- Since 1970, federal law has categorized marijuana as a Schedule I drug. This categorization is generally reserved for medications that are thought to have high potential for abuse and harm and no acceptable role in medical treatment. Furthermore, it is illegal to manufacture, distribute, dispense, or possess these substances. The Federal Government’s position on the status of medical marijuana is highlighted below.
- However, many states have rejected the federal government’s position based on their review of the potential benefits and harms. In fact, currently medical marijuana is legal in 29 states and Washington DC, Guam, and Puerto Rico. This conflict between federal and state law was addressed to some degree on August 28, 2013, when the federal Justice Department announced that that it would no longer prosecute marijuana offenses in states where it has legal status unless it involved distribution to minors, to states where it is illegal, involved drug cartels, firearms, or violence. The position of the current administration is not yet clear.
- It’s clear, however, that may patients are increasingly using medical marijuana or asking physicians if medical marijuana may help them. Advocates of medical marijuana have stated that it may be useful for the treatment of many conditions, ranging from seizure disorders, chronic pain, muscle spasticity, severe nausea, post traumatic stress disorder, anxiety disorder, as an appetite stimulant, sleep disorders and a number of other conditions. The list of resources below will be a reference for health-care providers to learn more about medical marijuana. This is not a comprehensive list but will direct the reader to information that reviews conditions that may be treated, the quality of evidence supporting the indications for treatment, potential dangers of medical marijuana use and basic information on the different types of substances (cannabinoids) in marijuana that may help treat symptoms or cause side effects. There is also information on the different approaches to delivering therapeutic effect.
Stoned: A Doctor’s Case for Medical Marijuana is written by a David Casarett, a hospice physician and currently Chief of Palliative Care for Duke University Health System. He reviews the compelling anecdotal stories suggesting benefit as well as the limited high quality evidence to support its uses as well as the medical, pharmacologic and legal difficulties in conducting these studies.
- Below is a book review in the New York Times and video-link to a TED Talk by the Dr. Casarett for a more abbreviated overview of the material discussed in the book.
- A recent article in JAMA reviewed the most common indications for medical marijuana and the quality of published evidence.
- This review from the New England Journal of Medicine details current concerns about the potential dangers of chronic marijuana utilization.
- The “Medical Cannabis Primer” is written by two physicians, Dr. Laura Bultman and Dr. Kyle Kingley, and succinctly reviews the biology/mechanism of action of the cannabinoids in marijuana and its synthetic analogues. It also offers a practical overview of its therapeutic use, safety/side effects, dosing, and various routes for administration.
- For pulmonologists, toxicity related to smoking marijuana is of great concern. Marijuana smoke contains many of the same substances (eg. tar, aldehydes) as cigarette smoke known to cause harmful disorders such as COPD and lung cancer. However, the published studies have not confirmed this risk in moderate-to-low dose users. It is not certain if heavy use increases risk. A few articles summarizing the effects of marijuana smoke on lung function and disease are listed below: