Medical marijuana has been legal in Maine for almost 20 years. But Farmington physician Jean Antonucci says she continues to feel unprepared when counseling sick patients about whether the drug could benefit them.
Will it help my glaucoma? Or my chronic pain? My chemotherapy’s making me nauseous, and nothing’s helped. Is cannabis the solution? Patients hope Antonucci, 62, can answer those questions. But she said she is still “completely in the dark.”
Antonucci doesn’t know whether marijuana is the right way to treat an ailment, what amount is an appropriate dose, or whether a patient should smoke it, eat it, rub it through an oil or vaporize it. Like most doctors, she was never trained to have these discussions. And, because the topic still is not usually covered in medical school, seasoned doctors, as well as younger ones, often consider themselves ill-equipped.
Even though she tries to keep up with the scientific literature, Antonucci said, “it’s very difficult to support patients but not know what you’re saying.”
As the number of states allowing medical marijuana grows — the total has reached 25 plus the District of Columbia — some are working to address this knowledge gap with physician training programs. States are beginning to require doctors to take continuing medical education courses that detail how marijuana interacts with the nervous system and other medications, as well as its side effects.
Though laws vary, they have common themes. They usually set up a process by which states establish marijuana dispensaries, where patients with qualifying medical conditions can obtain the drug. The conditions are specified on a state-approved list. And the role of doctors is often to certify that patients have one of those ailments. But many say that, without knowing cannabis’ health effects, even writing a certification makes them uncomfortable.
“We just don’t know what we don’t know. And that’s a concern,” said Wanda Filer, president of the American Academy of Family Physicians and a practicing doctor in Pennsylvania.
This medical uncertainty is complicated by confusion over how to navigate often contradictory laws. While states generally involve physicians in the process by which patients obtain marijuana, national drug policies have traditionally had a chilling effect on these conversations.
The Surgeon General warns against the use of Marijuana, on August 13, 1982 – 34 years ago. Today physicians are still confused about it’s use, the side effects and when, why and if prescribing this drug is beneficial to their patients. One would think the first question would be, (1) will the effects of the drug negatively impact the user; i.e. will the euphoric effects override the necessity of being able to remember to smoke the weed?
The Surgeon General of the Public Health Service has issued the following warning on marijuana:
Marijuana use is a major public health problem in the United States. In the past 20 years, its’ use has increased 30-fold; it is estimated that more than a quarter of the American population has used it. The age at which persons first use marijuana has decreased gradually to the junior high school years. Until recently, nearly 11% of high school seniors used it, and although that figure has declined to 7%, its daily use still exceeds that of alcohol; more high school seniors use marijuana than smoke cigarettes. In a recent study, 32% of those surveyed had used marijuana during the previous 30 days, while 25% had smoked tobacco.
On March 24, 1982, the Department of Health and Human Services submitted to Congress a report reviewing the consequences of marijuana use. Marijuana and Health, 1982, ninth in a series, is primarily based on two recently conducted, comprehensive, scientific reviews by the Institute of Medicine of the National Academy of Sciences, the Canadian Addiction Research Foundation, and the World Health Organization (WHO). Both independent reviews corroborate the Public Health Service’s findings of health hazards associated with marijuana use: Acute intoxication with marijuana interferes with many aspects of mental functioning and has serious, acute effects on perception and skilled performance, such as driving and other complex tasks involving judgement or fine motor skills.
Among the known or suspected chronic effects of marijuana are:
- Short-term memory impairment and slowness of learning.
- Impaired lung function similar to that found in cigarette smokers. Indications are that more serious effects, such as cancer and other lung disease, follow extended use.
- Decreased sperm count and sperm motility.
- Interference with ovulation and pre-natal development.
- Impaired immune response.
- Possible adverse effects on heart function.
- By-products of marijuana remaining in body fat for several weeks, with unknown consequences. The storage of these by-products increases the possiblilties for chronic, as well as residual, effects on performance, even after the acute reaction to the drug has worn off. Of special concern are the long-term developmental effects in children and adolescents, who are particularly vulnerable to the drug’s behavioral and psychological effects. The “amotivational syndrome,” characterized by a pattern of energy loss, diminished school performance, harmed parental relationships, and other behavorial disruptions, has been associated with prolonged marijuana use by young persons. Although more research is required, recent national surveys report that 40% of heavy users experience some or all of those symptoms.
The Public Health Service concludes that marijuana has a broad range of psychological and biological effects, many of which are dangerous and harmful to health, and it supports the major conclusion of the National Academy of Sciences’ Institute of Medicine.
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