Medical Marijuana—Ready, Fire, Aim!

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?