Poll Response: Medical Marijuana

Deepak Cyril D’Souza, MBBS, MD, Professor of Psychiatry at Yale School of Medicine, and Mohini Ranganathan, MBBS, Assistant Professor of Psychiatry at Yale School of Medicine, stated the following in their June 2015 editorial titled “Medical Marijuana: Is the Cart Before the Horse?,” published inJournal of the American Medical Association:

“For most qualifying conditions, approval has relied on low-quality scientific evidence, anecdotal reports, individual testimonials, legislative initiatives, and public opinion. Imagine if other drugs were approved through a similar approach… For most of the conditions that qualify for medical marijuana use, the evidence fails to meet FDA standards…If the states’ initiative to legalize medical marijuana is merely a veiled step toward allowing access to recreational marijuana, then the medical community should be left out of the process, and instead marijuana should be decriminalized.

Conversely, if the goal is to make marijuana available for medical purposes, then it is unclear why the approval process should be different from that used for other medications. Evidence justifying marijuana use for various medical conditions will require the conduct of adequately powered, double-blind, randomized, placebo/active controlled clinical trials to test its short- and long-term efficacy and safety.”

I agree with the quote above in principal, but in practice I feel that the FDA has long since fall apart and no longer serves the purpose it was intended for. But that is a topic for another day. What’s important in this quote is that political agendas should stay out of medicine (for the most part). If you want to legalize pot, push for that. Why go the round about way of moving it through the medical system? It’s plan silly. I just wanted to note here that I feel this debate is being held in an improper forum. That being said, I will move into the topic itself.
There is a good deal of discussion over this. A lot of things from both sides that requires consideration. I was surprised that my little survey reflected 100% in favor. Since that’s the way the poll played out, I’ve decided that I’ll play devil’s advocate here and argue the other side. Please, feel free to make comments. Just be sure to play nice!
  1. Marijuana is listed in schedule I of the Controlled Substances Act (CSA), the most restrictive schedule. What this means is that the drug has a high potential for abuse, has no currently accepted medical use in treatment in the United States, and has a lack of accepted safety for use under medical supervision. If the FDA has placed it in this category, why should it be made legal for medical purposes?
  2. A past evaluation by several Department of Health and Human Services (HHS) agencies, including the Food and Drug Administration (FDA), Substance Abuse and Mental Health Services Administration (SAMHSA) and National Institute for Drug Abuse (NIDA), concluded that no sound scientific studies supported medical use of marijuana for treatment in the United States, and no animal or human data supported the safety or efficacy of marijuana for general medical use.
  3. There just isn’t any good research (meeting the FDA standards that all other drugs undergo) out there to support its medical use. THC research is out there and suggests that it could be helpful for several diseases. But that out on the market as an isolated chemical for a medication is much different than using the plant as a whole. There is currently sound evidence that smoked marijuana is harmful. Perhaps making drugs with only THC and in a non-smoked route could address this concern. Despite all the talk about the medical benefits of marijuana, smoking the stuff is not going to do your health any good.
  4. No major group of medical experts supports the use of smoked marijuana for treatment of health problems. If the experts in medicine are not supporting this movement, why is it still a movement at all? It is scary that medical policy can be so driven by popular opinion. Because I don’t know about you, but I prefer there to be some science behind the medical treatments that I receive from my medical providers.
  5. We do not have enough information to reliably estimate the safety of marijuana when used long term. Most studies to date have followed patients for very short periods of time, often less than a week. This is not adequate to assess risk of use for indefinite periods of time. Is it causing more harm then good? We just don’t know yet.
  6. The CMA [California Medical Association] has decided that the solution is completely to legalize marijuana for all purposes, both medical and recreational, and then study it. But this is backwards. With no other modern medication have we taken this approach. Can you imagine if we made some new psychoactive substance — say Spice, K-2, or ‘bath salts’– fully legal before researching it? How about something that is just mixed up in a lab and thrown out there?
  7. We don’t smoke opium to reap the benefits of morphine, nor do we chew willow bark to receive the effects of aspirin. Similarly, we should not have to smoke marijuana to get potential therapeutic effects from its components.
  8. One of the largest problems with legalizing for medical purposes is the complete lack of consistency in the product. Each person growing it will have a different type and will handle it a different way. Medicine should not be handled in this manner. Imagine if blood thinners were dispensed under these conditions. Smoked marijuana cannot be subjected to careful, well-controlled trials, because it does not come in a standard, reproducible formula or dose, and cannot meet the accepted standards for drug purity, potency and quality. Different strains of cannabis vary radically in their cannabinoid composition and in the contaminants — fungi, bacteria, pesticides, heavy metals and other substances — they contain.
  9. Other plant-derived drugs — morphine, codeine and Taxol, to name a few — have made it through the F.D.A.’s review process, and there is no reason drugs made from cannabis should not be required to meet the same standards.
  10. Although it is true that smoking marijuana carries no immediate risk of death, there may be serious adverse effects in the very patients for whom medicinal marijuana is most commonly considered (i.e., those whose immune defenses are already compromised by AIDS or cancer plus chemotherapy). For example, in patients with AIDS, marijuana use has been associated with the development of both fungal and bacterial pneumonias. Moreover, among HIV-positive persons, marijuana use has been shown to be a risk factor for rapid progression from HIV infection to AIDS and the acquisition of opportunistic infections or Kaposi’s sarcoma, or both.

So, from a medical point of view: keep it illegal until it goes through the proper process. Recreational use is a different issue all together and should be discussed that way.


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Posted on August 21, 2015, in Medical, Polls and tagged , , , . Bookmark the permalink. 3 Comments.

  1. I agree that if medicine is to be made from marijuana it needs to be made with science. The problem is, that the government that requires all this research and approvals is the same government that has been keeping marijuana out of researchers labs. Researchers can’t get it so they are having to rely on anecdotal evidence and research from other countries. Israel is actually doing quite a lot of research with marijuana and the elderly and England has come up with a formulation called Sativex, which contains THC and CBD (http://medicalmarijuana.procon.org/view.resource.php?resourceID=000883).

    What I see happening is a push by the states, through its citizens, to try to legalize marijuana, but only a little bit. So they slap the label “medical” on it. And they set up hoops to jump through and the states collect the tax (and so does the IRS) and politicians are able to sit back, having (sort of) given the people what they want, while still admitting that the Federal Government disapproves.

    I think if you ask a lot of people to really think if they want medical marijuana or legal pot, they will choose legal pot. But the states are doing an end run around the federal government. There is going to come a tipping point, very soon I would think, where the majority of the states are legalizing if not just pot, then at least “medical” marijuana. And the tax revenue will be impossible for the Federal government to ignore. And the majority will push the rest through.

    On a personal level, I don’t find it any more disturbing to smoke a joint or eat a brownie then I do to down Ativan, prozac, lamictal, neurontin, elavil, voltaren, pyridium, and restoril which is my personal daily cocktail for all that ails me. I could theoretically ditch the ativan, elavil, restoril and neurontin with access to the right strains of marijuana.

    At the very least it’s an interesting debate.


    • I have no real problem with marijuana being legal. I just feel that if we are going to make it a medical product, we should at least research that product so that people can look at the risk versus benefit when deciding how to treat their medical problems. Because I doubt that marijuana is any worse then many of the other meds out there. Maybe the push should be for the research to be allowed? But if this is really just about getting recreational pot to be legal, then keep the medical part out of it. Make it just like cigarettes and alcohol.


  2. I completely agree with you. There has been a little bit of loosening of the restrictions on researchers. That should help.


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