Sierra Sacramento Valley Medicine
Vol. 61 / No. 1 - Jan / Feb 2010
| BACK to Table of Contents | ||
A Posit on Cannabis |
||
"In the present circumstances, physicians should advocate for local or state regulation of production, taxation and distribution/sale of cannabis." BACKGROUND: See the report on a marijuana clinic in our November/December issue, a recent editorial and an essay by Dr. Paul Phinney, CMA President-Elect, in The Sacramento Bee, and the CMA position paper on regulation of marijuana at these links: http://www.cmanet.org/news/detail/?article=cma-urges-legalization-and-regulation-of, http://www.cmanet.org/files/pdf/news/cma-cannabis-tac-white-paper-101411.pdf (See also Dr. Don Lyman’s article in this issue.) Results: Agree, 50; Disagree, 27. Some edited comments follow: I agree (only) in part, in that this needs to be a federal matter, not a state matter. Cannabis is significantly less dangerous than alcohol, and it has further been used quite successfully for medical purposes. Continuing to mark this drug as Schedule I is both exacerbating the crime associated with it as well as making it impossible to use in a therapeutic manner. Legalization and regulation make the most sense in preserving our freedoms and serving the public good. Much as we tax tobacco and alcohol and attempt to reduce their ill effects, we do not ban them, and cannabis should be similarly managed. — Srihari Namperumal, MS IV Why advocate for another drug that leads to multiple accidents, abuse, and exacerbates psychological illness? Working in the ED most trauma, gang-related injuries and psych issues have positive drug screens for THC. It seems to be much more prevalent than alcohol-related problems. You can blame the accepted use for another bad medicine. — Franklin Robinson, III, MD It’s a tough issue. Criminalization is a wasteful and destructive failure. Medicalization is often, but not always, a pretense. The DEA prevents legitimate research. So regulate it like tobacco or alcohol…sister drugs as they are. — John McCarthy, MD If cannabis has medical benefit and it is used as a pharmaceutical, then standardizing dosage forms and dosage for indication would seem logical. Also, distribution through usual pharmaceutical outlets would be most appropriate. We don’t have Vicodin shops or Valium shops — why have we set up an independent distribution system for cannabis? The reason is that it is used more recreationally than it is used medically. Just look at the clients. If it isn’t medically useful, then license and regulate it; you won’t ever stop people from using it. — Thomas Atkins, MD The only patient that I saw who benefitted from taking pot was dying! — Alan Galbreath, MD I am particularly proud of CMA’s effort in this regard. There is a need for leadership on marijuana public policy, and CMA has provided it. There is little argument that the “war on drugs” is a flawed and failed policy. Despite our best efforts, illicit drug use is rampant. Diversion of prescribed medications is epidemic. The good people of California agreed to compassionate use of medicinal marijuana and trust that we in the medical community honor that trust. In order to achieve that, I believe we need a rational policy directed at appropriate treatment, adequate study, and regulation just like we do for any other pharmaceutical. Now that cannabis is prescribed as a medicine, it needs to be further studied and regulated. The CMA looked at this issue carefully and thoughtfully. CMA is [at its] best when we work together for the benefit of our patients. Good job CMA. — Lee Snook, MD Docs can write a recommendation but not a prescription for cannabis. Prescribing [is] illegal. Stating a patient would benefit medically from it is a medical opinion. (I learned this from a doc who is in the cannabis need assessment business. Legalization and regulation of THC should reduce the murder rate in Mexico, indirectly driven by U.S. demand for the product. Selected businesses already screen prospective employees for THC, some using hair analysis. For our people as a whole, the benefit of control through legalization and regulation exceeds the risk. — Jerry Rogan, MD I agree. It would be ideal if the federal government would do the same. — John Rogers, MD I agree but only with stringent oversight and control. The cannabis shops that now exist ad infinitum and that advertise medical acceptance, i.e., medical acceptance with an MD within one-half hour, is absurd and is another example of poor local and state law enforcement — or is the state legislature faulty? Any MD willing to certify any individual within one-half hour after their arrival at a “shop” should be humiliated and disciplined. — Wayne Matthews, MD I was astonished that the CMA adopted a position in support of “medical” marijuana. Recently, The Medical Letter summarized the evidence-based literature on this subject and concluded there was little quality evidence to support “medical marijuana.” Further, given