Consider the following questions: Do you experience pain, nausea or lack of appetite due to treatments or symptoms related to having HIV/AIDS or cancer? Do you experience pain, headaches, muscle spasms, anxiety, or trouble sleeping? These two very different questions can both elicit the exact same prescription from a physician. The use of medical marijuana has increased rapidly, and since 1996 16 states have legalized the use of medical marijuana. Are the statutes regarding medical marijuana in these states stringent enough? Are doctors prescribing the drug only to people who truly need it? I don’t think this is the case, based on numerous examples within recent studies.
Recent research conducted in Colorado has shown that with the expansion of medical marijuana, for some physicians the patient-physician relationship has been degraded to a single recommendation of a single substance, without a more in-depth look at patient history or even follow up appointments. 2% of Colorado residents (170,717 people) are now registered for the use of medical marijuana. 85% of all of these people are being prescribed by only 50 physicians. 49% of all of these people are being prescribed by only 15 physicians. Lastly, a single physician is prescribing for 10% of these people. This means that one physician in Colorado has prescribed medical marijuana to 17,071 people; and each of 15 physicians is prescribing 5,576 people. These statistics certainly speak negatively to the care some of these physicians are providing regarding the welfare of their patients. (Nussbaum, 2011)
Another study conducted nationwide reported that adolescent marijuana use from 2002 to 2008 was higher in states with medical marijuana laws than states without (Wall, 2011). Finally, a study in California revealed that the most common conditions for which physicians recommend medical marijuana has changed. In 2005, the most common use of medical marijuana was to relieve symptoms of HIV/AIDS or cancer treatment. Now, the most common causes for medical marijuana use are unrelated to either of these, with the most common reasons listed as relief of pain, muscle spasms, headache, anxiety, and to improve sleep or increase relaxation. (Reinarman, 2011)
I believe that for some patients, the use of medical marijuana is unquestionably warranted. However I also deem that the use of medical marijuana is being abhorrently abused by certain persons, and that the standards and regulations for the recommendation of medical marijuana by physicians need to be reevaluated.
Nussbaum A, Boyer J, Kondrad E. 'But my Doctor Recommended Pot': Medical Marijuana and the Patient-Physician Relationship. JGIM: Journal Of General Internal Medicine [serial online]. November 2011;26(11):1364-1367. Available from: Academic Search Premier, Ipswich, MA. Accessed November 22, 2011.
Reinarman C, Nunberg H, Lanthier F, Heddleston T. Who Are Medical Marijuana Patients? Population Characteristics from Nine California Assessment Clinics. Journal Of Psychoactive Drugs [serial online]. April 2011;43(2):128-135. Available from: Academic Search Premier, Ipswich, MA. Accessed November 22, 2011.
Wall M, Poh E, Cerdá M, Keyes K, Galea S, Hasin D. Adolescent Marijuana Use from 2002 to 2008: Higher in States with Medical Marijuana Laws, Cause Still Unclear. Annals Of Epidemiology [serial online]. September 2011;21(9):714-716. Available from: Academic Search Premier, Ipswich, MA. Accessed November 22, 2011.
I do agree with you it seems that since only a handful of physicians are prescribing medical marijuana to their patients, that these physicians are being very lax with the standards and regulations regarding prescriptions.
ReplyDeleteAccording to one of your sources, Reinarmann states that the use of medical marijuana has shifted from treating symptoms of HIV and chemotherapy towards alleviating pain, muscle spasm, headaches, etc. However is this such a bad thing? I don’t think so because it may be that people back in 2005 were skeptical about using medicinal marijuana as a legitimate drug to alleviate their symptoms. It could be now that people are becoming more comfortable with using medicinal marijuana now that there are many dispensaries in Colorado. I don’t find this shift alarming or bad as long as the people who request medical marijuana to alleviate HIV symptoms aren’t being turned down because of people who are requesting medicinal marijuana for other uses.
As for the physicians who seems to be abusing their medical license prescribing medicinal marijuana carelessly to whomever they wish, how would you go about regulating this?
In November 2000, Coloradoans passed Amendment 20 establishing the Medical Marijuana Registry. The Colorado Department of Public Health and Environment maintains a confidential database of patients who have applied for a registry identification card for the medical use of marijuana. Registry identification cards are available to Colorado residents and valid only in Colorado and those applying can only do so after a physician has recommended its use. This goes against the common thought that marijuana is a prescribed drug that you can pick up at your local pharmacy. Physicians recommending the use of medical marijuana to their patients must carry an active Colorado medical license (board certified M.D. or D.O.) and complete a state drafted certification that then allows the patient to apply for the state registry and to receive a card to be able to pick up a set amount or form from a Colorado marijuana center (also regulated closely by the state).
ReplyDeletePer the Colorado constitution, medical marijuana may be recommended ONLY for the following: cancer, glaucoma and/or positive HIV or AIDS symptoms. Exceptions may be made for a patient with a chronic or debilitating disease/medical condition that produces one or more of the following AND “which, in the physician’s professional opinion, may be alleviated by the medical use of marijuana”: Cachexia, persistent muscle spasms, seizures, severe nausea and/or severe pain. As of September 30, 2011 through the Colorado governmental website, severe pain accounted for 94 percent of reported conditions and muscle spasms are the second most reported condition with a lot of those in the registry reporting more than one condition.
