There are few issues in American health care that generate more heated discussion than the use of marijuana for medical reasons. The debate may, in part, stem from the strange dichotomy between data supporting cannabis’ benefits and evidence pointing to its adverse effects.
That cannabinoids help to allay the symptoms of specific medical conditions is beyond dispute. So, it would appear, is the fact that tetrahydrocannabinol, marijuana’s active ingredient, is a two-edged sword (not to mention the sundry contaminants and adulterants that may be coupled to its delivery).
Thirteen states have passed statutes that legalize marijuana for medical use. The specific conditions for which marijuana has been approved in these states are relatively consistent (although not universal) and are based upon a 1999 report from the National Academy of Science’s Institute of Medicine, which recognized the potential value of cannabinoid drugs for pain relief, control of nausea and vomiting, and appetite stimulation. (Joy J, Watson S, Benson J, Eds. Marijuana and Medicine: Assessing the Science Base. Washington, DC: Division of Neuroscience and Behavioral Health, Institute of Medicine. 1999)
As new uses for marijuana are discovered, states with medical marijuana laws revise their statutes to include additional accepted conditions.
Medical Conditions Where Marijuana Can be Useful
- Cancer
- Glaucoma
- Multiple sclerosis
- Epilepsy
- Spinal cord damage with intractable spasticity
- HIV/AIDS
- Painful peripheral neuropathy
- Intractable nausea/vomiting
- Severe anorexia/cachexia
- Hepatitis C infection (currently receiving antiviral treatment)
- Post-traumatic stress disorder
- Amyotrophic lateral sclerosis (ALS, or Lou Gehrig’s disease)
Unfortunately, even physicians who practice in “marijuana-legal” states and who accept cannabis as a viable treatment option may be constrained by concerns over marijuana’s adverse effects or by organizational policy. Indeed, while recognizing cannabis’ potential uses, the Institute of Medicine cautioned that the benefits of smoking marijuana are limited because of the harmful effects of smoking. And, in one representative policy statement, the American Academy of Family Physicians “…opposes the use of marijuana except under medical supervision and control for specific medical indications.” (AAFP Policies, 1989, 2007)
On the face of it, such phrasing seems to give physicians relatively free reign in recommending marijuana for appropriate patients. However, this and similar policies spawn a Hydra-like conundrum for medical professionals.
Since the most common delivery vehicle for cannabis is inhaled smoke—which is ostensibly loaded with tar and carcinogens—how can any physician who cares about the long-term vitality of another human being condone the use of marijuana, whose source and purity is often uncertain?
How much liability does a physician bear when, beneath the umbrella of “medical supervision”, a patient encounters a medical or legal complication from marijuana use? Informed consent that allegedly relieves physicians of responsibility provides paltry protection from litigation in today’s medicolegal climate.
And what of the employee who, while using medically-endorsed marijuana, fails a routine urinalysis and loses a job? Just because an individual has the blessings of his state and some well-meaning doctor to smoke pot doesn’t mandate that employers—whose concerns are for their own liability—must retain “impaired” workers.
Consider the medically-approved-marijuana-smoking driver who’s involved in a crash, and subsequent lab tests confirm the use of cannabinoids. What will insulate this individual from the full weight of motor vehicle law?
The ramifications for physicians, lawmakers, and patients are endless. One final recommendation from the Institute of Medicine, should it ever become reality, might defuse the more incendiary points in this debate: Researchers must “…isolate or develop (purified) cannabinoids that are medically efficacious and have little or no potential for abuse.”
Once such medications are available and affordable (unlike the currently-marketed Marinol) at least some of the argument surrounding medical marijuana will become moot.
