Medical marijuana, or cannabis, is a hotly debated topic. Maybe you’ve seen the videos of small children with unrelenting seizures suddenly cured by medical cannabis; or you’ve heard the term “gateway drug” as someone describes an addict who can no longer function. But many of us (including me until about 72 hours ago) don’t really understand the medical uses of marijuana. Let’s talk about where medical marijuana stands today, what the biggest pros and cons of it are, and how we move forward.
The status quo
Medical cannabis is legal in 29 states in the U.S.; while it is still illegal on a national level, the federal government currently defers to the state’s decisions on marijuana’s legality (at least for now). In these states, a physician writes a recommendation letter for a patient who meets some indication of medical cannabis (like nausea from chemotherapy, uncontrollable pain, or loss of appetite from HIV). The patient then takes their letter to a dispensary, where they work with the employees to decide which strain and formulation is best for their symptoms. Not all strains are created equal- they differ in their components, or cannabinoids. There are over 500 different active compounds, but the two most relevant are THC and CBD. They have different effects, and so have variable benefit depending on a patient’s symptoms.
Source: Visual Capitalist
One of the biggest barriers to medical marijuana right now is research- or the lack of it. Marijuana is classified by the Drug Enforcement Agency (DEA) as Schedule 1, meaning it has a high potential for abuse and no currently accepted medical uses; other Schedule 1 drugs are heroin, LSD, MDMA, and bath salts. Because of this, clinical research on cannabis must be approved by both the FDA and DEA, which can take up to a year. If the research intends to use cannabis, the only place to get it legally is through the National Institute of Drug Abuse (NIDA). NIDA’s mission is to support research on the causes, consequences, and treatment of drug abuse/addiction, not the medical use of the drugs. This means that a lot of proposals to study the benefits of marijuana are denied or have to be altered. NIDA has also been using the same strains for decades; the concentrations of THC and CBD are not representative of many of the strains currently used. In August 2016, the DEA announced they would allow applications for more cultivators for research cannabis; however, no proposals have been accepted yet.
The other large problem with our current system is that while it may be legal on a state level, it is still illegal on a federal level, leading to an unstable system. One consequence of this is most banks don’t want to risk working with a somewhat-illegal business. This means that dispensaries have to deal in all cash, and they become a large target for robbery. There is also confusion as to whether people who have medical marijuana referrals can be fired from jobs for testing positive for marijuana on drug screens, as it is still somewhat illegal.
Should it be legal? In this post, I’ve attempted to lay out what I view as the most compelling arguments both ways- in an effort to help you form your own opinion, but also to see the other side. As I always try to be upfront about my own bias, here’s my opinion- I really don’t know, this is not a clear-cut issue. I agree that we need more research on the topic; but I also feel that physicians prescribe much more addictive and/or harmful substances, like opioids. I understand each side, but this issue isn’t going to go away- it’s important we work together to come up with the best solution for patients and our society.
The argument FOR medical marijuana
- Marijuana is relatively safe. It’s been used safely for thousands of years, with very few known adverse effects. In contrast, many medications that are currently prescribed have either not been out long enough to know long-term effects, or have very serious side effects. It is not possible to die from either an overdose or withdrawal from marijuana (both of which can be deadly for alcohol). While marijuana can be both psychologically and physically addictive, it is less addictive than opioids, tobacco, and alcohol. There may be a small association of smoking cannabis with lung cancer, but it has less effect than tobacco and there are multiple formulations of marijuana available.
- Medical cannabis can provide relief for some of our most vulnerable patients who are currently without relief. The most common indications for medical cannabis are people suffering from HIV, cancer, untreatable seizures, or intractable pain. These are patients who have been failed by current medical options, and without medical marijuana, have no options left.
- There is evidence that cannabis could be used to augment, or increase, the pain relief from opioids. This could help slow down the deadly opioid epidemic; in fact, states with medical marijuana have had decreases in opioid-related hospitalizations and deaths.
- Decriminalizing medical marijuana could reallocate law enforcement. The War on Drugs has eaten away at our enforcement resources, and led us to have the highest proportion of incarcerated citizens of almost any other country. In 2012, there were over 650,000 arrests for marijuana possession alone. Allowing people to use cannabis for medical reasons could decrease focus on a relatively safe substance, and allow us to focus on other public safety issues.
- Legalization doesn’t cause an increase in either youth using marijuana or crime. Many people were concerned that legalizing cannabis, either for medical or recreational purposes, would be the downfall of society. But in Colorado, the proportion of teenagers who admit to marijuana use has remained stable and violent crime has actually decreased since cannabis legalization.
- Marijuana is an untapped source of tax revenue and jobs. Colorado’s first year of legal cannabis provided $63 million in sales tax profit, which was then invested into their public schools. Growers and dispensaries would also result in more jobs, something that many states desperately need.
The argument AGAINST medical marijuana
- Marijuana is not a standardized drug– different strains have different amounts of both THC and CBD, which have different effects. And because it can (and often is) grown privately, standardized strains will be difficult to achieve. Because of this, patients currently decide with the dispensary what the best option for them is. This runs counter to other types of prescriptions- physicians don’t let the patient and pharmacist decide which diabetes medication or anti-depressant would be best for them without provider input.
- Effects of marijuana can be unpredictable. This has to do with the wide variety of cannabinoids, or active components. There are also a variety of receptors in the human body for cannabinoids, and they differ in type and number. While some patients may have very few side effects, some will be debilitated by a strain, and we currently can’t predict who will be effected. For example, cannabinoid hyperemesis syndrome is a condition where someone using marijuana begins to have frequent nausea and vomiting; it is unpredictable, and can occur at any time during marijuana use.
- There hasn’t been enough research to support medical use of marijuana. In the US, medications prescribed by a physician have to undergo FDA approval, with multiple levels of clinical trials. Marijuana has not been put through these rigorous, large-scale trials yet, and thus is not a candidate for pharmaceutical use.
- Frequent use can cause cognitive effects. Marijuana is not harmless- heavy use can cause decreased attention and learning, and impaired executive function. Cannabis is also bad for people with heart disease (it can either increase or lower blood pressure), and can exacerbate some underlying mental illnesses (like anxiety or psychosis).
- Cannabis use leads to increased car and workplace accidents. There was a slight but significant increase in the number of automobile accidents in states with legalized cannabis. As we can’t currently determine if somebody is high (testing for marijuana stays positive for weeks after last use), driving under the influence laws would be hard to enforce. One study has also shown that workers who tested positive for marijuana are also more likely to be injured on the job.
- Medical cannabis should not currently be prescribed as there is still a stigma surrounding it and it is technically illegal. While the federal government is turning a blind eye at the moment, dispensaries require ID, and providers may be subjecting their patients to future stigma or legal recourse.
Well that depends on what your opinion of medical marijuana is. There are powerful lobbyists on both sides that you can get involved with- the National Cannabis Industry Association on the pro side, and Smart Approaches to Marijuana on the anti side. I encourage you to call your representatives, and talk to them about your stance on medical marijuana. And finally, if you value more research on the medical uses of marijuana, you can reach out to the DEA (you can call them at 202-307-7977).
If you’re interested more in the current evidence of medical marijuana, you can download a free PDF of the National Academies of Sciences, Engineering, and Medicine report here. The Curbsiders also have a podcast on medical marijuana that I found interesting.
As I’m sure you’ve picked up by now, this is complicated issue, but the current system isn’t sustainable whether you support it or not. I hope you now feel more informed about the pros and cons of medical cannabis, and are empowered to go and make a change!