Medical Marijuana - The Wrong Patients Want It

I frequently have patients ask me about using medical marijuana. Unfortunately, they are not the patients I think would benefit most from its use. I found a very good article in Psychiatric News that discussed the issue in detail and with good balance. The evidence is scant, but suggests that medical marijuana has some usefulness for limited conditions. The best evidence is in appetite stimulation in chemotherapy-induced nausea, and in HIV/AIDS-related wasting disease. (medical munchies?) Essentially all of the studies are of short duration with very small numbers of patients. There is no good data about longer-term use medically. A moderately large body of evidence shows that there is a measurable but only moderately decreased ability to learn and remember new information in chronic marijuana users, but no other cognitive problems have been demonstrated. Addiction is yet another concern, and outside the scope of this post. Clearly more study is needed. My prediction is that if good studies are done they will show some additional conditions where marijuana can be useful. However, doing the studies is going to be a challenge. This is an issue where proponents and opponents of medical marijuana have opinions that are not based on data, but rather on values and beliefs about drug use and laws regarding drug use.

I work in the State of Washington, where the laws regarding medical marijuana are pretty liberal. I have only recommended marijuana once to a patient, and I believe it helped her die more comfortably with her end-stage pancreatic cancer. Her nausea seemed diminished in her last few days.

In general, when patients ask me about medical marijuana, I just tell them that I do not prescribe it. Essentially every patient who has asked me is already using marijuana. I essentially never have chemotherapy patients, end-stage cancer patients, or others who need short-term use. I only see patients with long-term anxiety, pain, or other conditions who are already overusing prescription opiates or benzodiazapines who hope marijuana will be of help. I feel like most of the time I am being asked is to give users a legal out in case they are arrested. I have mixed feelings about casual or recreational marijuana use. I believe it can be a big problem for regular users, and am not willing to facilitate its use as of this time. I do look forward to more data, and am keeping an open mind.

Ed Pullen, MD, is a board certified family physician practicing in Puyallup, WA. He blogs at DrPullen.com — A Medical Bog for the Informed Patient.

This article originally appeared online at DrPullen.com.