Although the list of conditions applicable towards a consult card seems like it could account for almost anything, the legislature does include a list of 13 different conditions that were not approved to be included as “debilitating medical conditions” and could also keep someone from being approved for one of the accepted conditions. Bi-Polar disorder and Asthma are two of these diseases.
After reading up on the Colorado state website, I was surprised to learn that using the language of “marijuana prescriptions” and/or being “prescribed” it as a therapeutic drug is actually inaccurate. Although at first thought I would have agreed with the notion that physicians do “over-prescribe” marijuana, it does seem like the legitimate state-defined process is rather well defined and enforced. However, the amount of websites and distribution sites do seem a bit extreme; perhaps because with every legitimate source there are a dozen of fakes. After reading Kelly’s post and the comments that followed, my vision has changed to less placing blame on the doctors that might be contributing to the growing amount of marijuana use and more towards the possible phonies in our midst.
http://www.cdphe.state.co.us/hs/medicalmarijuana/
In America most people are deceived with thinking marijuana is a horrible drug. We have been brainwashed to think this way. Nonetheless numerous researches have provided evidence that marijuana can be appropriately used to alleviate pain. In Oxford University Press, advances in cannabis research shows that it can down-regulate neural receptors that modulate synaptic transmission of pain associated with inflammation. As such cannabis possess valuable therapeutic properties against pain (Hosking and Zajicek, 2008).
ReplyDeleteIf medicinal marijuana is associated with fewer side effects than opioids, then should not it be the first line treatment for pain?
I agree with both Kellie and Kelly's points. Yes, we need to enforce strict criteria when allowing physician's to recommend medical marijuana for patients. There is also an extremely high instance of deceit perpetrated by individuals seeking medical marijuana prescriptions for recreational use. But I believe that we also need to look at what the medical marijuana industry does for our economy and also, the potential long term side effects of marijuana use on neurological function to truly assess the pros and cons of this drug and its future.
ReplyDeleteIn Colorado, it seems as though dispensaries are popping up on every street corner at a rate that rivals the Starbucks monopoly. This seems to have a positive influence on local economies as these businesses are owned and operated by local entrepreneurs, providing a steady income for citizens with clean legal records. But recently there's been an increased push to ban medical marijuana dispensaries in numerous cities. The measure reached the ballot and passed in Fort Collins, Yampa and Brush in early November, but failed in Steamboat Springs, Oak Creek, unincorporated Routt County and Palisade.
The reason why the state is torn in terms of whether or not to support these businesses is that most people don't understand the actual impact of THC on the brain and long term side-effects associated with its use. The main active chemical is delta-9-tetrahydrocannabinol, which is inhaled through the lungs into the bloodstream and to the brain where it binds cannabinoid receptors to stimulate the release of dopamine. The highest densities of these receptors are found in the areas of the brain that influence pleasure, memory, thinking, concentrating, sensory and time perception, and coordinated movement. Long-term studies about the effects of this drug on brain structure and functioning haven't produced concise results, possibly due to confounding effects such as other drug use, residual effects, or withdrawal symptoms. One study administered a 12th grade version of the Iowa Tests of Educational Development to adult marijuana users and non-users. The "heavy" users (7 or more times weekly) demonstrated deficits in mathematical skills and verbal expression, as well as selective impairments in memory retrieval processes restricted to words that were easy to visualize. However, "light" and "intermediate" users (1-4, and 5-6 times weekly, respectively) were not associated with deficits. Intermediate use was even associated with superior performance in the "fuzzy" concepts portion of a Concept Formation test. Another study investigated the effects of driving under the influence of cannabis, which demonstrated that during times of acute cannabis intoxication, driving faculties were diminished and associated with an elevated risk of collision.
With economic, social, clinical, and biological data all seeming to conflict, its difficult, if not impossible, to evaluate the use of marijuana for medical purposes. I believe in its use for conditions such as Parkinson's, HIV/AIDS, and cancer, but people with chronic, less severe, conditions should investigate other holistic treatment options without potential long-term cognitive functioning impairments and public health risks. More research needs to be performed to determine the exact effects and risks of chronic marijuana use, but until then it's up to the practicing physicians to do their homework and follow the hippocratic oath.
References:
ReplyDeleteBlock, R.I., and Ghoneim, M.M. "Effects of chronic marijuana use on human cognition." PubMed. http://www.ncbi.nlm.nih.gov/pubmed/7870889
Ingold, J. "Ban on medical-pot businesses leads in Fort Collins." denverpost.com. http://www.denverpost.com/news/marijuana/ci_19244423?source=pkg Nov. 2, 2011.
NIDA InfoFacts: Marijuana. National Institutes of Health. http://www.nida.nih.gov/infofacts/marijuana.html Nov. 10, 2011.
Richer, I., and Bergeron, J. "Driving under the influence of cannabis: links with dangerous driving, psychological predictors, and accident involvement." PubMed. http://www.ncbi.nlm.nih.gov/pubmed/19245889 March 2009.