Medical marijuana in psychiatric illness

Recently, 16 states and Washington DC have legalized medical cannabis.

An additional 10 states have pending legislation. With all the attention legalized medical marijuana has been receiving, patients have started asking if they are candidates for a prescription. Well, my answer is easy.  Right now it is not legal in Illinois, although it is one of the states that is pending. Even if it does become legalized, I work at a federal hospital under federal law, which still prohibits marijuana. Generally state law supersedes federal law, but not in the VA.

That still does not address the issue of potential benefits of medicinal marijuana. What I know about the use of marijuana in the context of psychiatric illness, is that some people find it worsens their symptoms (increase in anxiety and paranoia) and others find it to improve their symptoms (as a relaxant, to ease pain, or improve insomnia). Longterm use of marijuana can also cause apathy and low motivation.

There is also a myth that there is no such thing as addiction to marijuana. Over recent years, however, with more and more people including children using marijuana, it is becoming evident that there is a small subset of people that do become physically addicted, with problems seen similar to those in other drug addictions.

Let’s say in theory I could prescribe cannabis as a treatment for patients. I suppose the one problem I have with it is that there is not enough research and evidence to say that it is clinically useful. What we do know about marijuana (with some evidence), is that it helps in nausea (in specific patients, like those receiving chemotherapy), muscle spasticity (like in patients with spinal cord injuries), and in some cases neuropathic pain. Marijuana is still classified as a Schedule I drug (in the same category as LSD, PCP, and meth), while cocaine, for example, is classified as a Schedule II drug. What this means is that it is in a category that says those drugs do not have any medical use. This limits the ability of researchers to explore potential medical uses for marijuana.

I am not committing to saying that medical marijuana is a good or bad thing–only that there remains a great deal to be discovered about specific medical uses, and that the laws are still somewhat murky. Hopefully physicians will tread lightly and consider these issues before they pull out their prescription pads.

Christina Girgis is a psychiatrist who blogs at getaheadwithdrg.

 

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