Following the passages of Measure 91 and Senate Bill 460, medical marijuana dispensaries in Oregon will begin limited cannabis sales to adult consumers on October 1st.
As availability to marijuana broadens, patients and doctors will together confront new questions and decisions about its appropriate use for managing a variety of health problems.
Dr. David Russo, a pain management specialist with Columbia Pain Management P.C. in Hood River, said marijuana’s medical benefits are unclear.
Dr. David Russo, a pain management specialist with Columbia Pain Management P.C. in Hood… more
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Oregon doctors, licensed by the state to practice medicine, and registered with the Federal Drug Enforcement Agency (DEA) to prescribe controlled substances, may find themselves uncertain about their professional obligations, disoriented by conflicting recommendations, and confused on how to advise patients considering using marijuana.
Policy, scientific, and legal differences surrounding the issue will certainly impact conversations between patients and their doctors.
The U.S. Food and Drug Administration does not approve marijuana to treat any medical condition. It still remains classified as a Schedule I drug by the DEA — a classification indicating that it has no legitimate medical use.
Any drug, including a botanical drug, must be carefully studied in many people before the FDA can approve it. Under the current regulatory structure, it is not feasible to conduct the kinds of studies that FDA would need until the DEA classification changes. And, while testimonials abound, most physicians agree that there have not been enough large-scale, high quality, studies of marijuana to definitively recommend that it is a safe and effective drug for any indication of use.
Nevertheless, there is some scientific evidence suggesting that marijuana, or its components, may be an effective treatment for some forms of chronic pain, neuropathic (nerve) pain, and muscle spasms due to multiple sclerosis or paralysis.
Even if the treatment effects were small, any benefit in quality of life for patients suffering from these conditions would be welcomed. This abiding hope, combined with a good deal of desperation and the allure of economic incentives, has pushed the topic to the center of a national conversation about drug use, harm reduction and patient autonomy.
Marijuana, like all drugs, has risks that should be carefully considered. Unlike prescription drugs, which are produced according to exacting standards to ensure uniformity and purity of active constituents, the proper dose of marijuana is variable and depends on the patient, the preparation, and the way the drug is used.
At some doses, it causes an increase in heart rate, which may increase the chance of heart attack in people who are already at risk. Regular smoking of marijuana may cause breathing problem,s such as cough and increased risk of lung infections. Other data show that people with mental health conditions or with a strong family history of certain psychiatric disorders should avoid marijuana.
Marijuana can be addicting and can interfere with work, school, and relationships. There are concerns that the current system of dispensing marijuana does not safeguard adequately against the potential for diversion, misuse, and abuse. In other states, the introduction of edibles into the marketplace has raised concerns about unintentional exposure, covert marketing to children and poisoning.
The use of marijuana in combination with other central nervous system medications such as opioid pain relievers, anxiolytics, or psychotropics has not been well studied.
A day hardly passes in my practice where I’m not asked by a patient if I would recommend that they try marijuana. Generally speaking, my answer is “no.”
It’s not that I don’t believe the science showing great promise for cannabinoids in managing a myriad of neurological symptoms, nor is it that I seek to be a paternalistic health care provider. To the contrary, I would be willing to prescribe anything to help my patients, so long as we both agreed it was safe, effective, did more good than harm and helped my patients lead as close to normal life as possible, despite their pain, disability, or chronic disease.
It is that, on balance, the benefits of regular marijuana use have not been established. As a clinician, it looks to me as though the scientific scrutiny of marijuana has been cheated for the expediency of a popular vote.
We hardly understand the effects that marijuana has on any disease, let alone its effects on the overall health status of a whole person. While some situations, such as palliative care or the end-of-life, merit consideration of all heroic measures, for the long-term management of long-term health problems, a more thoughtful consideration of marijuana’s relative risks versus benefits is warranted.
So it is the ethical basis of my medical practice that the objective of any physician should be to help the patient find health. Today, I’m not certain that recommending regular marijuana use will help my patients meet their functional goals and find the better health we all seek.
Absent data on its long-term effects, I worry that regular marijuana use will send patients “down the rabbit hole.” Trailing behind them will be their doctors and other health care providers chasing whatever unintended consequence is around the bend.
Oregon’s voters and legislators have elected to embark on a large-scale experiment in marijuana decriminalization. But when it comes counseling patients on benefits versus risks of regular marijuana use, Oregon’s physicians should abide by their profession’s enduring ethical commitment to “First do no harm.” There are some things that no new law or election can change.
Dr. David Russo is a physiatrist and pain management specialist with Columbia Pain Management P.C. in Hood River.