As an addiction psychiatrist, I have seen marijuana do far more harm than good. So with the medical use of marijuana in Massachusetts now legal under state law, what should physicians do?
Recently, I attended a chilling presentation from Dr. Kevin Hill, an addiction psychiatrist at McLean Hospital, at a meeting of the Massachusetts chapter of the American Society of Addiction Medicine on the topic “Medical Marijuana: What is the Proper Role of the Addiction Physician?”
As we all know, the people of Massachusetts have spoken: last November, 63% of the voters endorsed Question 3, “The Medical Use of Marijuana.”
Since that time, the Department of Public Health has been scurrying to operationalize the so-called medical use of cannabis in the Commonwealth. The community of physicians has been scratching its collective head and wondering, “What in the world are we going to do about patient requests to become certified to purchase, or grow, so-called medical marijuana?”
I use the terms “so-called” and “medical marijuana” together, because there is scant scientific evidence to support the use of marijuana as a medication.
The US Food and Drug Administration has yet to approve any “smokable” medications. The Drug Enforcement Agency classifies marijuana as a Schedule 1 substance. Schedule 1 substances are defined by the DEA “as drugs with no currently accepted medical use and a high potential for abuse. Schedule 1 drugs are the most dangerous drugs of all the drug schedules with potentially severe psychological or physical dependence.”
Many users of marijuana become addicted, suffering withdrawal symptoms when they attempt to stop, and experiencing a variety of impairments as a result of chronic use. They continue using because they feel worse when they don’t use. Frequent use of marijuana by young people may impede the development of the brain (which continues until the mid 20s), interfering with education and work performance.
I am not taking a position on the legalization of marijuana, but I am taking a position against the medicalization of marijuana. I strongly believe that it is misguided. Although small numbers of individuals with intractable, debilitating medical conditions may derive some benefit from the use of marijuana “when all else fails,” so-called medical marijuana laws open up a floodgate to entrepreneurs who will profit from the sale of this valuable addictive substance.
All patients with certificates who are covered by MassHealth or by Social Security Disability Insurance (SSDI) will have the option of growing their own. There will be massive amounts of diversion to non-patients, and the price of marijuana will drop. The health and well-being of the greater public will be jeopardized for the relief of a few, and for the profit of the unscrupulous.
Physicians who have taken a pledge to “do no harm” should simply steer clear of the emerging Massachusetts medical marijuana debacle and “just say no.” As physicians contending with the increasing demands of a complex and unevenly funded healthcare system, we should focus our attention on providing evidence-based care to patients, and sidestep getting involved in a social movement that is medical in name only.