Wednesday, February 17, 2010

Going to Pot (or Let's Talk about Medical Marijuana)



Our state is considering legalizing medical marijuana.

As a psychiatrist, my first thought is : NO! We treat addictions, and we try hard not to cause them. Marijuana (and many other illegal substances) may help mood and anxiety in the moment, but they don't seem to fix things for the long haul. And chronic pot smoking decreased motivation, burbles your brain, and does nothing good to your lungs. I have visions of patients at the door saying they need me to prescribe pot for their anxiety. Please, doctor, please.

But then I think of end-stage cancer patients, and it really doesn't bother me if a little cannabis helps with their symptoms.

There are those who claim that oral THC (marinol) can be helpful for many symptoms, oh, but unliked the smoked stuff, Marinol doesn't get you high. There's less evidence about inhaled marijuana being effective.

So here's my question: How does medical marijuana work in your state? How widespread is the use? What are the terms and conditions under which it can be prescribed? Who gets it and with what regulation? Is it a good thing or a bad thing and why? And please, if you have links to data or studies or interesting articles about the legalization of medical marijuana, by all means put them in your comments. If you want to tell me why cannabis should be legal and it's a government plot to keep it illegal and any information from NORML, you can hold off on those links...I think I've heard that side of the story.

19 comments:

IndiaSara said...

Burbles your brain? Is that a medical diagnosis? Will you write that in my chart? Please?

Sorry. I know this is a serious post and I really appreciate you addressing the issue. How do you deal with it when a patient has a marijuana habit?

Sara

meddoc said...

It is fascinating to me that the majority of doctors are fearful of prescribing Medical Marijuana, but have no problem addicting scores of people to vicodin, sleep drugs, etc, all which have a much more dangerous addictive profile and in my opinion, a much more serious side effect profile. Of course, teaching people to handle their issues in a drug free and more healthy way is best, but we have not, in any way, lead that charge. So the resistance to this is somewhat comical.

On a side note I have found a lot of patients with migraines who get great relief.

Anonymous said...

Meddoc,

Thank you for stating what I was about to say.

Here is an interesting article on ABC news about a mom giving her non verbal autistic son marijuana as he was in danger of dying due to not eating. He greatly improved

http://abcnews.go.com/GMA/AutismNews/mother-son-marijuana-treat-autism/story?id=9153881

He had tried a cocktail of meds that wasn't working.

Dr. Sharon Hirsh, a psychiatrist is totally opposed for it seems like similar reasons to Dina.

Kind of ironic because risperdal is approved for autism. Seems like the side effects from that drug are alot worse than marijuana.

You sound like the type of doctor I would love to have.

AA

Sarebear said...

Since I live in UTAH . . . . heh (for those who doin't know, ie, mostly international readers probably, and even some of them might), UTAH is VERY conservative.

Our Liquor laws were brought up before the '02 Olympics as liable to make us a laughingstock, etcetera.

By those who like to laugh at such things.

There's very few State-run Liquor stores around where you can get stuff that's harder than beer, which is the "hardest" liquor you can get at the grocery store.

So marijuana, I think, isn't gonna fly, but I'm not speaking from any educated position. If there's forms that are medically beneficial, I'd support those in those situations, just as I'd support any medicine - I mean doesn't heroin come from the same source morphine does?

But I'm perhaps more open than many to the idea. I also didn't grow up here. When I moved here, it was a bit of a culture shock. It's not a religious issue, so much as it's the culture. Some might wonder, what's the difference (and no, not everyone in Utah is LDS, sometimes better known as Mormon), but, and I cringe to use this analogy because the TYPES of things that the culture does that aren't REQUIRED by the religion are nowhere near like what one might find in the Middle East, but in a, say, more secularly-led country like Jordan, even there there are problems that stem from the ancient Middle Eastern culture that strongly affect women, that aren't necessarily a requirement of a certain religion, although it depends on the sect, the version . . . the interpretation . . . there are some . . . severe forms. One might say though that in areas of the Middle East that SOME of the issues involving women and men involve religion, and some of them are more because of culture, and some are a big morass of the intersection of the two.

Holy Smokes, how did I get onto that?

Geez, maybe my Add med needs upped . . . Arggg. Then again, stress will kind of mess with everything. heh, exacklet. word verify

moviedoc said...

