Despite the fact that marijuana remains a controlled substance that is illegal in the United States under federal law, 16 states and the District of Columbia have legalized "medical marijuana." Del. Cheryl Glenn's HB15, the "Maryland Medical Marijuana Act," was introduced and first read on Jan. 11, the first day of this year's General Assembly session. Two more bills calling for legalization of medical marijuana have been introduced since. We would like to make the case that medical marijuana, as currently "prescribed," makes a farce of medicine.
While inhaled marijuana may have some medical benefits, to legislate medical treatments evades the standard protocols that the Food and Drug Administration has put in place for the regulation of all other medications. Why would this "medication" alone be exempt from the usual monitoring and safety regulations, especially given that we know significant risks are involved with the use of inhaled cannabis?
In all states but one where medical marijuana is legal, access is granted with a card, authorized by a physician, and the card expires in one year. There is no stipulation as to dose or frequency of administration, or for standard follow-up appointments to determine whether the marijuana is helpful or is causing side effects. For those people in whom marijuana induces a negative reaction in the form of an addiction, lowered motivation, paranoia or even schizophrenia, no mechanism exists for the physician to monitor or halt use of the drug if the patient wishes to continue using it against medical advice. This is a strange way to prescribe the use of a controlled substance.
Medical marijuana is distributed by specialized dispensaries — not pharmacies — or patients are permitted to cultivate their own. In some states, these are marketed as boutiques with a variety of "flavors" and preparations, and the message is that smoking marijuana is part of "wellness." There is no quality control to regulate the potency of the active ingredient or to standardize and safeguard the product being delivered.
While it seems heartless to oppose the legalization of marijuana for those who are suffering from cancer, end-stage AIDS or debilitating pain, medical marijuana is often used for a much wider variety of conditions that fall under the realm of "chronic disorders."
In Colorado, it is estimated that only 2 percent of registered medical marijuana users suffer from cancer or AIDS. Medicinal marijuana is often prescribed for psychiatric conditions such as insomnia, anxiety and mood disorders — and often by prescribers who have no specialized training in psychiatric disorders. There is no research to support this practice, and it is not the current standard to recommend marijuana for psychiatric conditions. In fact, cannabis is known to exacerbate and accelerate some psychiatric symptoms. Still, HB15 specifically stipulates five psychiatric conditions that medical marijuana would be indicated for: anxiety, depression, bipolar disorder, post-traumatic stress disorder and agitation in Alzheimer's disease. As psychiatrists, we are astounded.
Of the two other medical marijuana bills being considered by our state legislature, one, HB1024, would allow for medical marijuana to be distributed at academic centers with oversight by a Marijuana Commission, and would require that data and outcomes be collected and published. The other, HB1158, also would require the formation of a commission and would require training and certification of physicians who prescribe marijuana, but it would allow for prescription outside of academic centers and would not require data collection.
The wide variety of ways in which our legislators believe it is appropriate to use marijuana for medical conditions leaves one to wonder whether doctors, rather than lawmakers, shouldn't be making decisions about medical treatments.
Access to medical marijuana has led to litigation in facilities where controlled substances are restricted or tightly regulated, and correctional facilities have defended lawsuits by inmates seeking to continue smoking medical marijuana while incarcerated.
We believe that marijuana for medical conditions should undergo the same study, scrutiny and prescription monitoring as every other prescribed medication, and the current means of "prescribing" violates all of the usual practices of medicine. What other medication do we authorize for a year, with no stipulation as to frequency, dose or certainty that there has been a positive response without side effects?
It has been suggested that medicalization is the first step toward legalization, If legalization is, in fact, the goal, perhaps that can be done without physicians as intermediaries. While legalizing marijuana may not make sense from the standpoint of public health and safety, there are certainly many examples of ways we allow members of our society to put themselves at risk without legislating a role for physicians.
Dr. Dinah Miller and Dr. Annette Hanson are psychiatrists in Baltimore. They are co-authors of "Shrink Rap: Three Psychiatrists Explain Their Work," Johns Hopkins University Press, 2011. Their emails are dinahMiller@yahoo.com and firstname.lastname@example.org. A version of this article appeared on the Clinical Psychiatry News website.