Questions about legal marijuana

Issue: BCMJ, vol. 59, No. 5, June 2017, Page 252 Editorials

“Hey, Doc, can you write me a prescription for medical marijuana?”

“Rick, you’re a healthy 25-year-old guy. What do you want it for?”

“Sometimes after work my shoulder or back hurts, so I smoke a joint.”

“How often does that happen?”

“A few times a day.”

Over the last few years, I have had numerous requests to prescribe medicinal marijuana. The majority of these have come from patients who already use the drug but want a script to cover themselves.

Years ago the only way a patient could receive a medical marijuana exemption was if they had one of a number of limited conditions and situations such as severe arthritis, symptoms from multiple sclerosis, and cancer pain. Rumor has it that certain BC communities had an exceedingly high rate of severe arthritis sufferers during this time period (you know who you are).

Eventually, the law changed and all conditions qualified as long as the patient had a valid prescription from a physician. Through the years, I have had marijuana prescription requests for anxiety, depression, bipolar disorder, insomnia, musculoskeletal pain, abdominal symptoms, fibromyalgia, and more. Many times, after I had declined the request, my patients would go to a marijuana dispensary and easily get a prescription. I’m not sure who was writing these scripts, but often a fee was charged. It is also unclear if a history or physical was done or if any face-to-face interaction occurred. Interestingly, I never had a patient report that they were refused a prescription.

With the federal government’s recent announcement that it plans to legalize marijuana by July 2018, all this will change. The government hopes this legislation will limit criminal involvement and also restrict marijuana access to our youth. This change in the law should also reduce the number of script requests, but perhaps patients will still require a prescription to obtain coverage from their respective medical plans.

The medical marijuana issue has been fascinating to me in many ways. Novel medical therapies and new medication approval are usually based on scientific principles and trials. The medicinal cannabis lobby has been advanced by special interest groups and members of society at large and hasn’t been guided by clinical trials or randomized double-blind studies. This movement has many so-called experts making fantastic claims of successful treatment of various medical conditions. They discuss how the varying percentages of cannabidiol oil and tetrahydrocannabinol (THC) are better for this illness or that ailment. These claims often seem too good to be true, and if investigated further, they don’t really hold up to scrutiny.

My experience has been that marijuana use is contributing significantly to a variety of mood disorders particularly among young people. My patients often claim that marijuana is the only thing that keeps them functioning, but if I can get them to stop using it, their depression or anxiety symptoms improve dramatically or even resolve.

The legalization of marijuana for general consumption marks a milestone in my lifetime as the first time a new recreational drug has been made legal. I wonder what challenges lie ahead. Will years of marijuana use be linked to the development of certain diseases? How will driving under the influence of marijuana be addressed? Will it be okay to use marijuana at work on coffee or lunch breaks? My bias is for unforeseen health and societal complications to arise from the decision to legalize marijuana, but perhaps I sound like the proponents for prohibition back in the early part of the 20th century. I guess time will judge whether this landmark decision is a good one. As a physician I just wish more science existed around the numerous biochemically active components of this plant prior to its expanded use.

For now I am just going to sit back with a brownie and watch the smoke rise.

David R. Richardson, MD. Questions about legal marijuana. BCMJ, Vol. 59, No. 5, June, 2017, Page(s) 252 - Editorials.

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