By Mary MacVean
February 20, 2013, 2:00 p.m.
Perhaps you know whether you’d want to use marijuana to relieve severe pain or nausea. But if you were a doctor, what would you tell patients who asked about taking something that’s against federal law?
The New England Journal of Medicine poses the question to its readers and on Wednesday presented arguments for and against from doctors.
The hypothetical patient is 68-year-old Marilyn, who has cancer and who says the standard medications are not relieving her pain and nausea. She lives in a state that allows medical marijuana use and says her family could grow it. She is asking her primary care doctor for advice.
“I endorse thoughtful prescription of medicinal marijuana for patients in situations similar to Marilyn’s,” writes Dr. J. Michael Bostwick, representing one side. Doctors should turn to marijuana only when “conservative options” fail, he says.
“Simply to allow a patient with uncontrolled symptoms of metastatic breast cancer to leave the office with a recommendation to smoke marijuana is to succumb to therapeutic nihilism,” Drs. Gary Reisfield and Robert DuPont write on the other side.
Bostwick says that federal policy has not kept pace with scientific advances and that “largely anecdotal but growing literature supports” the efficacy of marijuana for pain and nausea that don’t respond to ordinary treatments.
With 18 states making legal medicinal marijuana, “the cannabis horse long ago burst from the federal jurisdictional barn,” Bostwick writes. He notes that the abuse of the state laws by some doctors should not prevent all doctors from being able to prescribe marijuana.
He also notes that the federal law has meant that no Food and Drug Administration trials have looked at it in comparison to traditional drugs.
If Marilyn had never tried marijuana as a recreational drug, Bostwick writes, she might not like its “psychoactive effects,” but if she feels better with it, “she would channel 5,000 years of medical history.”
In the “no pot” camp, Reisfield and DuPont argue that smoking marijuana is “nonmedical, nonspecific and potentially hazardous.” The cannabis plant, they write, has hundreds of pharmacologically active compounds that could lead to unwanted effects. Among the several possible negative results, they write, are effects on Marilyn’s cognitive and psychomotor abilities, such as driving, and effects on her health at a time when her immune system is compromised.
While the doctors say the issues surrounding marijuana should be discussed with Marilyn, “there is little scientific basis for recommending that she smoke marijuana for symptom control.”
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