Marijuana: Not Quite Ready to Be Medical

Despite the fact that marijuana remains a controlled substance that is illegal in the United States under federal law, 16 states and the District of Columbia have legalized “medical marijuana.”

Del. Cheryl D. Glenn’s House Bill 15 (H.B. 15), the “Maryland Medical Marijuana Act,” was introduced and first read on Jan. 11, 2012, the first day of this year’s General Assembly session. Two more bills calling for the legalization of medical marijuana have been introduced since. We would like to make the case that medical marijuana as currently “prescribed” makes a farce of medicine.

While inhaled marijuana may have some medical uses, to legislate medical treatments evades the standard protocols that the Food and Drug Administration have put in place for the regulation of all other medications. Why would this “medication” alone be exempt from the usual monitoring and safety regulations, especially given that we know that significant risks are involved with the use of inhaled cannabis?

In all states where medical marijuana is legal, access is granted with a card, authorized by a physician, and the card expires in 1 year. There is no stipulation as to dose or frequency of administration, or for standard follow-up appointments to determine whether the marijuana is helpful or is causing side effects. For those people for whom marijuana induces a negative reaction in the form of an addiction, lowered motivation, paranoia, or even schizophrenia, no mechanism is in place for the physician to monitor or halt use of the drug if the patient wishes to continue using it against medical advice. This seems like a strange way to prescribe the use of a controlled substance.

Medical marijuana is distributed by specialized dispensaries – not pharmacies. In some states, these dispensaries are marketed as boutiques with a variety of “flavors” and preparations, and the message is that smoking marijuana is part of “wellness.” There is no quality control to regulate the potency of the active ingredient or to standardize and safeguard the product being delivered.

While it seems heartless to oppose the legalization of marijuana for those who are suffering from cancer, end-stage AIDS, or debilitating pain, medical marijuana is often used for a much wider variety of conditions that fall under the realm of “chronic disorders.”

In Colorado, it is estimated that only 2% of registered medical marijuana users suffer from cancer or AIDS. Medicinal marijuana is often prescribed for psychiatric conditions such as insomnia, anxiety, and mood disorders – and often by prescribers who have no specialized training in psychiatric disorders. There is no research to support this practice, and it is not the current standard to recommend marijuana for psychiatric conditions. In fact, cannabis is known to exacerbate and accelerate some psychiatric symptoms.

Still, H.B. 15 specifically stipulates five psychiatric conditions that medical marijuana would be indicated for: anxiety, depression, bipolar disorder, posttraumatic stress disorder, and agitation in Alzheimer’s disease. As psychiatrists, we are speechless.

Of the two other medical marijuana bills being considered by our state legislature, one – House Bill 1024 – would allow for medical marijuana to be distributed by academic centers with oversight by a Marijuana Commission, and would require that data and outcomes be collected and published. The other, House Bill 1158, also would require the formation of a Marijuana Oversight Commission. In addition, H.B. 1158 would require training and certification of physicians who prescribe marijuana, but would allow for prescription outside of academic centers and would not require data collection.

The wide variety of ways in which our legislators believe it is appropriate to use marijuana for medical conditions leave one to wonder whether doctors, rather than lawmakers, shouldn’t be making decisions about medical treatments.

Access to medical marijuana has led to litigation in facilities where controlled substances are restricted or tightly regulated, and correctional facilities have defended lawsuits by inmates seeking to continue smoking medical marijuana while incarcerated.

We believe that marijuana for medical conditions should undergo the same study, scrutiny, and prescription monitoring as every other prescribed medication and that the current means of “prescribing” violates all of the usual practices of medicine.  What other medication do we authorize for a year, with no stipulation as to frequency, dose, or certainty that there has been a positive response without side effects?

It has been suggested that medicalization is the first step toward legalization. If legalization is, in fact, the goal, perhaps that can be done without physicians as intermediaries. While legalizing marijuana may not make sense from the standpoint of public health and safety, there are certainly many examples of ways we allow members of our society to put themselves at risk without legislating a role for physicians.

How has medical marijuana been received in your state?  We’d love to hear how the legalization of marijuana has influenced psychiatry in your state.

—Dinah Miller, M.D. and Anne Hanson, M.D.

If you would like to comment on this article here, please register with CLINICAL PSYCHIATRY NEWS. If you are already registered, please log in to comment.

You can also comment on our Shrink Rap blog at http://psychiatrist-blog.blogspot.com/2012/02/should-state-legislators-determine.html.

DR. MILLER and DR. HANSON are two of the authors of Shrink Rap: Three Psychiatrists Explain Their Work, recently released by Johns Hopkins University Press.

