• The Role of the Physician in “Medical” Marijuana

    Below is the executive summary of the 2010 American Society of Addiction Medicine (ASAM) white paper republished by The Journal of Global Drug Policy and Practice:

    During the past 40 years, popular interest in the therapeutic potential of marijuana, also known as cannabis, has significantly increased, propagated by widespread media attention. Because cannabinoid research poses special challenges, data from such research has accumulated slowly and only recently has gained substantial attention within the scientific and medical communities.

    Research about the therapeutic potential of cannabis and cannabinoids has fallen behind that of other modern medications. Hence, all cannabis-based and cannabinoid medications should be subjected to the strict scrutiny of the Federal Food and Drug Administration (FDA) regulatory process. This process provides important protection for patients, making medications available only when they:

    1.)  Are standardized by identity, purity, potency, and quality;

    2.)  Are accompanied by adequate directions for use in the approved medical indication;

    3.)  Have risk/benefit profiles that have been defined in well-controlled clinical trials.

    The FDA has set forth the criteria that must be met if a botanically-based medication is to achieve marketing approval through this process. All the major medical organizations support the FDA approval process. Both the American Medical Association (AMA) and the American College of Physicians (ACP) have rejected the use of state legislative enactments to determine whether a medication should be made available to patients. The Institute of Medicine has also rejected this approach and has called for further research into the development of nonsmoked, reliable delivery systems for cannabis-derived and cannabinoid medications.

    Medical marijuana,” currently distributed pursuant to state legislation, does not follow critically important aspects of the modern scientific model. It lacks quality control and standardization; can be contaminated with pesticides and microbes; and does not assure patients a reliable and reproducible dose. Increased cannabis potency heightens the risk of adverse events, especially among cannabis-naive patients, as well as the dangers of dependence and addiction. There are no effective risk management measures to prevent diversion and abuse, especially by adolescents.

    The practice of medicine must be evidence-based; all medical interventions should be justified by high-quality data. Despite the rarity of rigorous scientific data, dispensaries are now distributing cannabis and cannabis products to large numbers of individuals. Yet physicians, who are being appointed the gatekeepers of a patient’s access to cannabis under state law, have inadequate information on which to base their judgment if they choose to discuss cannabis as a treatment option with their patients. Physicians should carefully consider their ethical and professional responsibilities before issuing a cannabis recommendation to a patient. In order for physicians to fulfill their professional obligations to patients, and in order for patients to be offered a high standard of medical care, cannabis-based medications must meet the same exacting standards that apply to other prescription medicines. A physician should not advise a patient to seek a treatment option about which the physician has inadequate information regarding composition, dose, side effects, or appropriate therapeutic targets and patient populations.

    Source:  http://www.globaldrugpolicy.org/Issues/Vol%205%20Issue%204/ASAM%20with%20front%20page.pdf

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    Categories: Substance Abuse

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