Recommending marijuana not high on my list

A patient of mine said this about marijuana and his Tourette Syndrome: “The only drug that’s worked!”

I believe him.

Medical marijuana is now legal in most states, including Ohio. A physician cannot “prescribe” marijuana – it’s a federal crime. Marijuana is a Schedule 1 drug, same as heroin or ecstasy, with “high potential for abuse” and “no currently accepted medical use.” But for a patient to buy marijuana legally, the state requires a “recommendation from a certified physician.”

I’ve got two questions.

1. Is marijuana Schedule-1 bad?

My answer: no. Alcohol and cigarettes aren’t all bad either. Moderate drinkers may have better heart health than non-drinkers. Smokers have lower incidence of ulcerative colitis, a form of inflammatory bowel disease, than non-smokers.

But I don’t “recommend” alcohol for heart health or smoking for gut health for a simple reason: the risks far outweigh the benefits.

2. What’s working: the magic dragon or the magic pill?

While our relationship with marijuana predates Buddha, its medical benefits are a mutton stew of yet-to-be-proven claims. The more established therapeutic benefits are modest: AIDS wasting, nausea induced by chemotherapy, and others.

But more than half of U.S. adults have tried pot and 20 percent have used it at least once or twice in the past year, according to an April survey from Yahoo News and Marist University. It’s not risk-free just because nobody dies of an overdose. Acute intoxication and withdrawal can occur. Infants exposed to marijuana during pregnancy can have persistent cognitive issues. Teens who are regular users can have decreased memory, attention (where marijuana hits the brain the hardest), and IQ. Smoking impairs lung function. It’s addictive. The thing about addiction: One can handle it, until one can’t. 

Each year more kids think marijuana is safe. Studies show that on college campuses there are now more pot users than cigarette smokers. Despite Attorney General Jeff Sessions’ warning about selling marijuana “at every corner grocery store,” I believe marijuana will eventually be decriminalized, driven by the same forces that brought down Prohibition.

My concern is when I recommend medical marijuana without fully understanding what’s at work, I add a dose of safety, trust and science that’s misleading and premature. I become a bureaucratic Band-Aid.

In California, Ryan Mac, a Forbes reporter, wrote a humorous account, “I got a marijuana prescription and pot in minutes without leaving my couch,” by using an app. The online physician consultation for his wrist pain took three minutes and cost $25.

In 2015, 23 Michigan physicians certified more than half of the state’s new marijuana applicants, according to a state audit; one of them certified 11,810 medical marijuana applicants, 14 percent of the state’s total applicants.

This September, the Ohio State Medical Board starts a process to certify physicians in preparation for the rollout next year. I’m opting out. 

But in the back of my head, I can still hear the words of my patient with Tourette's: “Whatever you say, Doc, I know what works for me.”

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Volume 9, Issue 10, Posted 9:37 AM, 05.16.2017