Doctor in the Middle: My Views on Medical Marijuana
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?
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