I don't know whether it has medical value or not, but there is no justification for Sched 1 status. Tobacco, maybe. One problem is that like most herbal remedies you never know how much you're getting of what, but maybe it doesn't matter, and caveat emptor.

What Katie Did said...

Dinah,

Isn't there a group of folks, who for genetic / constitutional reasons are especially sensitive to MaryJane and that it induce paranoia or some sort of psychosis, not as a dose related thing? Is that permanent? How would you know if the patient was going to have this type of reaction?

Sarebear,

Hang in there hon. Sounds like things are tough at the moment. I wish you well.

Jen said...

I'm in Ontario, and in my experience, it's fairly widely prescribed here. (Although my mom was in and out of oncology wards for 15 years, and my daughter for 6, so we've perhaps had a wider exposure because of its use in treating chemotherapy symptoms). There are supposedly 3 reasons why you can be prescribed medical marijuana

those with a terminal illness, with a prognosis of less than 12 months to live


those with specific symptoms, such as severe pain, associated with multiple sclerosis, spinal cord injury and disease, AIDS/HIV, severe forms of arthritis and epilepsy

those with symptoms from another serious medical condition not covered in the first two categories.

In my experience it's fairly easy to stretch many conditions to fit those definitions, and many doctors do so. The Canadian guidelines for medical marijuana use are found at http://www.hc-sc.gc.ca/dhp-mps/marihuana/index-eng.php.


It seems to be like any other med to me- it works very, very well for some people and conditions, not so well for others. I've certainly seen for myself how helpful it can be in cancer patients, and with Aids-related anorexia. I've got autistic kids and I wouldn't touch it with a 10 foot pole for them without considerably more research being done, but it does seem a bit silly to me not to use it for medical purposes if it's shown to be effective, when more harmful substances (alcohol, I'm looking at you), are so freely available.

Anonymous said...

If you're too nauseated to keep food down or too weak to swallow, you can't take Marinol, because you have to not vomit it up in order to benefit from it. Inhaled marijuana can benefit thousands of people who are too sick to benefit from THC in pill form (which, by the way, has side effects that are different from those of inhaled marijuana for many people, so some may do better on a different form). Please don't claim that one is a substitute for the other.

Rach said...

Gah, I was looking for the blog's email address... I put it somewhere... and of course I can't find it.

Is it possible for you guys to make mention of the following link:

https://surveys.dal.ca/opinio/s?s=7808

Stan Kutcher at Dalhousie University (Halifax, NS) is asking Canadians for feedback on how to improve infant, child and youth mental health services via an anonymous survey.
I know you guys have lots of Canadians reading - would be greatly appreciated.

~R

Sarebear said...

Thanks, What Katie Did.

Sunny CA said...

Here in California I first heard of a guy I knew getting medical marijuana for back pain right after the law passed. In August, 2009 after quite a long time of medical MJ use, I saw HUGE billboards advertising a marijuana prescribing clinic on HWY80. Based on that I doubt a wannabe druggie will go to a psychiatrist for their MJ, so you will not be bothered. Still I have wondered how many patients in my psychiatrist's practice have asked him for it. I wouldn't ask unless I was undergoing chemo though I might someday ask how many have asked him for it.

merope3 said...

meddoc said what I would have said.

When I am depressed I do not eat. At all. Sometimes for weeks on end. It's not that I don't want to eat; I'd love to be able to eat. I just completely lose my appetite.

Anyways, I suggested to my psychiatrist partly in jest that we try medical marijuana and you'd have thought I asked her to personally inject me with heroin. Absolutely out of the question. So she gave me Seroquel instead.

Anonymous said...

hi this is a bbc documentary from the United Kingdom, on the effects of cannabis particularly shizophrenia, addiction and the positive medical effects. to help anyone in making a decision.
part 1 of 5

http://www.youtube.com/watch?v=Vr04g0xcy90

hope this helps
Andy

Lockup Doc said...

Medical marijuana--a slippery slope in my opinion. I've always found it ironic that many patients have said that they "smoke weed to feel normal," but many of these same people will not even consider trying an SSRI because they fear the possible side effects.

Also, KevinMD just posted an article about medical marijuana today:

http://www.kevinmd.com/blog/2010/02/medical-marijuana-doctors-questions.html#more-42534

April said...

