To recommend, or not to recommend, medicinal marijuana? That's the question recently posed in a New England Journal of Medicine interactive online poll. To get a feel for physicians' opinions, NEJM presented readers with a fictional clinical situation. Here's the scenario:
"Marilyn is a 68-year-old woman with breast cancer metastatic to the lungs and the thoracic and lumbar spine. She is currently undergoing chemotherapy with doxorubicin. She reports having very low energy, minimal appetite, and substantial pain in her thoracic and lumbar spine. For relief of nausea, she has taken ondansetron and prochlorperazine, with minimal success. She has been taking 1000 mg of acetaminophen every 8 hours for the pain. Sometimes at night she takes 5 mg or 10 mg of oxycodone to help provide pain relief. During a visit with her primary care physician she asks about the possibility of using marijuana to help alleviate the nausea, pain, and fatigue. She lives in a state that allows marijuana for personal medicinal use, and she says her family could grow the plants. As her physician, what advice would you offer with regard to the use of marijuana to alleviate her current symptoms? Do you believe that the overall medicinal benefits of marijuana outweigh the risks and potential harms?"
Readers weighed in with a variety of impassioned opinions. And the results, the authors said, were surprising: 76% of respondents said they would recommend medicinal marijuana. Here's part of the discussion:
"Physicians in favor of medicinal marijuana often focused on our responsibility as caregivers to alleviate suffering. Many pointed out the known dangers of prescription narcotics, supported patient choice, or described personal experience with patients who benefited from the use of marijuana. Those who opposed the use of medicinal marijuana targeted the lack of evidence, the lack of provenance, inconsistency of dosage, and concern about side effects, including psychosis. Common in this debate was the question of whether marijuana even belongs within the purview of physicians or whether the substance should be legalized and patients allowed to decide for themselves whether to make use of it."
But the article concludes:
"Large numbers of voices from all camps called for more research to move the discussion toward a stronger basis of evidence."
And that's what I've heard from physicians over and over again, that we just don't have enough evidence to know for sure what's safe and what works.
Regardless, it's an incredibly timely discussion for Rhode Island:
- Just this afternoon, the Rhode Island Dept. of Health issued the final authorization for the Greenleaf Compassion Center to open for business (see my story from this morning about the look and feel of this brand new business and how retail marijuana dispensaries are striving for legitimacy).
- Also, Rhode Island lawmakers decided last night not to legalize marijuana for recreational use, but it's clear the idea is gaining steam nationwide.
- And finally, the fact that addictive prescription painkillers are sometimes hurting more than they're helping is motivating physicians and regulators alike to seek alternative pain management strategies.
Wherever you fall on the spectrum of opinions about medicinal marijuana, one thing seems certain: it's here to stay, and the business owners who've decided to sell it have decided the risks are worth it.