Should I consider prescribing marijuana?

[Juicyfruit12]

Medical marijuana has recently been approved in my state. However, the president of our local medical association seems to have some political differences with our governor. The president of our local chapter medical association has sent out a notification to all of the doctors warning us that prescribing marijuana, which has no FDA approval, could lead to us getting our license revoked in the future.

My question is whether I should consider prescribing the drug for some of my chronic pain patients (Such as: multiple sclerosis, neuropathy from HIV, etc.) if it's legal at our state level. Why should I have to worry about what our local chapter president has to say? If I am following the correct algorithm for prescribing this controlled substance, and I am ONLY prescribing it for the conditions it has been approved to treat, why would it matter?

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[Winged Scapula]

Medical marijuana has recently been approved in my state. However, the president of our local medical association seems to have some political differences with our governor. The president of our local chapter medical association has sent out a notification to all of the doctors warning us that prescribing marijuana, which has no FDA approval, could lead to us getting our license revoked in the future.

My question is whether I should consider prescribing the drug for some of my chronic pain patients (Such as: multiple sclerosis, neuropathy from HIV, etc.) if it's legal at our state level. Why should I have to worry about what our local chapter president has to say? If I am following the correct algorithm for prescribing this controlled substance, and I am ONLY prescribing it for the conditions it has been approved to treat, why would it matter?

Because its still against federal law. The DEA and the Justice Department may decide to aggressively enforce federal law over state law.

IANAL, but you're better off "recommending" marijuana and referring them to a center where someone else writes the prescription and provides the "medicine".

 

[gutonc]

Look at the law in your state. In mine, one of the "early adopter" MMJ states, marijuana is not prescribed. I fill out a form stating that my patient has one of the qualifying conditions (I'm an oncologist, cancer is the first thing on the list) and sign it. That's all I do. I don't recommend or prescribe it, only certify that my patient qualifies for it under the state law. They get a card from the state and can then legally (under state, but not federal law) grow or possess a certain amount of weed. They can also purchase from MMJ dispensaries.

Your state's law is likely to be similar. The law also probably has a clause that protects your license.

 

[TraumaLlamaMD]

Seems legit.

 

[the argus]

What dose and frequency are you going to write for? Will you allow generic substiutions, or specify a brand name? Which pharmacist is going to double-check your prescription and dispense the medication?

This whole thing is giant joke. "Medicalizing" a street drug is just absurd. If people wanna go get high, whatever. If the government wants to legalize it, whatever. But there is zero reason that any of us should be involved in this process at all.

what are you talking about? Many "street drugs" have been "medicalized". There are accepted medical uses for multiple drugs that people use recreationally, opioids, amphetamines, and cocaine being examples. Lots of pain medications are dosed PRN, with dosage and frequency restrictions based on overdose risk, which are not issues with marijuana.

There are many people, most with no history of illicit drug use, that find relief from their chronic pain using marijuana. The vast majority of people in the US live in places where you can't obtain pot legally. Physicians should absolutely consider this as a therapeutic option for certain patients, many of whom would not consider it on their own because they are not looking to just "go get high". You should spend some time around patients with cancer, MS, etc if you think these people are just looking for a legal loophole to get stoned. Of course some people abuse the system, but you don't throw the baby out with the bathwater.

The only real difference between opioids and marijuana for the treatment of chronic pain is that marijuana is much safer and cheaper.

 

[the argus]

You're right, almost. The other drugs have become standardized, with actual quantities of active ingredients known, no extraneous ingredients with unclear effects, etc. Pot is just a cornucopia of a bunch of stuff with highly variable levels of THC. It's not a medication. Turn it into medication and we can talk. Until then, "Smoke one blunt as needed" doesn't qualify as a prescription.

There are many instances in medicine of using medications that are a collection of things, some of which are not identified, or medications where the MOA is not directly understood. Blood products such as FFP or IVIG are good examples, as are most psych medications. It's unknown exactly what is in these blood products, and its also unknown exactly how blood products and psych meds work. But we know they do work and are relatively safe, so we use them. And as I said above, knowing the exact dose is great, but in many instances we have no idea what dose is actually going to be therapeutic, so you just increase until you get a response. A unit of FFP is just as arbitrary as a blunt of Maui Wowie. It's a standardized amount, but you have no idea what total amount will ultimately be therapeutic.

The fact that we don't know the full collection of compounds in marijuana, or the exact MOA of these compounds, is irrelevant. If a person states that marijuana helps with their pain, and knowing that marijuana is extremely safe, I think "smoke one blunt as needed" is perfectly acceptable. There are lots of different kinds of marijuana, but if a person finds one that works for them, they can continue to use that same kind, effectively creating a standard dose. That dose might work for them but not for someone else, just like the dose of morphine that works for one person might not work for another.