Like meddoc (second comment), I really don't understand when doctors have a problem with rx marijuana, but will write scripts for sleeping pills, drugs that have serious side effects, etc.

First of all, marijuana is a plant that has been used forever all across the world for many different conditions. (No one has ever died from it, either.) Secondly, its mis-classification as a Schedule I drug (for purely political reasons, which apparently you don't want to hear?) means legitimate research on its benefits for numerous medical conditions has been halted. Dose Nation recently linked to a NY Times article, "The first U.S. clinical trials in more than two decades on the medical benefits of marijuana confirm pot is effective in reducing muscle spasms associated with multiple sclerosis and pain caused by certain neurological injuries or illnesses."

Montana, our neighboring state, passed their medical marijuana initiative in 2004 and I think that's how it should be everywhere---left up to the voters.

Those who want to use it (for "real" medical reasons or not) will whether it's legal or not and why should a cancer patient (or whoever) be denied a certain treatment because of politics? At the very least it should be removed from schedule I so more testing can be done.

In order to get a medical marijuana rx, in MT at least, you have to have an established history of a "debilitating" medical condition. From their site: "A medical doctor (MD) or a doctor of osteopathy (DO) licensed by the State of Montana must certify in writing to the department that you have a debilitating medical condition and that the benefits of using marijuana for medical purposes would likely outweigh the risks." Doesn't that sound reasonable?

It's time for us to be rational and logical about what we use to treat illnesses. Lockup Doc says s/he thinks it's funny people would rather smoke weed than take a pill when in reality the method is the same---using a chemical to fix a problem.

Anonymous said...

First off, it can't possibly be any worse than Xanax, which is approved by the FDA and a lot of docs will prescribe it (though some, like our Shrink Rappers, will proscribe it). Second, its long-term effects can't be any worse than cigarettes, though in the short-term it will tend to make some people "high." My main objection to it is the stench and that smoking it means you're dosing hapless bystanders, as well. So, some pharmaceuticalized version would be better, like how about a nasal spray (that I think exists) or a sublingual tablet? I really don't want a country high on pot all the time, but I don't think all that many more will cross over to it if it's legalized as a medicinal. Hey, it might even get some people off alcohol, which, IMO, is a worse drug though one that will never go away no matter what. My opinions on the effects of the drug are a bit tenuous, as being under the influence of it has never appealed to me.

Anonymous said...

@ moviedoc's comment about not knowing how much or what you're getting: Isn't that more reason to legalize? If it's legal it can be regulated.

@ anon about Marinol: While the problem with having to keep Marinol down for it to work seems obvious, I still don't understand why it can't be incorporated into an inhaler, or anything besides putting a burning stick in your mouth and sucking. (Although of course vaporizers solve the burning-stick problem too..)

Roy said...

Since it does seem to help some people with certain problem, it makes sense to legalize and regulate. Why make people go to street drug dealers? Sure, I've seen people get severe anxiety and paranoid states, sometimes lasting for many weeks, with MJ. But this is infrequent compared to the number of times I see people with problems relating to alcohol, prescribed narcotics, benzos, lithium, and SSRIs. Yet another risk/benefit decision.

And can we stop spending so much money to lock up pot-users? Is this really effective?

Dinah said...

Interesting concept, Roy. So if I have back pain, and my doc prescribes percocet so that it only cures my pain if I double the dose, but the doc won't refill it early because he doesn't think I should be taking a double dose, but that's what it takes to get my pain to stop, then obviously he's forcing me to go to street dealers to meet my needs.

We need to study MJ and have clear studies showing it's efficacy for defined conditions. How hard can it be to find a group of chemo patients and have some smoke pot and some smoke placebo and rate their nausea? Or weigh AIDS patients before and after twice a day pot vs. placebo and then be able to say: MJ works for X condition.

The issue of safety is paramount however, and MJ would never pass this: it causes lung cancer, its slows reaction times, it decreases motivation and it ruins some lives. Ah, but we've already legalized alcohol which does those things BIG-Time for a large (say 10%) segment of society, and we've legalized cigarettes....so I don't have an answer to why one but not the other.

Agreed that we have better things to do with our correctional dollars than prosecute marijuana smokers.
My experience with those people who are able to negotiate a heavy habit habit without it interfering with their lives is that many of them grow their own or buy it from friends who do, smoke it in the privacy of their own homes, and never get anywhere near the legal system.