In the past decade several US states have enacted laws legalizing marijuana use to various degrees. Whilst these changes are very welcome federal laws at this time still classifies marijuana as an illegal substance. There are still many individuals doing jail time for various violations of marijuana statutes in both federal and state prisons across the country. In my medical practice I have used the legal marijuana derivative Marinol to treat various ailments but I have not recommended smoking weed, use of oils or edibles for any patient.
Some of my patients though have made their own decisions that marijuana or should I use the word cannabis served some of their health needs better and have elected to self medicate. In such cases I have learned to get out of their way whilst informing them that smoking cannabis daily has been associated with lung diseases such as COPD and there is a high likelihood that lung cancer could be a long term outcome for some daily users . At this time though there is no good research to support such a claim. I don’t see a lot of teenagers but for the few that I see I warn them that cannabis has been associated with low IQs in those who use daily in their teen years.
I still remember one patient who came to my office after the Maryland State Legislature legalized marijuana for medical use requesting a prescription. In that case the gentleman’s disease and prior treatment history did not meet Maryland State Criteria to recommend Medical Marijuana so I had to burst his bubble on that. The state Maryland has reserved that option for individuals who have tried other forms of therapy unsuccessfully. At that time though there were no dispensaries in our state and my patient would have had to travel to Washington DC if he needed to acquire marijuana legally. Today though there are up to 71 licensed dispensaries all over the state in several different stages of licensure, there are even online stores that provide marijuana derivatives from the hemp plant.
In my practice I have encountered several patients who insisted that smoking marijuana alleviates various ailments. Several individuals have mentioned that smoking weed was better for different types of pain symptoms than most opioid analgesics. In one case when one patient had to choose between stopping marijuana use so he can continue receiving prescriptions for opioid analgesia the individual chose to self-medicate with marijuana instead.
Cannabis today is slowly moving into the realm of everyday medical care. The rapid increase in CBD (Cannabidiol) and THC (Tetrahydrocannabinol) infused product on the markets is pushing the FDA to take a closer look at Cannabis. This week the FDA has invited Experts and Companies involved in the Marijuana industry to provide input on Regulations on both recreational and medical use of Marijuana
Whatever the FDA decides it is clear that use of Marijuana in our society is moving in the direction of broader acceptance. Former Republican Congressman and Speaker of the House of Representatives who in 2011 had been a vociferous opponent of Marijuana legislation said in March this year that his views on Marijuana evolved has he became aware of more and more individuals who use marijuana for health needs needs like chronic pain and PTSD (Post Traumatic Stress Disorder). Whilst I would like to applaud Boehner on his open-minded appraisal of the benefits of cannabis one must be well aware that this recent. evolution was also associated with his membership on the board of Acreage Holdings a publicly traded company in New York State that specializes in the distribution of Cannabis across 11 states.
At this time it is not really clear how much of John Boehner’s newly discovered love of Cannabis is the age old love of the green back as opposed to a real appreciation of the benefits of this popular centuries old herb.
With the rapid evolution of Marijuana laws across various states the usual federal government delays in legislative evolution has created some problems for this industry. Today most local Marijuana businesses are still cash only businesses. This unique situation has spurred a whole new business involved in the protection and transportation of the proceeds of these business to facilities that specialize in offering financial services to Marijuana businesses since most banks refuse to serve this billion dollar industry. There is currently a bill proposed by Democratic Congressman Ed Perlmutter from Colorado The Safe Banking Act in March this year, this bill has stalled in The House of Representatives.
At the time though most individuals involved in the industry believed that by the end of 2019 Marijuana banking would be moving into the mainstream federally. This may be too optimistic since others believe this would require a federal legalization bill which may be more complicated.
Whatever happens on the federal front though, I would advise that individuals interested in seeking Marijuana for health reasons follow these simple rules;
- Be aware of your local laws governing the use of marijuana and its products.
- Have an open and honest conversation with your primary physician (if your physician is not well informed and this is important to you consider looking for a new one)
- Always consider the use of other medicines and products that have been studied more extensively
- Use the same caution with marijuana use as you would alcohol and opioid analgesics and avoid driving or operating heavy machinery whilst using this drug.
- Be aware that the euphoria associated with the use of THC products may make it difficult for you to honestly determine if this drug is helping you as expected or just making you feel good.
On this note I would like to say that whatever happens with Federal Legislation all doctors must view Marijuana products as one of the many drugs available to us and our patients and educate ourselves to enable us help our patients better.
Dr. Leonard Sowah is an internal medicine physician in Baltimore, Maryland
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