Twenty-three states and the District of Columbia have legalized using marijuana. The federal government still maintains medical marijuana is illegal, but the Attorney General has decided not to prosecute registered doctors, patients, growers, and dispensers who are complying with their states laws. Still, many doctors, including me, do not like prescribing medical marijuana. Here’s some of the good, the bad, and the ugly about medical marijuana.
Like almost everything else in life and medicine, medical marijuana has its good parts and bad parts. Marijuana contains 60 different cannabinoids, some of which have psychoactive effects by interacting with cannabinoid receptors in your brain, spinal cord, and lymph tissue. Marijuana contains a lot of other substances that can hurt you.
A medical marijuana patient can ingest marijuana’s cannabinoids by inhaling aerosolized THC-containing liquids, smoking weed, eating THC-containing food, or orally taking cannabinoid extract.
There are two FDA-approved cannbinoid’s currently available in the United States for nausea and vomiting that results from chemotherapy and a third one that is used for muscle wasting accompanying AIDS and spasticity due to spinal cord injury. Chronic pain accompanying cancer and rheumatoid arthritis respond to marijuana use. Newer THC-containing drugs are being clinically tested to help with multiple sclerosis and neuropathic and cancer-related pain.
While they have been found to help some types of medical issues, as far as chronic pain is concerned, THC has not been found to be any more effective than diphenhydramine (Benadryl), codeine, or amitriptyline (Elavil). THC has not been proven effective for acute pain, glaucoma, Parkinson’s disease, tremor and many other diseases whom which patients suffer.
Marijuana will, no doubt, be found to help more medical illnesses as time marches on. Nonetheless, cannabinoids are not a magical silver bullet.
Both doctors and patients alike know the bad side-effects of marijuana. 9% of experimental users become addicted, especially in adolesence. Adolescents using marijuana may have larger dips in their IQs and may drop out of high school and college more than older users. Using marijuana during pregnancy has some negative effects on children later in life.
Even though marijuana smoke does not include nicotine, it does contain harmful toxins and may injure larger airways and result in chronic bronchitis. So, just like you should never smoke tobacco cigarettes, you should never smoke marijuana cigarettes either. In other words, “If you have to take that weed, take it orally.”
Doctors cannot prescribe marijuana for patients, but they can certify :
- the patient has a medical condition that can, to a medical probability, be helped with marijuana;
- the patient has not responded to other therapies;
- the patient has had a comprehensive assessment and a long talk about the risks and benefits of medical marijuana;
- the patient knows medical marijuana is not endorsed by many major medical organization;
- the patient does not suffer from substance abuse, psychosis, unstable mood disorder; and
- the patient lives in a state that allows the use of medical marijuana.
Many primary care physicians are declining to certify medical marijuana for patients who may in fact respond to it. The reasons include an aversion to beginning along the slippery slope of becoming pain management physicians. I, for one, choose to let the pain management consultants to whom I refer my patients handle all aspects of those patients’ pain management issue, including both marijuana or any other useful medication their pain-management specialists deem appropriate.