Stirring the pot on pot

Illustration by Megan Stewart

With cigarette smoking, I know where I stand. “It’s legal, but not good for you. Will you consider quitting?”

Marijuana use is tricky. Some take it for fun. Others swear by it because it helps their anxiety, back and belly pain, insomnia …

I get it.

To make matters worse, rules differ between the federal government and the states; opinions vary among my medical colleagues.

In Ohio, medical marijuana (plant extract) has been legal since 2018 for treatment of two dozen medical conditions: cancer, post-traumatic distress, chronic pain, etc. The list is expanding.

But federally, the FDA only approves 4 drugs (pure chemical forms) for 3 specific medical conditions.

They are:

1. Severe nausea associated with chemotherapy.

2. Severe loss of appetite in AIDS.

3. Seizures from three rare conditions.

Under state laws, many of my patients would qualify for medical marijuana, but under federal laws, I don’t have a single patient who qualifies.

The FDA insists on robust research and is unlikely to approve more medical indications. I get it. Others argue that just because science isn’t there – yet – doesn’t mean it doesn’t work. I get that, too.

Here’s my marijuana spiel:

First, please be honest with me if you’re using. I don’t judge. You should feel comfortable discussing your marijuana use – any drugs, really – with your healthcare providers. If you don’t want help, I won’t go there.

Second, let’s figure out how marijuana has impacted your life. Chronic or acute use has side effects.

For certain populations I worry more: the young, the pregnant, and those at increased risk for mental illness.

Marijuana is a big no-no in pregnancy, kids, and teens. The chemicals easily cross from blood to brain and placenta. Animal studies on marijuana’s negative impact on certain brain development are robust. For example, rats exposed to marijuana before or after birth exhibit problems with certain learning and memory later in life and have signs of accelerated brain aging. I’m sure better human studies will come out soon.  

Marijuana use and mental illnesses are a chicken-and-egg problem. While those with mental illness may use marijuana more, studies suggest marijuana use might trigger or worsen mental illnesses. Studies are ongoing. But depression, anxiety, and obsessive-compulsive disorder are not approved indications for medical marijuana use.

I know it’s tough – talking about drug use. It takes mutual trust, respect, and acceptance. I know what the drugs do, but I care what the drugs do to you. Whatever the Feds and states decide, I’m on Team You.

Read More on The Medical Insider
Volume 15, Issue 11, Posted 8:27 AM, 06.20.2023