I asked for questions to answer, and I got some responses. Hoorah! Ideas for posts! I’ll answer all three (or however many more may get added over time), but may as well start with a relatively easy question to answer. Says fellow LOOG blogger Jaybird:
I’d love to read a post about Medicinal Weed from the perspective of a doctor.
There’s a general answer to this, and a more particular one.
As far as marijuana is concerned, medicinal or otherwise, I am in favor of legalization, full stop. The “war on drugs” seems like an outright failure to me, obvious even before a high-profile international panel said so. It is preposterous to outlaw an easily-cultivated plant just because of its mood- and sensation-altering properties. I’ve had plenty of patients whose lives were destroyed by substance abuse, but the majority of them suffered from addiction to a perfectly legal substance widely enjoyed by most Americans. The leading preventable cause of death is a similarly-legal plant. If alcohol and tobacco use are legal (and I believe they should be), then I cannot construct an intellectually compelling argument for marijuana use to be otherwise. I’ve certainly had patients who used marijuana immoderately, and whose lives would have been improved by moderation or abstinence, but the same could easily be said about junk food or promiscuous sex. As a medical professional, I strongly support legalization.
On the particular question of medical marijuana when it is otherwise illegal, as a doctor it seems like a royal pain in the ass. That marijuana has medicinal uses, particularly for nausea or lack of appetite induced by chemotherapy or AIDS, is pretty well established. I think it should be available for medicinal use. But then the question arises about which disorders should be open to treatment with marijuana. If nausea, why not chronic back pain? If back pain, why not anxiety? Lawyers who live in California (ahem) should feel free to correct me, but I believe the text of that state’s medical marijuana statute says this:
… seriously ill Californians have the right to obtain and use marijuana for medical purposes where the medical use is deemed appropriate and has been recommended by a physician who has determined that the person’s health would benefit from the use of marijuana in the treatment of cancer, anorexia, AIDS, chronic pain, spasticity, glaucoma, arthritis, migraine, or any other illness for which marijuana provides relief
Once you’ve got something as subjective as “chronic pain” in there, then you’re pretty much taking all comers, even without that “any other illness” fillip there at the end. They may as well say “everyone who wants it” and be done with it.
My understanding is that California has providers whose practice is pretty much limited to doling out prescriptions for weed. I don’t know if that will end up being the case in Maine, or if “caregivers” who register to prescribe marijuana will maintain general practices as well. The more unrestricted the diagnoses that qualify one to use medicinal marijuana, the more of a pain this would be for a general practitioner outside of a dispensary. (With regard to pediatrics, it is dubious to what extent medical marijuana has any legitimate use.) Determining which patients “deserved” medical weed and which didn’t is a problem I’d gladly never face. Drug-seeking behaviors are a frequently-encountered and often intractable problem as it is. I can’t even imagine how to deal with patients who come in overtly seeking weed and then trying to determine if this patient wants it because of legitimate medical need vs. a simple desire to get high, and how to document whatever decision is reached and why. It makes most sense to me that providers who prescribe it be limited either to those who specialize in treating the qualifying disorders (eg. oncology, neurology, infectious disease, etc) or those in dispensaries. I suspect most other providers would rather avoid this question altogether.
Or we could sidestep this whole question in its entirety, and make marijuana use legal like it should be.