Michael Kirsch, MD:
Promoting
medical marijuana use is hot – smokin’ hot. States are racing to
legalize this product, both for recreational and medical use. In my
view, there’s a stronger case to be made for the former than the
latter.
Presently, marijuana is a Schedule I drug, along with
heroin, LSD and Ecstasy. The Food and Drug Administration (FDA) defines
this category as drugs with no acceptable medical use and a high
potential risk of addiction. Schedule I contains drugs that the FDA
deems to be the least useful and most dangerous. Schedule V includes
cough medicine containing codeine.
On its face, it is absurd that
marijuana and heroin are Schedule I soulmates. I expect that the FDA
will demote marijuana to a more benign category where it belongs. It
will certainly have to if marijuana is going to be approved as a
medicine.
There is no question that some advocates favoring
medicalization of marijuana were using this as a more palatable route to
legitimize recreational use. The strategy was to move incrementally
with the hope that over time the ball would cross the goal line. We have
seen this same approach with so many other reforms, legal decisions and
societal acceptances, many of which we take for granted. Consider gay
marriage and women’s role in the military as two examples of goals that
required a long journey to reach.
Marijuana has had no personal
or professional role in my life. I do not object to responsible
recreational use and would support such a measure. To criminalize
marijuana use while cigarettes, chewing tobacco and alcohol are entirely
legal seems inconsistent and hypocritical. Is smoking marijuana more
dangerous than riding a motorcycle?
Paradoxically, I have
hesitancy at this point to endorse medical marijuana use based on the
fragmentary data that supports its efficacy. If you ‘Google’ this
subject, and you believe what you read, you will conclude that marijuana
is the panacea we’ve been waiting for. It helps nausea, neuropathic
(nerve) pain, glaucoma, muscle spasms, Crohn’s disease, multiple
sclerosis, epilepsy, Hepatitis C, migraines, arthritis, Alzheimer’s
disease, cancer and numerous other ailments. Do we accept so readily
that one agent can effectively attack such a broad range of unrelated
illnesses? It sounds more like snake oil than science.
Shouldn’t high quality medical studies demonstrate benefit before we sanction medical marijuana use?
The
medical profession and our patients should demand that all our
medicines be rigorously tested for safety and efficacy. I realize that
there is huge public acceptance that marijuana is real medicine. Not so
fast. Let the FDA evaluate marijuana as it does for all medications and
treatments. I do not think we should relax our professional standards
just because the public is willing to inhale without evidence and
entrepreneurs want to cash in.
If you had a chronic disease,
would you expect your doctor to offer you a medicine with definite risks
but no proven benefit? Why would you accept it and why would he
prescribe it?
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