Medical Marijuana: Smoke & Mirrors?

By Jason M. Broderick
Published: Thursday, May 20, 2010
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In January, New Jersey became the 14th state in the nation to legalize marijuana use for certain chronic illnesses. Other states where the use of medical marijuana is permitted include Alaska, California, Colorado, Hawaii, Maine, Michigan, Montana, Nevada, New Mexico, Oregon, Rhode Island, Vermont, and Washington; around a dozen more states are weighing pending bills. The New Jersey law is the most restrictive in the nation and authorizes prescribed marijuana for only a handful of chronic illnesses, such as multiple sclerosis, cancer, glaucoma, epilepsy, Crohn’s disease, AIDS, muscular dystrophy and Lou Gehrig’s disease. Unlike other states, physicians in New Jersey will not be able to prescribe medical marijuana for anxiety, headaches, or chronic pain.

The state plans to authorize 6 dispensaries, and patients will receive identification cards authorizing them to purchase the drug. They will not be able to grow their own marijuana or use it in public, however. And individuals without a prescription will still be subject to criminal prosecution if caught in possession of marijuana.

Richard J. Rosenbluth, MD, is medical director of the Hospice Program and division chief of Geriatric Oncology at John Theurer Cancer Center at Hackensack University Medical Center in New Jersey. He is also the editor of the Journal of Pain Management, and he supports New Jersey’s decision to legalize marijuana for medical use, predicated on a physician’s determination that good clinical evidence exists to prescribe it. “I believe any drug that might be beneficial should be decriminalized, if currently not available,” he said. “Marijuana should be available and doctors should treat it as any other drug, as per the Medical Board of California’s 2004 recommendations,” said Rosenbluth.

Shifting attitudes toward medical marijuana

According to Patrick Stack and Claire Suddath, authors of “A Brief History of Medical Marijuana,” published in Time, medicinal marijuana can be traced back to Emperor Shen Neng of China, who prescribed marijuana tea in 2737 BCE as a treatment for gout, rheumatism, malaria, and poor memory. Its use became widespread throughout Asia and the Middle East. As of the late 18th century, medical journals in Britain and the United States were recommending hemp seeds for everything from inflamed skin to incontinence and venereal disease. Marijuana for medical use eventually fell out of favor in the United States, however, as state and federal regulators imposed increasingly harsh criminal penalties for growing, possessing, using, and selling marijuana.

Paul M. Zeltzer, MD, clinical professor in neurosurgery, David Geffen School of Medicine, University of California Los Angeles, explained that medical marijuana has been tainted with an association between marijuana and criminal enterprise. “Smoking medical, ordinary marijuana helps to alleviate many symptoms of pain and depression in persons who have cancer,” he said, but he noted that marijuana use has been commingled with “an underground that involves crime syndicates and domestic/foreign nationals who may kill and maim in the process of cultivation, acquisition, and distribution.” Some people have had trouble divorcing these two issues. “One alternative,” Zeltzer suggests, “would be for [marijuana] to be [completely] legalized, thus sidestepping or eliminating the crime connection and adding to our country’s tax base.”

Although a minority of Americans support legalizing marijuana outright, 81% do support legalizing marijuana for medical purposes, according to an ABC News/Washington Post poll. Presidential administrations have differed on what approach to take toward medical marijuana, which remains a federal crime. Under the Obama administration, the Justice Department formally announced that it will not prosecute people who are using marijuana in compliance with state laws that permit its use for medicinal purposes. This is a reversal of the position taken by the previous administration, which dispatched federal agents to raid marijuana dispensaries and farms in states with legalized medical marijuana. Operators were charged under federal drug laws.

The FDA maintains that “marijuana has a high potential for abuse, has no currently accepted medical use in treatment in the United States, and has a lack of accepted safety for use under medical supervision.” Though the FDA bans the use of raw marijuana, delta-9- tetrahydrocannabinol (THC) is the herb’s most active ingredient and has been available by prescription as dronabinol (Marinol) since 1985. It is sometimes used to treat chemotherapy-induced nausea and vomiting. Rosenbluth said in terms of patient benefit, research fails to show either dronabinol or raw marijuana as superior to one another. He added that “anecdotally, patients who have prior history of smoking marijuana seem to get more benefit from smoking than from oral preparations.” The NCI advocates THC use only when first-line therapies prove ineffective.

How does medical marijuana affect patients?

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