Recently I've been asked by several patient about my opinion of medical marijuana. Over time we've built up a relationship of trust, and they want my take on what they’re reading in the news about marijuana being legalized for recreational use in Colorado and now Nevada. It seems to be just a matter of time before Utah follows suit. My patients are smart folks, and many of them suffer from chronic pain or other disabilities that traditional medicine has been unable to alleviate, and many are tired of taking pills to get relief.
So when they ask for my take on medical marijuana, I tell them that there's no such thing! My answer always surprises them, and requires explanation: If I were to prescribe marijuana for one of my patients how would I tell them to dose it? How much should they use? How often should they take it? What are the potential drug interactions? What are the adverse effects? What are the long-term risks? These are questions I discuss any time I start a new medication, and marijuana should be no different. A failure to inform my patients of the answers to these questions would be unprofessional at best, and may constitute malpractice!
I would never prescribe a medication that hadn't been tested, that had never been through rigorous clinical trials, randomized double-blinded trials that control for bias and are powered to answer questions of safety, efficacy and tolerability. Marijuana has not gone through such trials, and hence cannot be considered a medicine in the traditional sense.
Interestingly, there are some parallels between marijuana and alcohol. Both are psychoactive substances with depressant properties. Both are used recreationally. And both are under investigation for potential medical benefit. Wine has been found to be cardioprotective to a degree: a glass of wine per day can reduce the incidence of heart attacks and strokes, but the benefit isn't strong enough that non-drinkers should start. And that small benefit has taken years of trials to discover.
Marijuana has yet to go through the trials that would be needed for me to feel comfortable prescribing it to anyone. Until it does, I counsel my patients that if they choose to smoke marijuana or drink alcohol for recreational purposes, that is a completely separate issue from any uncertain medical benefit. There's no such thing as medical alcohol, and neither is there any such thing, at least at this point, as medical marijuana.
Scott Bishop, MD