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Voices: Medicinal cannabis: The genie is out of the bottle

Nov 18, 2015

Medicinal cannabis: The genie is out of the bottle | Christopher Lutman, MD

In 1996, Proposition 215 was passed by the citizens of California, which became the first state to legalize the usage of cannabis for medical purposes. Since that historic ballot measure, medicinal cannabis has now become legal in 23 states. It is also legal in the District of Columbia and the overseas territories of Guam and Puerto Rico.

Christopher Lutman, MD

Christopher Lutman, MD

Recently, Sen. Rand Paul, a physician, submitted bipartisan legislation (the CARERS Act of 2015) in the U.S. Congress for rescheduling marijuana and reforming cannabis laws at the federal level. Clearly, the proverbial genie is “out of the bottle” when it comes to cannabis legalization in the United States.

My home state (Ohio) does not have legalized medicinal cannabis. Earlier this month the citizens of Ohio soundly voted down Issue 3. This ballot measure was a first of its kind in that it proposed to legalize both recreational and medicinal cannabis in our state with one vote. This was unprecedented. Previous legalization efforts in other states have followed a gradual pattern of decriminalization followed by progress toward legalization of medicinal, and ultimately, recreational pot.

According to pundits and polls, the major reason Issue 3 failed in Ohio was because of the “monopoly style system” that would have been established here. Opinion polls have clearly shown that most Ohioans overwhelmingly support the legalization of medicinal cannabis.

As I watched the media circus surrounding Issue 3 unfold in Ohio over the past few months, I was struck by a simple fact: Most doctors do not appear to be involved in this important debate. Other than a few Ohio pediatricians speaking out on television about the perils of increased cannabis usage by teenagers; there has been no sensible evidence-based debate about cannabis as medicine “by physicians, for physicians.”

In my opinion, it is unfortunate that the only “medical opinion” about medicinal cannabis given to my fellow citizens recently was a widely distributed television endorsement of the “vote NO on Issue 3” campaign by the Ohio State Medical Association–a non-scientific, political lobbying organization.

In 1999, the Institute of Medicine issued a thoughtful and provocative report on medicinal cannabis. I would encourage all of my colleagues to review this document. In my opinion, it serves as a good starting point and a late wake-up call (published 16 years ago) for physicians now actively engaged in caring for seriously ill patients.

At this point in time, I am generally ambivalent on the usage of medicinal cannabis by my patients. I am trying to learn what I can, but solid data and firm conclusions about medicinal cannabis are sparse due to restrictive federal cannabis policies.

Unfortunately, much of the knowledge that our patients are receiving about medicinal cannabis at the local level is anecdotal and non-scientific. At best, in places like Colorado, non-medical “Budtenders” at cannabis dispensaries serve as “doctor-pharmacists” compassionately helping patients choose the right cannabis strains for their ailments. At its worst, in places like Ohio, drug dealers might be making recommendations to my patients on the usage of cannabis for a variety of symptoms and illnesses.

I am not ambivalent (nor naive) about the political and social realities of the age in which we practice. Physicians should become more aware and socially engaged on the issues surrounding medicinal cannabis. As a cancer doctor and palliative medicine specialist, I will continue to encourage myself and my colleagues to get engaged–scientifically and politically about medicinal cannabis.

If physicians continue to be sidelined by politicians and “ganjapeneurs” in the national debate on medicinal cannabis, then we risk losing yet more ground in our role as the primary drivers of best practices, patient advocacy and patient care. In my opinion, the sanctity of the doctor-patient relationship deserves more from us on the issue of medicinal cannabis.

The National Hospice and Palliative Care Organization (NHPCO) has proclaimed November as National Hospice and Palliative Care Month, to encourage citizens to increase their understanding and awareness of care at the end of life. The 2015 theme is “Hospice. Helps. Everyone.” Outreach materials are available through the NHPCO website and related articles have been posted on the organization’s Facebook page.