The case for researching benefits of marijuana

Richard Feldman 
I struggle with the issue of legalization of marijuana, knowing what I know as a physician, but understanding the problems associated with its continued status as an illegal drug.

For now, permit me to discuss medical marijuana, its potential medical uses, and suggest one change in federal regulation.

The tide has turned in America regarding attitudes toward marijuana. Medical marijuana is now legal in 23 states, and in the near future, medical marijuana will be legal in the majority of states. Colorado, Alaska, Washington, Oregon, and the District of Columbia have legalized recreational use; more than 14 states are now considering legalization of medical or recreational marijuana.

A national survey of physicians’ attitudes and beliefs regarding medical marijuana was recently released. Nearly 70 percent of physicians questioned believed that marijuana possesses therapeutic benefits and 49 percent indicated that the benefits outweigh the risks (many physicians did indicate concerns about untoward effects). 

Sixty-eight percent of physicians in the study responded that marijuana should be a medical option, and when asked if it should be legalized, just more than half of physicians answered affirmatively. Surprisingly, a higher percentage of physicians believed that marijuana possesses therapeutic benefits than did lay people questioned in the study.

Richard Feldman (Photo: Provided)

That being said, review of the medical literature indicates that the legalization of medical and recreational marijuana remains controversial. From discussions with Indiana physicians, it appears that they have a more negative opinion of marijuana compared to the national survey.

Marijuana and synthetic pharmaceutical cannabinoids (two approved by the FDA and others available in other countries) have demonstrated evidence-based medical benefits for specific ailments by legitimate scientific studies. There are also ample additional credible empirical reports for smoked marijuana. It should be noted that some of the studies used oral pharmaceutical cannabinoid products, not smoked marijuana.

From this experience, marijuana has demonstrated therapeutic benefits for a number of conditions including moderate to severe chronic pain, especially neuropathic pain; recalcitrant epilepsy; nausea, especially in cancer patients receiving chemotherapy; spasticity in multiple sclerosis patients; and possible benefits in inflammatory bowel disease, fibromyalgia, and glaucoma.

It has also displayed utility for stimulation of appetite and weight gain in cancer and AIDS patients with anorexia/cachexia. There may even be an antiviral effect in late-stages of HIV infection. The prestigious Institute of Medicine acknowledges the benefits for many of these conditions. Clearly however, marijuana is not without worrisome harms, some proven, some theoretical, and some by association (but not proven as causal).

There are conflicting study results in some aspects of medical marijuana research. There is also discussion regarding whether smoked marijuana, synthetic oral cannabinoid medications, or established non-cannabis pharmaceuticals may have the greatest efficacy in specific illnesses.

The potential medical benefits of marijuana warrants much more research. One problem is that the federal Drug Enforcement Administration classifies marijuana as a “schedule I” drug. 

Other examples of schedule I drugs are LSD and heroin. These drugs are considered to have high abuse potential and no accepted medical use (for comparison, cocaine is in the lower schedule II). This classification not only criminalizes these drugs but also impedes research since studies require difficult-to-obtain special licensing by the DEA to be conducted.

Reclassifying marijuana to a less restrictive schedule could create a body of rigorous research necessary to identify not only specific evidenced-based medical uses for marijuana (which could also serve to tighten up state medical-marijuana statutes), but more importantly, the development of oral pharmaceuticals of purified cannabinoids. The American Medical Association, The Institute of Medicine, and the American College of Physicians support changes in federal regulations to this end.