A Doctor For Legalization, But Against Medical Marijuana
Skylandia, a doctor and guest blogger at the feminist Echnide of the Snakes, argues for marijuana legalization and against medical marijuana.
As a physician who practices evidence-based medicine, Skylandia is committed to prescribing based on research, not anecdotes. Yet, she faces a Catch-22: Since marijuana is a Schedule I drug, there's a dearth of research on its safety and efficacy for most of the conditions that it is recommended for. She writes:
And thus we set the stage for the farce that is medical marijuana. In New Mexico, physicians actually have a list of approved indications, which includes chronic pain, inflammatory arthritis, PTSD, glaucoma, painful peripheral neuropathy, and (in an ironic nod to the state’s epic battle with injection drug use) the discomfort associated with hepatitis C. We have no evidence that this substance is effective for any these conditions (nor any evidence that it is ineffective, or that it is harmful, nor that it is ineffective for a long list of excluded conditions), but someone came up with a list of inclusionary and exclusionary criteria, and there we are.
Because of the perversity of U.S. drug laws, it's easier to get permission to do medical research with cocaine and amphetamines than cannabis.
Skylandia is frustrated that she has no solid basis dosing because so little research has been done. And where there is research, there's no guarantee that the herb that her patients are buying is of comparable potency and purity to the substance described in any given study. She allows that marijuana is somewhat more standardized in the era of medical pot that it was in the black market, but the standardization isn't even close to what you'd expect from a pharmaceutical product.
Without any kind of dosing standardization or quality control, handing out medical marijuana cards is essentially the equivalent of telling patients to open up a bottle of Jack Daniels, insert a straw, and start drinking until you feel better. [...]
The medicalization of marijuana means that I am forced into the farce of pretending that marijuana is modern medicine. Marijuana is medicine only in the way that opium poppies are medicine: there’s something in there that’s awfully potent, but I wouldn’t feed it to patients straight up if wanted a predictable effect from a set dose – which is the essence of what separates modern medicine from the stuff your great grandma boiled up in her kitchen to treat the neighborhood nose bleeds and fevers. Marijuana is medicine only in the way that that proverbial bottle of Jack is medicine: it sure does something, but as a doctor, I’m pretty sure that is a something I don’t want to be responsible for prescribing.
This is a thought-provoking essay for proponents of science-based medicine.
Skylandia's right about how we'd proceed in an ideal world: First, make marijuana legal and therefore legal to study with controlled clinical trials. Then incorporate it into modern medicine when the data come in. Unfortunately, the political climate doesn't allow for that, and doctors like Skylandia are caught in the middle.
In the grand scheme of things, I'd prefer a world where doctors are pushed outside their comfort zone to a world where little old ladies with glaucoma have to score from their grandkids. But I'm also sympathetic to the conscientious, scientifically scrupulous doctors who are caught in the middle of a stupid political fight. I agree with Skylandia. Let's just drop the farce and legalize marijuana already.
Update: Skylandia is in good company. California's largest physician industry group, the 35,000-member Trustees of the California Medical Association, is calling for legalization instead of medical marijuana. HT: Digby56