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Thursday Apr 23, 2015

Doctors Need the Straight Dope on Medical Marijuana

Nearly half the states,(www.ncsl.org) and the District of Columbia have adopted comprehensive medical marijuana programs, and more than a dozen more have approved use for a limited number of medical conditions. Two states -- Colorado and Washington -- have taken things even further, legalizing marijuana for recreational use.

Of course, none of this changes how marijuana is viewed by federal authorities. The Department of Justice has issued guidance to federal prosecutors(www.justice.gov), reiterating the agency's commitment to the Controlled Substance Act. The FDA(www.fda.gov) has not approved marijuana as a safe and effective drug for any indication.

Legislators are again impacting the care of patients and the health care delivery system. So where does that leave us as physicians?  WebMD polled physicians(www.webmd.com) last year and nearly 70 percent of respondents agreed that medical marijuana can help patients with certain conditions. But physicians were less enthusiastic about making the drug available. Half of the doctors polled in states where medical marijuana is legal supported its legality. In those states still debating medical marijuana laws, 52 percent of doctors supported it.

Hence, although an overwhelming majority of U.S. physicians understand the potential benefits of medical marijuana, roughly half oppose it.

In my home state of Illinois, legislators have legalized medical marijuana. Many patients are asking for it; many have valid reasons, such as cancer or chronic pain. For those who do not, the discussion explaining the reason for denial is lengthy. Illinois, like many states, used model legislation to create its medical marijuana program, and physicians are not required to write prescriptions. Rather, we certify which patients meet conditions that allow them to legally buy the drug at a dispensary.

Sadly, conversations with my patients have highlighted some obvious problems with medical marijuana. I have had patients suffering from chronic pain ask for medical marijuana because they fear becoming addicted to prescription narcotics. They, like many others, don't understand that marijuana can also be addictive. According to the 2013 National Survey on Drug Use and Health(www.samhsa.gov), marijuana use accounted for more than 4 million of the 7 million Americans who are dependent on or abusing illicit drugs.

In short, many patients don't know the harmful effects of marijuana. So although there are limited health benefits to medical marijuana(www.aan.com), we must also ensure that patients understand the risks(www.nejm.org).

At last year's Congress of Delegates, the AAFP adopted policy stating that decisions about medical marijuana should be based on evidence-based research and called for further studies into the use of medical marijuana and related compounds. But with new studies being published regularly, it can be hard to keep up on what the latest evidence tells us.

The AAFP can help. The March edition of FP Audio has a clinical topic that will help physicians evaluate current evidence on the use of medical marijuana for the treatment of multiple sclerosis and severe childhood epilepsy. Another edition exploring the topic further is scheduled for July.

The Academy will offer two sessions related to medical marijuana Sept. 29-Oct. 3 at FMX in Denver. An interactive lecture will cover what family physicians need to know about medical marijuana. And during an "Out and About" -- an offsite CME session -- a family physician and a patient will discuss legalized marijuana from the physician and patient perspectives. That session will be followed by a tour of CannLabs(www.cannlabs.com), an advisor to commercial, governmental and educational entities focused on the cannabis industry.  

State chapters also can play a role. The Illinois AFP is offering its second webinar(attendee.gototraining.com) on medical marijuana and its implications for physicians on April 27. Registration is limited to the first 100 participants, but an archived version will be available. (The event is not limited to Illinois AFP members.)

The bottom line is that medical marijuana is becoming available in a growing number of states. There is a tremendous economic advantage to a state’s economy.  Consumer advocacy groups have formed to urge the federal government and the FDA to ease federal restrictions and fund marijuana research. When patients come to us for help, we should know the law governing our actions and what liabilities may exist. And, we should have an informed conversation with our patients about the potential risks and benefits of a drug for which long-term safety for adults and children is not yet truly known. The laws are changing rapidly. Family physicians should become knowledgeable of the laws in our own states regarding the use of medical marijuana. Consult your state medical boards and/or departments of professional regulation for guidance where necessary. The train has left the station.

Javette Orgain, M.D., M.P.H., is vice speaker of the AAFP Congress of Delegates.

Posted at 08:35PM Apr 23, 2015 by Javette Orgain, M.D.

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