Questioning the ‘wonder drug’

Unlike many of my peers, I have never tried marijuana in any form. I am not bragging; it is a simple fact. Why not? Well, I had other interests and passions and smoking pot did not factor into them. Looking back, I don’t believe I missed much. 

Now, as a medical professional I am disturbed by what I see as a huge shift in attitudes toward marijuana. Far from being a throwback to the psychedelic “Age of Aquarius” and the purview of aging hippies, marijuana is now mainstream and, according to some, the new medical wonder drug. Recent polls show that over 50 percent of adults over 18 have tried marijuana and nearly half of those still use it. Even more telling is that over 80 percent of adults support legalization of medical marijuana. The numbers for legalization of recreational marijuana are more evenly split with about 50 percent for and 50 percent against. 

How did we get from the days of “Reefer Madness” to marijuana as medical magic bullet for all sorts of ills?

Advocates of recreational marijuana use have asserted that marijuana is no more dangerous than alcohol and tobacco. In fact, it is claimed to be safer in terms of its negative impact on society and the individual. For years, anecdotal reports claimed that marijuana is effective for pain in terminal cancer patients that does not respond well to standard pain medications. In addition, marijuana is claimed to be beneficial for all sorts of other medical conditions ranging from seizure disorders to behavioral problems, such as attention deficit disorder, and even major psychiatric illness such as depression and schizophrenia. State governments, if not the federal government, see legal marijuana as a nice source of tax revenue. 

Medical use of marijuana has given it a legitimacy it did not possess as a purely recreational drug. Politicians jumped on the marijuana bandwagon with a vengeance. Many regard it as harmless. Attorney John “For the People” Morgan has made it his personal mission to legalize marijuana in Florida. 

Marijuana has been around for generations and is widely regarded as a relatively harmless drug. It appears to have some legitimate medical uses. Legalization will clear a lot of jail cells, add tax revenue, help a lot of very sick people. What’s not to like? 

I question whether marijuana is really as great a drug as advocates claim. Where is the data on this? As a physician who must practice evidence-based medicine, where are the studies showing safety and effectiveness?

Alex Berenson, an investigative reporter and author of the book, “Tell Your Children: The Truth About Marijuana, Mental Illness, and Violence,” paints a darker picture than advanced in much of the popular media. Berenson cites large studies published in notable publications such as the American Journal of Psychiatry, Frontiers of Forensic Psychiatry, Schizophrenia Bulletin, and Journal of Interpersonal Violence. These show that marijuana use is linked to a threefold increased risk of opiate use, to increased risk of schizophrenia and psychosis (breaking from reality), especially in teenagers, and increased risk of violence, including homicide. OK, all drugs have a down side, but what about the supposed medical benefits of marijuana? 

In 2017, the National Academy of Medicine published a comprehensive review of marijuana*. Among its findings was this, “cannabis use is likely to increase the risk of developing schizophrenia and other psychoses; the higher the use, the greater the risk.” Newer growing methods and preparations have increased the potency of marijuana several fold, from about 2 percent THC (the active ingredient) in the ’70s to as high as 20-25 percent today. The review found a disturbing lack of evidence for effectiveness for many of the medical conditions for which marijuana is promoted. There was conclusive or substantial evidence for benefits only in three areas: chronic pain, nausea and vomiting associated with cancer chemotherapy, and patient-reported spasticity from multiple sclerosis. For the latter two, cannabis was taken orally, not smoked or inhaled. For spasticity from MS, the reports from clinicians did not corroborate what patients reported. Hardly a wonder drug. 

The conclusions of the review were we need more, and better, studies before recommending marijuana for many indications. This is not what marijuana advocates want to hear, especially those with a financial, political, or other vested interest. 

All prescription medications are sold through pharmacies and managed by a physician who knows the patient and is in the best position to monitor the individual’s response to treatment. Why do we treat marijuana differently? Why establish separate, “licensed” marijuana shops. Medical use of marijuana is not a moral, social, or political issue; it is a medical one. Medical marijuana has become a divisive political football. This does not help those who might benefit from its use.  

*http://www.nationalacademies.org/hmd/Reports/2017/health-effects-of-cannabis-and-cannabinoids.aspx