Is Prescribing Pot to Patients a Clinical Dilemma?

Neal Conan of the show Talk of the Nation in Washington recently discussed medical marijuana in the U.S.  While marijuana is now legal in 18 states and the District of Columbia because of popular vote of the people, some of the health care practitioners are balking at the decision.

Prescribing pot brings up several possible problems:  these include efficacy, potency, corruption and the fact that marijuana may be legal under state law but it is still a federal offense.

Other physicians see pot as a solution for patients' symptoms which are difficult to address by any other method.  To make matters worse, individual cases can vary widely.

For instance, patients can range from a 70-year-old cancer patient who is trying to make it through chemotherapy to a 20-something college student who has problems sleeping. 

Conan had Dr. Robert DuPont, the first director of the National Institutes of Drug Abuse, as a guest on his show.  From a studio At the Mayo Clinic in Rochester, Minnesota Dr. Michael Bostwick joined in.

Dr. Bostwick stated he had written an article about medical marijuana being a "very complicated question with no easy answer."  Dr. Dupont agreed and called it a "polarizing issue" with extreme positions.  He added that marijuana is not a medication so it cannot be prescribed, but only "recommended."

Dr. Dupont went on to say that more than 90 percent of the marijuana recommendations made by physicians in the U.S. were by doctors who are virtually doing nothing but making medical marijuana recommendations.

Conan asked if such a state of affairs is corrupt, but Dr. Dupont called it a "kind of de facto legalization."

Dupont went on to explain a doctor sells the marijuana certificate to a patient for a year for a price of about $200.  This process takes about 15 minutes.  The "patient" then goes to a dispensary where he or she picks out how much marijuana they want and what kind.  As Dr. Dupont admits, "It's a discussion that bears no relationship to medicine anywhere in the country.  That's what medical marijuana is as it's going on in the country today."

Dr. Bostwick claims one of the challenges is that marijuana has been used medicinally for 5,000 years.

"You don't take medicines that are taken by smoking," explains Dr. Dupont.  "This is not medicine.  The Food and Drug Administration doesn't approve plants.  They approve products that have purity, safety and efficacy. There's no possibility of doing that with this."

Radio host Conan joked the good doctor should tell that to the voters in the 18 states who approved it.

While this subject is definitely a volatile one that will not be easily worked out in the United States (and probably elsewhere as well), Dr. Dupont makes a good argument.

"But I think the point is that look at what's happened to morphine," he said.  "Morphine came from opium when it was purified.  And it wasn't only that morphine became used as a purified chemical, but the synthetic analogs were developed.  That is exactly the future of cannabis."

Dr. Dupont went on to conclude, "And the reason it's so interesting is I'm in favor of that, and the people who are supporting medical marijuana are against it because all they want is to smoke dope."

There is no doubt the debate will go on.


Posted in Is Prescribing Pot to Patients a Clinical Dilemma?

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