Medical Marijuana

[Guest guest]

I have been looking for some good resources on just what the

medical benefits of marijuana are and what receptors Joann was talking about

all the great benefits. And guess what, I can’t find any.

Maybe can help me out.

Joann, your explanations of the poor people you treat are heartfelt.

But they sound like rationalizations. I still have trouble with poor

people coming up with cash for drugs of abuse when they have no cash for food

or drugs with proven value. Who is checking that glaucoma patient’s

eye pressure to see if the marijuana is actually helping? And the

research indicates it really doesn’t help. With MS, the

research is very wishy-washy as to any real benefit. Same with appetite

loss and nausea and vomiting. As for neuropathic pain, the research is

showing that the dose response is critical as too much increases pain

sensitivity. The research that is out there really is very

interesting. It really sounds no different than us offering patients a

drink or two. And who is counseling them to not drive? And

for how long? What about all the adverse health risks like cancers and

heart disease? I have a bipolar patient smoking pot 3 times a day

(not prescribed by me) to take the edge off, but “I never get high”.

Really, how about she has never been sober in 10 years as the last time she

didn’t smoke was when she was pregnant. And what kills me is

she is currently undergoing fertility treatments and going to get a donor egg

and implantation done while she is actively smoking pot 3 times a day.

The fertility clinic “wishes she would stop smoking”.

I truly have my doubts as to whether there is any medical

benefit and whether it is better than what is out there already. Is

smoking pot better than taking a vicodin for pain?

What I did find is that the AMA has made recommendation to take

marijuana out of DEA Category 1 (no medical benefit) and that it is suggesting

that further research be done to explore the possibility of medical benefits

and the ACP came up with the statement paper indicating the same. Interestingly, the ACP paper makes

statements in direct contradiction to what the DEA says an IOM report of 1997

said.

http://www.justice.gov/dea/ongoing/marijuana.html

http://www.acponline.org/advocacy/where_we_stand/other_issues/medmarijuana.pdf

DEA: Q.

Does marijuana have any medical value?

Any

determination of a drug's valid medical use must be based on the best

available science undertaken by medical professionals. The Institute of

Medicine conducted a comprehensive study in 1999 to assess the potential

health benefits of marijuana and its constituent cannabinoids. The study

concluded that smoking marijuana is not recommended for the treatment of any

disease condition. In addition, there are more effective medications

currently available. For those reasons, the Institute of Medicine

concluded that there is little future in smoked marijuana as a medically

approved medication.8

ACP: The IOM concluded that scientific developments

indicate

marijuana and its cannabinoids have therapeutic properties that could

potentially

treat many illnesses and conditions. The IOM recommended that

cannabis

research should focus on the development of rapid-onset, reliable,

and

safe delivery systems (5). Since the IOM report, the body of research on

cannabinoids

for symptom management has grown slightly

I am still trying to read through the ACP paper. But

mostly what I am finding is the lack of evidence of benefit or that if there is

benefit, it is modest and there are other drugs that are better. It is an

interesting read, especially in the areas that we thought there was good

evidence like glaucoma and nausea and vomiting and cachexia. It

seems that AMA and ACP just suggested that it’s time to do some research

and find if there really is benefit or not and they also recommend alternative

delivery methods. And somebody or somebodies grabbed these pretty simple

statement papers, called them ringing endorsements and suddenly legal marijuana

is being prescribed to anybody who likes to smoke pot. Nobody

is talking about the mental impairment of someone under the influence of

marijuana and how that is to be handled. So far, I haven’t found

anything saying there is tachyphylaxis of the neurologic and psychological

impairments from getting high. Can anyone (like ) find

other resources? Up To Date mentions very little except for MS and that

there is no clear benefit. So far, no one has sold me on this.

Kathy Saradarian,

MD

Branchville, NJ

www.qualityfamilypractice.com

Solo 4/03,

Practicing since 9/90

Practice Partner

5/03

Low staffing