Medical Marijuana

Now that medical marijuana is legal in 29 states, including Massachusetts, there is quite a lot of conversation among cancer patients and between patients and providers about its use. It is interesting and troubling to me that most providers are not so well informed and choose not to participate much in the discussion. When I have talked with several of our doctors, they express concern that it is not nationally legal, and that they are worried about their own position in writing prescriptions. At least in Massachusetts, the process is rather arduous and there are a limited number of legal pharmacies.

As long as I have been doing this work, there have been patients who used marijuana for help with mood or anxiety or nausea. Until fairly recently, it was always weed that was purchased illegally, and patients were fairly reticent to talk about it. Since 1985, a drug called Marinol has been legally available by prescription anywhere in the United States. And what is its active ingredient? Answer: a synthetic version of THC, the active ingredient in marijuana.

My experience has been that Marinol, like every other medication used for similar purposes, helps some patients, but not all patients. Other people preferred to smoke or use edibles, and that, too, helped some people, but not everyone. It makes sense that this seems to be the same experience with medical marijuana. I do think that physicians have an obligation to learn more about the law and the process and be able to, at least, be a resource for their patients who are interested in this approach.

From Heather Millar in the New York Times:

Should You Consider Medical Marijuana?

Lots of people dealing with cancer wonder about the potential benefits of medical marijuana, and the discussion about whether or not to use it comes up often in cancer treatment centers. The questions often fall into several categories: Does it treat cancer? Will it manage the side effects of chemotherapy, radiation or surgery? Can it quiet my worry about cancer?

One patient named Bill, an engineer, asked if he could use marijuana to treat his prostate cancer. He said that he had found some studies online from other countries that showed marijuana was used to cure people of cancer. Unfortunately, there's no solid scientific evidence that marijuana holds curative powers.

We would need a number of quality studies (which doctors call randomized controlled trials) involving a large number of people who have a specific kind of cancer and who are using a very specific type and dose of drug in order to prove that something is a cure for cancer – and that kind of research hasn't been done on marijuana.

Another patient, Sara, struggled with nausea and low appetite during chemotherapy for breast cancer. She asked about using marijuana to help her low appetite and lack of energy. Many patients have reported benefit from using marijuana for nausea and vomiting. But because marijuana is a complicated plant (it has over 400 compounds) and people take marijuana in a variety of forms (smoking, eating, oil drops), it was hard for Sara's doctor to recommend a specific marijuana remedy for her nausea. Prescription medications like dronabinol and nabilone are cannabinoids (one compound from the marijuana plant) that can be used for nausea, in addition to many other available medications for nausea. Because the prescription medication has a specific dosing guidelines, and there is regulation and quality control of medications, Sara's doctor recommended she try one of the approved prescription cannabinoid medications first. Her doctor also got Sara to focus on a healthy diet and change from soda to ginger tea, which diminished Sara's nausea.

Read more about Medical Marijuana at the Harvard Health Blog.

And, if you are interested, here is an article from Medscape that is directed at clinicians:

Physicians' Knowledge of Marijuana Risks Falls Short

By Batya Swift Yasgur, MA, LSW

Physicians need to be familiar with issues surrounding contemporary cannabis use so they can counsel patients regarding its risks, new research suggests.

Cannabis can cause psychosis and impaired social or occupational functioning and can create safety risks for the families of users, the investigators note. They add that in order to provide adequate counseling, physicians must understand the patient's patterns of use, including the type, dose, and delivery method of the cannabis product.

"We noticed that many of our patients were using novel cannabis products that we didn't know much about. We realized that many physicians — including us — had only basic, often dated knowledge," lead author Jeremy Peters, DO, Department of Psychiatry, the Oregon Health and Science University, Portland, told Medscape Medical News.

The investigators undertook the review to educate clinicians, who should "absolutely initiate discussion with patients about cannabis use, even though the available time with patients is often limited," said Peters. The review was published in the February issue of the Journal of the American Osteopathic Association.

Print Medscape's Physicians' Knowledge of Marijuana Risks Falls Short