PORTLAND – Medical marijuana prescribing is now legal in 14 states, with Maine the latest to join the growing social movement to legalize pot for medicinal use.

Prior to the vote last November and as the mechanisms for distribution are finalized, there has been a relative silence from the medical establishment on the pros and cons of prescribing marijuana to treat various medical conditions.

In my own practice in rheumatology, I am increasingly asked, “Will you prescribe marijuana for me?”

In trying to decide whether to prescribe marijuana, I read Maine LD 975: The Maine Marijuana Act. I wanted to evaluate the indications which might apply to my patients.

As a rheumatologist, I treat patients with osteoarthritis and fibromyalgia syndrome, as well as a diverse group of immune system disorders including rheumatoid arthritis, lupus, ankylosing spondylitis and vasculitis.

Many of these conditions may be painful and chronic. Some of them are life-threatening and may require life-long treatment.

WHAT’S COVERED IN LAW?

Since my patients are already asking me for prescriptions for medical marijuana, I looked to see if these conditions were specifically identified in the current law.

They were not. They seem to fall under the catch-all category of the medical marijuana law as: “Debilitating medical conditions,” defined as “a chronic disease or medical condition that produces intractable pain — pain that has not responded to ordinary medical measures for more than 6 months.”

In other words, the patient tells me their pain is intractable, therefore medical marijuana is indicated.

When I reviewed the literature and looked for well-designed trials establishing medical marijuana’s effectiveness in pain as it relates to osteoarthritis, a common form of arthritis affecting more than 20 million Americans, there were no trials to evaluate. None.

Fibromyalgia syndrome, a disorder that affects an estimated 6 million patients? None. Vasculitis? None.

Rheumatoid arthritis? One small Canadian study published in 2006 found marginal benefit with an oral spray form of marijuana called Sativex involving 55 patients.

That’s it, for a chronic painful disorder that affects 1 percent of the U.S. population.

Yes, there are a number of small, placebo-controlled studies assessing the effectiveness of marijuana in cancer pain, chemotherapy-induced nausea, multiple sclerosis and glaucoma.

Yes, there are animal studies that hint at beneficial effects on the immune system with marijuana.

Yes, it has historically been difficult to perform adequate studies due to the classification of marijuana as a Schedule 1 drug by the federal government.

Yes, there may be future studies someday documenting the effectiveness of marijuana on various rheumatologic diseases.

But, alternatively, these future studies may show no effectiveness, or potential deleterious unforeseen side-effects, or interactions with other medications commonly prescribed.

What research is out there is painfully thin. There is much we just don’t know.

The prescribing of medical marijuana is a unique and curious social phenomenon.

It has been incorporated into my prescription options not through approval by the Food and Drug Administration, not through vigorous placebo-controlled trials, but through the ballot box.

DESIRES IN CONFLICT

The majority of Maine voters decided to have it available as a medical option.

Paradoxically, most patients want their doctors to evaluate scientific evidence and prescribe medications that are found scientifically to be effective and safe in well-controlled studies.

The use of medical marijuana, in my specialty of medicine at least, fails this test. For now, I won’t be prescribing it.

But as a physician, I look forward to the time when well-designed studies answer the critical question: Is medical marijuana an effective treatment for my patients?

 

- Special to the Telegram