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October 14, 2012 at 10:34 PMComments: 6 Faves: 0

Doctor in the Middle: My Views on Medical Marijuana

By Jeffrey VanWingen M.D. More Blogs by This Author

I've never tried marijuana or "pot" as it's commonly called. Like most people I must admit I have subscribed stereotypical views on marijuana: joint smoking, red eyes, "the munchies," getting stoned, illegal... but with the momentum successful medical use legalization  has spurred, healthcare providers have found themselves in the middle of debate with strong opinions on both sides.

Now, in many states, doctors have the (often unwanted) power to prescribe marijuana. After a couple years in this position, I offer my views.

Is Marijuana Medicine?

When the legalization of medical marijuana was first proposed, my first thought was, "Can it actually be a medicine?" A medicine is something that has an overall positive affect on a person's health. Though some have adverse side effects, in general they must have a positive function.

I studied the claims that it helped with nausea, pain, and appetite where other medications failed, but I also examined the ill effects of marijuana. The drug has a potential for dependence - but so do a number of other drugs I prescribe regularly (pain medications and stimulants for instance). The ill effects of smoking the drug were probably my biggest concern. One joint delivers the toxins, pollutants and cancer risk of a whole pack of cigarettes, but then again, it doesn't necessarily need to be smoked. Other delivery method such as food preparations exist.

Who Should Get Marijuana?

Marijuana affects perception of symptoms and a distinction needs to be made between treating symptoms and the pursuit of marijuana-induced euphoria. Sometimes this can be difficult. Marijuana is used to treat symptoms, but it does not cure the cause of symptoms such as nausea and pain. 

As there are a number of safer, readily-available medications existing for the ailments marijuana typically prescribed for, marijuana should not be the first line treatment for an illness. Standard therapies should be tried and failed before considering marijuana. All options in treating a cause of symptoms should be exhausted before using marijuana.

A Doctor's Dilemma

Sometimes patients come to me prepared with a case for why they should be prescribed marijuana and it makes me feel more like a judge than a doctor. I am left to question and advocate for both sides and to come up with a verdict. 

Sometimes the decision is simple: the patient has cancer, is on chemotherapy, is losing weight, and has had no help with pharmaceutical anti-nausea drugs.

Sometimes it's quite difficult: the patients has vague symptoms of low back pain, depression, anxiety, or headaches.

Sometimes it makes me want to hide, to put up the fence and say, "I don't just fill out cards for anyone wanting medical marijuana. Go to one of those clinics that will if that's what you're looking for!"

In the end, I am reminded that this is just another example of the art of balance every doctor must practice. I clear patients for sports or surgery, pitted between them and the school or surgeon. I prescribe pharmaceuticals that require a prescription pitting myself between the patient with ailment and the Food and Drug Administration. I write countless notes to keep my sick patients out of school or work. I am thrust between patients and the government in determination of disability. How is this any different? 

In Conclusion...

Though I did not make this law, marijuana is legal for medical conditions, and I am left to determine the validity of my patients' requests for its use. While a challenge, it is a fair part of my practice as a family physician.

Photo Credit: Eggrole

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  • I do not envy your position sir. It seems the balance really is the key though, but I imagine that plays a role in almost all the decisions you have to make as a doctor. Good blog

  • I don't know much about the medical benefits of consuming marijuana, but in my opinion, it makes no sense that marijuana is illegal while alcohol is not.

    I've seen alcohol addiction first hand and I can tell you - it destroys lives in a way marijuana addiction could never come close to. Further, alcohol can kill you in one sitting. Marijuana can't.

    If you look at the origins of marijuana ban, you'll see that the government was more interested in getting rid of Mexican immigrants than protecting the public when they set things in motion. You'll also see that the information they were feeding the public was largely scare-tactics with no grounding in actual fact. For example - ads that claimed it would make you violent - so violent in fact, you may kill someone with a frying pan.

    Overtime, that message - that marijuana was scary and dangerous - stuck with the gullible, unquestioning public and it's taken until now for things to actually begin to shake it.

    Now - am I encouraging everyone to smoke pot? Of course not. But if it were legalized, marijuana could be regulated and taxed the way alcohol and tobacco are. Filters may be able to reduce the negative impact of smoking for those that are doing it regardless of it's legal status. The prevalence of it's use and connection to other health conditions would be much easier to follow as well.

    I think it's about time we stop holding onto antiquated idea and started to look at the facts of things. If it can be used more safely to treat a health condition than something else, why would we treat it different from any other plant?

  • Very interesting - it's good to get a doctors point of view - thanks.

    I think marijuana has this stereo type as being a drug known as "pot" for so long it's hard to accept it at this point of being offered as a prescription medicine.

    It just still seems like "pot" and the fact that as you mention one joint delivers the toxins, pollutants and cancer risk of a whole pack of cigarettes is crazy!

  • If, and when, Medical Marijuana starts generating the same insurance payoffs that the destructive drugs we are currently prescribing to people do, I bet the moral conundrum that doctors face will fade quickly.

    Much like the education system, the medical establishment has become big business, and nothing more. I credit you for holding a modicum of care for the average citizen Dr. V, but too many of your contemporaries carelessly feed death to their patients without thinking about the larger consequence.

    Overworked? Most definitely...
    Uneducated? Doubtful...
    Willfully ignorant? Without a doubt....

    Let people decide how they want to spend their lives and what treatments they should use. Doctors are there for emergency situations, to share they knowledge they have accumulated over years of experience, and to HELP people. Two things need to happen in order to restore the medical field:

    1.) People need to learn to care for themselves. This means all facets of life, not just some lose weight diet that they stick to for a month and drop.

    2.) The medical field needs to remember what it is to be a human, to be frail and frightened in a world full of ever evolving viruses and corporations who could care less.

  • I'm with Erin on this one. There have been countless studies that show alcohol is in every way more harmful and more dangerous than bud. Not to mention the extreme versatility of hemp.

    To be honest I think the medical portion of Mary Jane was just a step to get it closer to legal recreational usage. Eventually it will be legalized for recreational purposes. The only people holding it back now are the people who watched Harry Anslinger PSA that were total outright lies.

    Being from CA where people aren't as restrictively conservative you see a lot more people safely smoking marijuana and there are no real issues. I have friends that smoke with their parents. It's quite common in CA today.

  • Where are you on cbd products?

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