Nearly half the states have legalized medical marijuana, including four -- plus the District of Columbia -- that also have legalized recreational use of the drug. Colorado is among those four.
Steven Wright, M.D., of Littleton, Colo., discusses the effects of marijuana on patients. Wright was one of the speakers during a CME session about marijuana Sept. 30 in Denver during the Family Medicine Experience.
So at a time when physicians are looking for more information on the topic, what better place to learn could there be than the Mile High City?
"This is an opportunity that wouldn't be possible in a lot of other locations where this conference is held," said Syed Naseeruddin, M.D., of Clarksville, Tenn., one of roughly 50 family physicians who participated in an Out and About session that focused on medical marijuana Sept. 30 during the AAFP Family Medicine Experience (FMX). "In Tennessee and Kentucky, this has come up in the legislature, so I wanted to have some background."
It was the second year the Academy has offered offsite CME during its annual meeting that combined an educational course with an educational tour. After the CME presentation by Steven Wright, M.D., and a patient, participants toured CannLabs Inc., the cannabis testing facility that hosted the event.
"I found the testing part fascinating to see -- all the solvents, molds and pesticides they can look for," said Scott Hammer, M.D., of Milford, Del. "It's interesting."
Hammer said possession of marijuana has been decriminalized in his state, and the state's first medical marijuana dispensary opened in June. However, neither Hammer nor his practice partner has written certifications for patients to receive the drug -- yet.
"No one wants to be first," he said. "The legalities are still nebulous. I've had a lot of patients asking about it."
So Hammer and dozens of his peers were eager to hear from Wright, a family physician from Littleton, Colo., who specializes in addiction medicine and pain management.
Wright launched the sold-out session by asking whether the physicians in the room supported medical marijuana, recreational use of marijuana, both, or neither. Not surprisingly, there was no consensus. This remained true at the end of the session, when Wright asked the question again.
A CannLabs Inc. staff member preps a marijuana sample for potency testing. About 50 family physicians toured the facility Sept. 30 in Denver as part of a CME session about medical marijuana during the Family Medicine Experience.
According to a 2013 survey(www.samhsa.gov) by the Substance Abuse and Mental Health Services Administration, 5.7 million Americans use marijuana daily, up from 3.1 million in 2006. Nineteen percent of Americans ages 18-25 indicated in the same poll that they had used marijuana in the past month. The drug is linked to nearly 500,000 ER visits annually.
Wright said that in Colorado, which decriminalized medical use of marijuana in 2000 and legalized possession of the drug for recreational use in 2012, poison center calls have increased 30 percent and the percentage of patients self-reporting to treatment centers because of problems with marijuana has increased 66 percent. From 2013 to 2014, the number of state residents using marijuana rose 7 percent among teens, 8 percent among college students and 32 percent among adults.
The 130 metric tons of marijuana sold netted Colorado more than $60 million in taxes last year.
Was it worth it? Although there have been numerous studies of the drug, Wright said many of them have been small, poorly designed or inconclusive.
"There's a lot of information out there about marijuana," Wright said. "Unfortunately, there's not a lot of excellent information."
For example, Wright said marijuana is not associated with chronic obstructive pulmonary disease, but results are mixed on whether it is linked to airway obstruction or lung cancer. One confounding factor in sorting out the drug's risks and benefits is that many marijuana users also smoke cigarettes. Results also are mixed, he said, regarding the drug's effects related to anxiety, depression and suicidality.
Wright's presentation also outlined the negative effects of the drug on psychomotor and cognitive functions, as well as on motivation. For every positive aspect of the drug (decreased nausea and vomiting and intestinal anti-inflammatory benefits) presented, there also were negatives (associations with cancers of the prostate, testicles and brain in adults and associations with cancers in children exposed to parental marijuana smoking).
"Many of the medical groups say it needs more research, and that includes the AAFP," Wright said.
Yet, despite the many potential negatives, Wright said medical marijuana is worth the risks in some cases.
"I've seen patients' lives turned around with medical cannabis," said Wright, whose thorough presentation also included information related to recommendations, contraindications, risk evaluation and mitigation, monitoring and followup.
One of those patients, Michael Williamson, was on hand during the CME session to provide that perspective. He explained that he suffered from vision problems, pain and muscle spasms as a teenager before a seizure led to hospitalization and a multiple sclerosis (MS) diagnosis.
Williamson began self-medicating with marijuana and found that it could help alleviate his symptoms, but he was unsatisfied with the products that were available to him on the street. So he eventually decided, with the help of other disgruntled patients, to tear up his Florida roots, move to Colorado and open a dispensary there. He now is co-owner of a company that designs, builds and consults with growing operations.
Williamson said marijuana allowed him to stop taking interferon for his MS four years ago, and he has not relapsed. He also said that because he no longer suffers side effects from the MS drug, he has been able to cut his marijuana use in half.
"I believe in marijuana," said Williamson. "It changed my life. I've seen it change others' lives."
In addition to the nearly two dozen states (plus the District of Columbia and Guam) that have legalized medical marijuana, at least three states have legislation pending. More than a dozen other states considered, but did not pass, marijuana legislation this year.
"It was fascinating," Roger Tolar, M.D., of Keller, Texas, said of the Out and About. "It's good to increase your knowledge base because eventually, it's going to be in our laps."
The other Out and About sessions offered at FMX involved obesity and oral health. Both of those courses included related tours at the University of Colorado-Denver.
"There is a lot of power in being with like-minded people," said Pam Roberts, M.D., of Kalispell, Mont. "The people on this bus were here to learn and help their patients."
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