pradarelli | Jan 16, 2008 8:20:04 PM

In India Marijuana is called Ganja and widely used in Ayurvedic Drugs. It is also used by intellectuals, Sadhus and other persons across the different part of society. To my experience it is psychologically addictive not physiologically. I have come across many people who craves for Ganja when others using it.

Posted by: Dr Raj K Gupta | Jan 16, 2008 11:44:18 PM

Preferably I wud never want to prescrib such a drug,but in cases where no pther option is available then ,ofcourse it would be appropiate to prescribe it.

Posted by: Sonia | Jan 17, 2008 12:18:49 AM

a good idear. naturally available harbs help to reduce the risk of side effects of synthetic phamacitical medicamentation. we should on the other hand try to work out the correct dose to precribe the harbs, and to go fishing for more such medications. it is also evident in the bible where treatment using marijuana(mandracs) ,as a treatment for infertility. furthermore in the african traditional society marijuana was widely used as a mediator to stimulate the working of the brain. so NO TO SYNTHETICS, YES TO NATURE.

Posted by: edward | Jan 17, 2008 1:44:04 AM

This is a complex issue, there is a lot of personal feelings being used as basis for arguments. It seems people are confusing marijuana' image as a drug of recreation with its side effects. IT undoubtedly has side effects, as do the synthetic opioids but you need to compare them dispassionately. Another thing to consider is the problem of taking synthetic THC as a pill for nausea or as an anti-emetic - one of the benefits of marijuana is that it doesn't need to be swallowed, so patients don't have to struggle with throwing it back up. Would I prescribe - I'd need to see more evidence and some clinical guidelines.

Posted by: Eddie | Jan 17, 2008 3:49:22 AM

"Is marijuana also a physically addictive drug? Well, this seems to be a highly debated topic. I’ve seen evidence for both sides, but I think the preponderance of evidence favors the fact that it’s not physically addictive."

Please. Do explain the evidence, preferably with citations. Because a simple PubMed search on "cannabis addiction" or even "cannabis withdrawal" creates a very different impression. Start with reviews by AJ Budney for the easy version. Even for what I am amazed to find is our unbelievably dated dualist medical education culture, the evidence should be sufficiently "physical" for you.

" Even if there is an addictive component, however, could it ever be as strong as the addiction to opioids?"

And here is where you make a fundamental mistake. Acute withdrawal symptoms are relatively meaningless in drug dependence as a societal and lasting personal health problem. Acute detox is do-able. Drugs which are not classically considered recreational drugs of abuse have acute withdrawal profiles. It is rather the lasting changes in brain function that lead to repeated relapse to drug taking that are the problem in drug abuse. And in your dualist culture, this equates to "psychological" addiction.

Given that, how do you assess the "strength" of addiction to cannabis versus any other drug of abuse?

How do you assess the chances of dependence in a treatment population versus a recreational use population? (surely you must have come across the changes in narcotic prescription in recent decades that arose from the realization that perhaps when opiates were prescribed for legitimate post-surgical pain, for example, the risks of dependence were lower than in a "normal" persons, yes?)

Posted by: Drugmonkey | Jan 17, 2008 1:15:21 PM

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