Despite the fact that marijuana remains a controlled substance that is illegal in the United States under federal law, 16 states and the District of Columbia have legalized “medical marijuana.”

Del. Cheryl D. Glenn’s House Bill 15 (H.B. 15), the “Maryland Medical Marijuana Act,” was introduced and first read on Jan. 11, 2012, the first day of this year’s General Assembly session. Two more bills calling for the legalization of medical marijuana have been introduced since. We would like to make the case that medical marijuana as currently “prescribed” makes a farce of medicine.

While inhaled marijuana may have some medical uses, to legislate medical treatments evades the standard protocols that the Food and Drug Administration have put in place for the regulation of all other medications. Why would this “medication” alone be exempt from the usual monitoring and safety regulations, especially given that we know that significant risks are involved with the use of inhaled cannabis?

In all states where medical marijuana is legal, access is granted with a card, authorized by a physician, and the card expires in 1 year. There is no stipulation as to dose or frequency of administration, or for standard follow-up appointments to determine whether the marijuana is helpful or is causing side effects. For those people for whom marijuana induces a negative reaction in the form of an addiction, lowered motivation, paranoia, or even schizophrenia, no mechanism is in place for the physician to monitor or halt use of the drug if the patient wishes to continue using it against medical advice. This seems like a strange way to prescribe the use of a controlled substance.

Medical marijuana is distributed by specialized dispensaries – not pharmacies. In some states, these dispensaries are marketed as boutiques with a variety of “flavors” and preparations, and the message is that smoking marijuana is part of “wellness.” There is no quality control to regulate the potency of the active ingredient or to standardize and safeguard the product being delivered.

While it seems heartless to oppose the legalization of marijuana for those who are suffering from cancer, end-stage AIDS, or debilitating pain, medical marijuana is often used for a much wider variety of conditions that fall under the realm of “chronic disorders.”

In Colorado, it is estimated that only 2% of registered medical marijuana users suffer from cancer or AIDS. Medicinal marijuana is often prescribed for psychiatric conditions such as insomnia, anxiety, and mood disorders – and often by prescribers who have no specialized training in psychiatric disorders. There is no research to support this practice, and it is not the current standard to recommend marijuana for psychiatric conditions. In fact, cannabis is known to exacerbate and accelerate some psychiatric symptoms.

Still, H.B. 15 specifically stipulates five psychiatric conditions that medical marijuana would be indicated for: anxiety, depression, bipolar disorder, posttraumatic stress disorder, and agitation in Alzheimer’s disease. As psychiatrists, we are speechless.

Of the two other medical marijuana bills being considered by our state legislature, one – House Bill 1024 – would allow for medical marijuana to be distributed by academic centers with oversight by a Marijuana Commission, and would require that data and outcomes be collected and published. The other, House Bill 1158, also would require the formation of a Marijuana Oversight Commission. In addition, H.B. 1158 would require training and certification of physicians who prescribe marijuana, but would allow for prescription outside of academic centers and would not require data collection.

The wide variety of ways in which our legislators believe it is appropriate to use marijuana for medical conditions leave one to wonder whether doctors, rather than lawmakers, shouldn’t be making decisions about medical treatments.

Access to medical marijuana has led to litigation in facilities where controlled substances are restricted or tightly regulated, and correctional facilities have defended lawsuits by inmates seeking to continue smoking medical marijuana while incarcerated.

We believe that marijuana for medical conditions should undergo the same study, scrutiny, and prescription monitoring as every other prescribed medication and that the current means of “prescribing” violates all of the usual practices of medicine.  What other medication do we authorize for a year, with no stipulation as to frequency, dose, or certainty that there has been a positive response without side effects?

It has been suggested that medicalization is the first step toward legalization. If legalization is, in fact, the goal, perhaps that can be done without physicians as intermediaries. While legalizing marijuana may not make sense from the standpoint of public health and safety, there are certainly many examples of ways we allow members of our society to put themselves at risk without legislating a role for physicians.

How has medical marijuana been received in your state?  We’d love to hear how the legalization of marijuana has influenced psychiatry in your state.

—Dinah Miller, M.D. and Anne Hanson, M.D.

If you would like to comment on this article here, please register with CLINICAL PSYCHIATRY NEWS. If you are already registered, please log in to comment.

You can also comment on our Shrink Rap blog at http://psychiatrist-blog.blogspot.com/2012/02/should-state-legislators-determine.html.

DR. MILLER and DR. HANSON are two of the authors of Shrink Rap: Three Psychiatrists Explain Their Work, recently released by Johns Hopkins University Press.

