By Dr. Adam Breinig, DO, FAAFP
Chairman of WV Academy of Family Physicians
Senior Council-at-Large of WV State Medical Association
We have heard the words so often this legislative session that marijuana begins to sound like a legitimate fix-all medication. Proponents support that it is a natural substance whose medical benefits are limitless. Opponents sight that this is a highly addictive substance and potentially a gateway drug that will lead to further substance abuse.
Is there a middle ground to the marijuana debate?
During one of the most contentious and highly volatile elections in recent history, marijuana was passed back and forth by both Democratic and Republican leadership at the state and national level. Five states across the US went to the polls on November 8th to vote on the legalization of marijuana. Four states approved it, Arizona did not. Currently 8 states have legalization of recreational use and 25 states and DC have laws supporting medical marijuana.
The state of West Virginia is discussing medical marijuana today, during the final week of the 2017 legislative session.
We hear so much about medical marijuana, but how is it truly defined?
Currently, under Federal law, marijuana is considered a schedule I substance, despite the legalization at the state level in various areas.
But it is difficult to blindly ignore the passionate few that have benefitted from marijuana. When a tearful mother is stating that marijuana oil has been the saving grace of her child with epilepsy, it is difficult to dismiss that information.
The FDA understands that caregivers and patients are looking for treatment options for unmet medical needs. In some instances, patients or their caregivers are turning to marijuana in an attempt to treat conditions such as seizures and chemotherapy-induced nausea. The FDA has not approved marijuana as a safe and effective drug for any indication. The agency has, however, approved one drug containing a synthetic version of a substance that is present in the marijuana plant (Marinol/Drabinol) and one other drug containing a synthetic substance that acts similarly to compounds from marijuana but is not present in marijuana (Nabilone/Cesamet). Although the FDA has not approved any drug product containing or derived from botanical marijuana, the FDA is aware that there is considerable interest in its use to attempt to treat a number of medical conditions, including, for example; glaucoma, AIDS wasting syndrome, neuropathic pain, cancer, multiple sclerosis, chemotherapy-induced nausea, and certain seizure disorders. (2) I would like to point out that Marijuana is still a Schedule I drug, the most restricted, even after decades of research.
There are many misconceptions regarding medical marijuana.
First, when discussing other medications, a physician must write a prescription for the medication. There really is no such thing as a “medical marijuana” prescription for an FDA approved dose or schedule. As a physician, I can’t write a script for X mg of marijuana and send you on your way to the local pharmacy, and you fill it exactly as I intended. There are currently no methods in place to purify, quantify, or verify the amount and consistency of marijuana that I have approved for you to consume.
Second, as with any other substance that we provide as a medication, there are side effects. States that have permissive use of marijuana have seen unintended consequences of impairment. For example, Colorado has seen an increase in impaired drivers and accidents since its inception of legal marijuana, almost 3X fold.
The Denver Post reports that 2015 saw an 11.7% increase of traffic fatalities in the state, the highest in 11 years.
AAA reports as of May 2016 that fatal crashes involving drives who recently used marijuana doubled in Washington State shortly after legalizing the drug.
While there are no readily available cases of anyone dying from an overdose from smoking marijuana, there have been numerous cases of people dying from overdosing on marijuana in baked goods. The trouble lies in that by smoking marijuana, the active ingredients are immediately released into your bloodstream. When you eat marijuana laced goods, the “high” can take up to several hours to penetrate your vascular system. By then the victim may have eaten so much more because they didn’t feel any high, that once it does reach the blood stream through the stomach, the concentration is high enough to kill that victim. So people have died from overdosing on marijuana. Don’t let anyone tell you any different.
Third, I often hear “marijuana is a plant, it’s natural, it can’t be harmful.” So is cocaine and heroin, made from the cocoa plant and poppy plant, respectively. Would anyone argue that they aren’t harmful? That argument doesn’t even really deserve a response.
Fourth, a lot of the “research” promoting marijuana is from anecdotal sources, not scientific sources. While these sources do show some potential advantages of marijuana, we need thoroughly vetted scientific studies; double-blinded studies, not some retrospective studies whose data is questionable at best, and done by those that have a conflict of interest.
So to be fair, just what does marijuana have to offer?
Well, it does have some potential to offer some relief for the various ailments mentioned above. But it needs more study. We have to find out exactly how much is a therapeutic dose and recommend how often to administer it. Before it could be called “medical marijuana” it would have to pass FDA approval and research. In this day and age, it is highly unlikely that a natural substance with such variability in concentration would ever obtain FDA approval. That is why we already have synthetic versions as mentioned above.
So we have debunked the issue about whether marijuana is a harmless natural substance to be used in medicine.
Before medical marijuana is approved by legislation for West Virginia, we need to consider the impact to physicians and their practices. West Virginia physicians are currently sitting in the epi-center for an unprecedented opioid epidemic. With a criticism coming from many lawmakers and other individuals, blaming physicians for the opioid epidemic, it seems brazen that now physicians may be expected to bare the weight of prescribing a known addictive, potentially harmful and currently illegal substance to our patients simply because they call it “medical.”
The AAFP has a strong stance on the issue, and if you would like to review it, go to this website: http://www.aafp.org/afp/2015/1115/p856.html
Before the medical community can approve any “medical marijuana” there needs to be much more research and proof of its efficacy and also research on how much is therapeutic. This is the current stance of almost every medical organization. We acknowledge that marijuana has the potential to have some therapeutic effects, but we need to know the dosing and potency and be able to provide a consistent dose that is objectively measureable. We aren’t hiding behind the issue, we need more data. That has always been our stance, and will continue to be as long as the research eludes us.
Lastly, as a physician, my first and foremost concern is the safety of my patients. I would never give my patient something that hasn’t been thoroughly tested and approved by the FDA. Marijuana is not there yet, other than in the forms that I already mentioned. I could never give my patients my approval to go smoke some marijuana that someone grew in their basement knowing that it had not been properly sterilized, quantified, and approved by some regulating body.
So in summary, there is no such thing as “medical marijuana.” That is a misnomer. At best all the physicians in the states that allow medical marijuana can do is give the patient permission to smoke marijuana indiscriminately due to an illness that they have. They aren’t able to regulate how much they smoke.
Marijuana overdoses have killed people.
Treatment with marijuana needs to be endorsed by science, not by governing bodies.
Adam J. Breinig, DO, FAAFP
- 1. http://www.mayoclinic.org/healthy-lifestyle/consumer-health/in-depth/medical-marijuana/art-20137855
- 2. http://www.fda.gov/NewsEvents/PublicHealthFocus/ucm421163.htm)