the extensive evidence of adverse effects from marijuana use, the CMA’s position is frankly embarrassing. Please see “Long Term Medical Effects of Cannabis Use” at www.uptodate.com. — Michael A. Patmas, MD Given the millions currently using it, regulation to prevent contamination, and taxation to realize revenue, seem obvious. — Patricia Samuelson, MD It is the very height of hypocrisy in this nation to permit advertising of alcohol to millions of young children on national TV during major sporting events… yet to keep marijuana illegal to patients with terminal disease. — James Ruben, MD [The] posit puts physicians in a non-clinical area. We, as physicians and researchers, have no business in taking any political or business position of the use of marijuana. We should continue to research medicinal use of marijuana. — Boone Seto, MD Medical marijuana is a joke in California. I recommend it be limited drastically to terminally-ill patients only; all the other “conditions” can be better treated with traditional and alternative medical care. I would limit the prescribing to the patient’s primary care physician only. — James Margolis, MD I support legalization and regulation of cannabis, but I worry that the regulation will be yet another onerous task put on the primary care doc. Unless the stuff can be injected into the spine at exorbitant costs to the healthcare system, pain management clinics will probably leave the prescribing to me, as is currently being done with opioid medications. Ceiling doses should be better defined in each of these scenarios to make my job a little bit easier. — Nathan Hitzeman, MD It should not be advocated until it is legal on a national level. — Terry Zimmerman, MD While there are some benefits to medical marijuana, for the most part they are over-hyped, and there are better medications for most of the reasons marijuana is “prescribed.” As a medical oncologist, I have written for [recommended] it many times for my patients, but most of the use is for other “indications.” A large percentage of medical marijuana use is predominantly for recreational use. I favor legalizing it for all the reasons listed in the CMA editorial. There is no way for society to completely prohibit use of marijuana. It… would be better for our society if it were controlled like other similar products such as alcohol and tobacco. Doses can be standardized, and there are obvious benefits to taxation of such products… Legalization would take a large burden off of the police and other authorities… [and] help with congestion in our courts for what are generally minor offenses. — Sidney Scudder, MD As physicians, we should not advocate for distribution/sale of cannabis and should not support its legalization. Already, too many people are using cannabis for the most benign reasons and getting prescriptions from any willing provider. Examples include a teenager who was getting cannabis because his parents knew he used it, but did want to have a legal RX to protect him if he got caught; a patient who just wanted to use it for better sleep; etc. Physicians should oppose any legalization of this drug. And, we should not be swayed by the arguments that its legalization will provide profit to the state of California. — Pankaj Patel, MD The current decriminalization is cost effective for an illegal substance. Legalization will increase use by all age groups, in particularly, the young. Marijuana adversely affects short-term memory and the ability to multi-task. A state of dependence by nine percent of the user population would be a large number of people in California draining health care resources and not contributing to society. Tax dollars gained from legalization would be absorbed by increased government bureaucracy and increased need for treatment of dependency. The real winner will be the tobacco industry that is ready to cash in with legalization. — Richard Park, MD American society does not seem able to get a handle on the marijuana problem currently. The “Posit” seems a reasonable change as a start to the situation. I would prefer the state regulate the situation rather than have it done locally. …Physicians should support studies to determine scientifically the efficacy of marijuana and cannabis as therapeutic for the various conditions as claimed. This would require federal and/or state funding as there would seem little profit… for drug companies from such efforts. A simple, inexpensive test for blood levels needs to be developed; and standards for mental and physical impairment… We need a study to show if this could be partially or completely paid for by reductions of expenditures for policing. — Ray F. Fitch, MD Posits are simplistic one sided statements intended to promote discussion among members. Therefore your comments are particularly relevant. Results do not constitute valid polling data and may not reflect the position of the Editorial Committee, or SSVMS Board of Directors. | ||
| BACK to Table of Contents |
||