Despite the fact that marijuana remains a controlled substance that is illegal in the United States under federal law, 16 states and the District of Columbia have legalized “medical marijuana.”

Del. Cheryl D. Glenn’s House Bill 15 (H.B. 15), the “Maryland Medical Marijuana Act,” was introduced and first read on Jan. 11, 2012, the first day of this year’s General Assembly session. Two more bills calling for the legalization of medical marijuana have been introduced since. We would like to make the case that medical marijuana as currently “prescribed” makes a farce of medicine.

While inhaled marijuana may have some medical uses, to legislate medical treatments evades the standard protocols that the Food and Drug Administration have put in place for the regulation of all other medications. Why would this “medication” alone be exempt from the usual monitoring and safety regulations, especially given that we know that significant risks are involved with the use of inhaled cannabis?

In all states where medical marijuana is legal, access is granted with a card, authorized by a physician, and the card expires in 1 year. There is no stipulation as to dose or frequency of administration, or for standard follow-up appointments to determine whether the marijuana is helpful or is causing side effects. For those people for whom marijuana induces a negative reaction in the form of an addiction, lowered motivation, paranoia, or even schizophrenia, no mechanism is in place for the physician to monitor or halt use of the drug if the patient wishes to continue using it against medical advice. This seems like a strange way to prescribe the use of a controlled substance.

Medical marijuana is distributed by specialized dispensaries – not pharmacies. In some states, these dispensaries are marketed as boutiques with a variety of “flavors” and preparations, and the message is that smoking marijuana is part of “wellness.” There is no quality control to regulate the potency of the active ingredient or to standardize and safeguard the product being delivered.

While it seems heartless to oppose the legalization of marijuana for those who are suffering from cancer, end-stage AIDS, or debilitating pain, medical marijuana is often used for a much wider variety of conditions that fall under the realm of “chronic disorders.”

In Colorado, it is estimated that only 2% of registered medical marijuana users suffer from cancer or AIDS. Medicinal marijuana is often prescribed for psychiatric conditions such as insomnia, anxiety, and mood disorders – and often by prescribers who have no specialized training in psychiatric disorders. There is no research to support this practice, and it is not the current standard to recommend marijuana for psychiatric conditions. In fact, cannabis is known to exacerbate and accelerate some psychiatric symptoms.

Still, H.B. 15 specifically stipulates five psychiatric conditions that medical marijuana would be indicated for: anxiety, depression, bipolar disorder, posttraumatic stress disorder, and agitation in Alzheimer’s disease. As psychiatrists, we are speechless.

Of the two other medical marijuana bills being considered by our state legislature, one – House Bill 1024 – would allow for medical marijuana to be distributed by academic centers with oversight by a Marijuana Commission, and would require that data and outcomes be collected and published. The other, House Bill 1158, also would require the formation of a Marijuana Oversight Commission. In addition, H.B. 1158 would require training and certification of physicians who prescribe marijuana, but would allow for prescription outside of academic centers and would not require data collection.

The wide variety of ways in which our legislators believe it is appropriate to use marijuana for medical conditions leave one to wonder whether doctors, rather than lawmakers, shouldn’t be making decisions about medical treatments.

Access to medical marijuana has led to litigation in facilities where controlled substances are restricted or tightly regulated, and correctional facilities have defended lawsuits by inmates seeking to continue smoking medical marijuana while incarcerated.

We believe that marijuana for medical conditions should undergo the same study, scrutiny, and prescription monitoring as every other prescribed medication and that the current means of “prescribing” violates all of the usual practices of medicine.  What other medication do we authorize for a year, with no stipulation as to frequency, dose, or certainty that there has been a positive response without side effects?

It has been suggested that medicalization is the first step toward legalization. If legalization is, in fact, the goal, perhaps that can be done without physicians as intermediaries. While legalizing marijuana may not make sense from the standpoint of public health and safety, there are certainly many examples of ways we allow members of our society to put themselves at risk without legislating a role for physicians.

How has medical marijuana been received in your state?  We’d love to hear how the legalization of marijuana has influenced psychiatry in your state.

—Dinah Miller, M.D. and Anne Hanson, M.D.

If you would like to comment on this article here, please register with CLINICAL PSYCHIATRY NEWS. If you are already registered, please log in to comment.

You can also comment on our Shrink Rap blog at http://psychiatrist-blog.blogspot.com/2012/02/should-state-legislators-determine.html.

DR. MILLER and DR. HANSON are two of the authors of Shrink Rap: Three Psychiatrists Explain Their Work, recently released by Johns Hopkins University Press.