By Ginevra Liptan, MD
Marijuana is very effective as a pain reliever for many pain conditions, including fibromyalgia, and has a safety profile that far surpasses all currently available pain medications. So why don’t more doctors recommend it?
The biggest reason is that marijuana has only a semi-legal status from a physician’s perspective. Although it is legal for medical use in nearly half of all U.S. states, it is still classified as an illegal drug by the federal government. This disconnect puts physicians—whose practice is regulated by both state and federal laws—in a legal grey zone that makes many hesitant to recommend its use. As if the legal concerns weren’t enough, cultural stereotypes about recreational marijuana usage (what I call the “Cheech and Chong effect”) make it hard for doctors to take it seriously as a medicine.
To try to avoid any negative association, the preferred term for medical usage of this plant is cannabis. But frankly there isn’t much “medical” about medical cannabis right now. No doctor wants to recommend a patient try something called Trainwreck, Skywalker, or Girl Scout Cookies. The comedian John Oliver said it best: "If you want this drug with serious medical benefits to be taken seriously, how about adulting up the names a little bit? That way a sick old man doesn't have to ask for a quarter ounce of Rainbow Diesel Funkadelic Cheddar Harmony."
Currently regulation of the new cannabis industry is in its infancy, so products and strains can vary greatly in their ingredients, quality, and purity. This lack of consistency and safety regulations make it feel very “non-medical” to most doctors. Most of the high quality dispensaries and growers do put their products though fairly rigorous testing to assess for THC and CBD content, and to look for the presence of pesticides, mold, and other contaminants. But not all of them do this, and since there is no agency regulating this testing, it is on the “honor system.”
The final issue is that most doctors don't know anything about cannabis, so can't give guidance on dosing, strains, or usage. Any insight they may have comes not from any medical training comes but from what they may have, ahem, learned on their own during youthful experimentation. This is slowly starting to change. I was excited to see recently that now continuing education courses being offered to physicians about cannabis.
The legal landscape is changing fast, and I predict that federal laws regarding marijuana will change in the next few years. In the meantime, doctors should feel reassured because the Department of Justice has had an official “non-interference” policy with state laws about medical marijuana since 2009, and no U.S. physician has ever been successfully prosecuted or sanctioned for authorizing medical marijuana consistent with their state laws. To learn more about the laws in your state visit http://www.medicalmarijuana.procon.org or the Marijuana Policy Project at www.mpp.org.
My next blog post will review medical cannabis specifically for fibromyalgia.