Can physicians justify medical marijuana?
“Primom non nocere” (First, do no harm)
Almost fifteen years later, it still haunts me. Did I have a role in it? Her obituary didn’t give any clues, and I never received a call from the coroner. Yet just a few weeks earlier, I had written that prescription.
My patient, in her 30’s, had never given any red flags that she was misusing her oxycodone. But the medicine never seemed to control her pain as well as hoped, either. So maybe it was an automobile accident, or an unforeseen hidden illness. But in my mind, I had possibly caused acute respiratory failure from narcotic overdose. My good intentions to relieve pain had possibly led to tragedy.
This year Ohio joins 30 other states in adding another medication to the toolbox in an attempt to soothe pain: marijuana. According to the Ohio Medical Marijuana Control Program, it is available for either chronic or severe and intractable pain. Additionally, 20 other medical conditions qualify for referral to a medical marijuana dispensary, including cancer, PTSD, HIV, and several neurologic diseases. How did this diverse set of conditions become eligible for treatment with marijuana? What common biologic pathway links them? How effective is it for each of these conditions?
As I reflect on my own patient from years ago, what is the risk? Though I acknowledge marijuana will not put my patients’ lives in respiratory jeopardy like narcotics, I feel the public is being mislead about its safety. Patients may develop a false sense that marijuana is safe since physicians effectively “prescribe” it (trained and certified physicians will refer patients to marijuana dispensaries rather than write prescriptions).
A 2014 New England Journal Of Medicine review by Volkow, et al on the harms of cannabis sheds some sobering light on the dark side of cannabis use. Potential risks include addiction, impaired psychomotor function leading to accidents, impaired brain development in teenagers, psychosis at high doses, and symptoms of chronic bronchitis.
Does the balance of benefits and risks favor utilizing marijuana as medication? Or is it a recreational substance re-packaged to gain legitimacy and sell products?
Trained in analyzing medical science, we physicians have a duty to make sense of the science justifying medical marijuana. Rooted in morality and professionalism dedicated to the well-being of our patients and society, we have an obligation to guide and comment on this contemporary issue.
I look forward to the Columbus Medical Association’s presentation, Marijuana as Medicine: What Clinicians Want to Know About the Science on October 24, 2018.