 

[shojimoji]

I can very proudly proclaim that I will give up my license before providing marijuana to any patient. I have seen very many families affected by children getting stuck on it. It is very tragic situation. Please try and protect youth from these evils.

 

[WholeLottaGame7]

I can very proudly proclaim that I will give up my license before providing marijuana to any patient. I have seen very many families affected by children getting stuck on it. It is very tragic situation. Please try and protect youth from these evils.

Going to make it your whole career without prescribing opioids, either? I know it sounds sarcastic, and it sorta is, but it's also a legit question. Opioid abuse ruins a lot more families these days than marijuana.

I, too, am curious as to how the whole prescribing thing will work out. I realize there aren't any better options right now than to let patients figure it out themselves, but I've gotta think/hope there will be a more controlled, standardized method in the future.

 

[backrow]

One of the greatest lines I heard in regards to medical marijuana and glaucoma:

"Great, we correct your pressure for a short time, but you get to be stoned all day. Sounds like a great idea!"

 

[shojimoji]

Going to make it your whole career without prescribing opioids, either? I know it sounds sarcastic, and it sorta is, but it's also a legit question. Opioid abuse ruins a lot more families these days than marijuana.

I, too, am curious as to how the whole prescribing thing will work out. I realize there aren't any better options right now than to let patients figure it out themselves, but I've gotta think/hope there will be a more controlled, standardized method in the future.

When you see innocent children in the psyhiatric ward who were goaded into this lifestyle by family and friends, you will see the destruction it can cause. One girl told me during observership that her father (chronic pain patient) gave her the marijuana because he thought it was something they have bonding over.

I am going into Psychiatry study of mental illness, o I will not have much need to prescribe opiods which I am very happy about it.

 

[Gastrapathy]

Yup, cuz those anxiolytics and sleep aids have no potential for abuse.

I'm pretty sure you are just naive but this sort of certainty can cause some major distress when confronted with that not so clean reality that the rest of us call the real world.

 

[shojimoji]

Yup, cuz those anxiolytics and sleep aids have no potential for abuse.

I'm pretty sure you are just naive but this sort of certainty can cause some major distress when confronted with that not so clean reality that the rest of us call the real world.

Of course there is potential for abuse I am not denying it. But I just do not like the people who take marijuana for migraines then give some to their children in baked goods or those that take fentanyl lollipops away from their kids. I just see marijuana as a gateway drug for children and I would like to join coalition to stop the distribution of this harmful drug.

 

[VA Hopeful Dr]

Yup, cuz those anxiolytics and sleep aids have no potential for abuse.

I'm pretty sure you are just naive but this sort of certainty can cause some major distress when confronted with that not so clean reality that the rest of us call the real world.

Hence why some of us don't prescribe either of those chronically either...

 

[WholeLottaGame7]

Of course there is potential for abuse I am not denying it. But I just do not like the people who take marijuana for migraines then give some to their children in baked goods or those that take fentanyl lollipops away from their kids. I just see marijuana as a gateway drug for children and I would like to join coalition to stop the distribution of this harmful drug.

For some reason you have built this up in your head as a major issue, when in reality it will be a very small subset of children admitted to a psychiatric ward. You will see much worse things than marijuana use landing kids on a psych ward, and much more frequently.

The point I am trying to make is that as physicians, we are responsible for prescribing a wide variety of drugs, all of which have dangerous side effects when abused or taken incorrectly. EVERY thing we do in medicine has a risk and a benefit. Your job as a physician is not to avoid prescribing a medication because it might be abused, but to prescribe appropriate drugs in an appropriate manner to appropriate patients. We try to minimize the risks and maximize the benefits.

Then again, you could specialize in psychotherapy and just avoid prescribing all together, which is totally fine, but you can't make it through residency without prescribing medications.

I'm also not saying it's wrong to be wary of a particular drug (such as marijuana). I think there are perfectly good reasons to not want to prescribe it. It just sounds from your posts that you are regurgitating a lot of propaganda without considering other sides of the issue.

 

[hamstergang]

I just see marijuana as a gateway drug for children

Well this is an empirical question, not one you can just guess an opinion on. If I'm not mistaken, the whole gateway theory with marijuana didn't pan out (but alcohol and cigarettes have stronger cases for them being gateway drugs).

 

[serimeri]

I'm curious. If one has a medical license for marijuana, obviously it will show up on drug screen, but can this disqualify them form employment at a hospital?

 

[VA Hopeful Dr]

I'm curious. If one has a medical license for marijuana, obviously it will show up on drug screen, but can this disqualify them form employment at a hospital?

Yes

 

[Raryn]

I'm curious. If one has a medical license for marijuana, obviously it will show up on drug screen, but can this disqualify them form employment at a hospital?

It gets worse than that. Even in states where it is otherwise completely legal for personal consumption, like Colorado, the medical board reserves the right to pull your license for using pot. And they clearly state that they *will* do it.