I read with interest Dr. Levin’s letter advocating for medical marijuana in Mississippi. I paid particular attention as he is the current president of the Mississippi Chapter of the American College of Emergency Physicians (a position I held several years ago). His letter implies that marijuana is a potential panacea for many medical problems.
Unfortunately, this is not true. It is true that some studies have shown some effectiveness of marijuana in some diseases. Unfortunately, that’s a few too much “some” for me, and most physicians and scientists. In fact, it is too much for the American College of Emergency Physicians (ACEP), which has chosen not to support medical marijuana despite much discussion. (For full disclosure, ACEP doesn’t oppose it either, they feel there is not enough information at this time to fully endorse or oppose.) Many studies supposedly showing the benefits of marijuana are poorly designed and not rigorous. Most are not placebo-controlled-double-blinded, which is the gold standard for medical research.
While we are unsure if marijuana can truly help a variety of conditions, we know that it can cause problems. This should not be a surprise. If we are to treat it as a medication, then, like every other medication we should expect and discuss side effects. Side effects of marijuana often include hallucinations, delusions and intoxication. It is not recommended to drive a vehicle while using marijuana. Additionally, a relatively new disease is cyclic vomiting syndrome which causes severe and recurrent nausea and vomiting and is increasingly seen in patients in states with medical marijuana.
Might marijuana be an excellent treatment for some diseases? Yes, it may. But in my professional medical opinion, if any other medication were to apply for an FDA indication with the data currently available for marijuana, it would be denied. So why should we treat marijuana differently?
However, my main objection to medical marijuana is that this designation treats it like a pseudo-medication. It would allow people to use marijuana if approved by a physician. But if marijuana is such a wonderful medication, then why not treat it like a medication and require a prescription with dosing and administration instructions?
The entire concept of medical marijuana demeans the profession of medicine. Marijuana is either a medication or it isn’t. Right now, we don’t know. Doctors should not effectively be asked to approve a lifestyle choice. Why not ask for “medical” alcohol, tobacco or even double espressos. By the way, alcohol, tobacco and coffee have all been shown to have positive health effects in some disease states and in some patient populations. They have also all been shown to have negative health effects. Wow, sounds a lot like marijuana.
The obvious difference between marijuana and the other drugs listed above is that marijuana is illegal. OK, fine, then let’s debate that. Let’s have a healthy debate on legalizing marijuana. Unfortunately, for some reason, it has been decided not to have that debate. Instead, there is this ill-defined and petition for medical marijuana. Please don’t co-opt the medical profession while striving for social change.
Finally, I would like to clarify that my opposition to medical marijuana is my personal opinion. I would also like to clarify that the opinion expressed by Dr. Levin is his personal opinion. The Mississippi Chapter of the American College of Emergency Physicians does not have an official opinion or position on this issue.
Jonathan S. Jones, MD