When the Government Promotes Medical Marijuana Use for Pain

Brandon Cohen

A new law in Illinois encourages patients to request marijuana as a substitute for prescribed opiates. A recent article on Medscape described the initiative and asked healthcare professionals for their opinions. The responses came quickly and ardently.

Many were completely in favor of the new idea. A physician's assistant saw it as an issue of basic decency:

We have an epidemic of undertreated pain. This suffering is cruel and unnecessary

An internist continued in this vein:

Cannabis has the safest therapeutic index of any scheduled drug. It is safer than acetaminophen and NSAIDs... As a physician who has seen the broad scourge of the opiate epidemic decimate towns all over the land, I find this therapeutic substitution not only timely but essential.

But more than a few were worried about how well-regulated marijuana would be. One primary care physician spoke for many:

I live in a state where marijuana use has been legalized, and I watch people using it on a daily basis in my community with less instruction than what you receive on a bottle of ibuprofen... Who is going to support my prescribing, or is this off-label and I'm naked here?

Another physician saw dark forces at work:

Use marijuana for chronic pain, and make the patient so brain-addled that even if he feels no pain, he'll be useless as a member of society. Opiates, properly dosified, leave the patient's mind clear to pursue his/her life normally. Once marijuana is legal all over, we'll have a doped-up population easy to manipulate by the very few who make money out of that particular drug trade and are smart enough not to use it at all themselves.

An anesthesiologist relied on dramatic phrasing to hammer home the point:

What could possibly go wrong? Two words: opioid epidemic. Will this social experiment with cannabis be the same? The evidence is not there yet for prescribing cannabis for chronic pain.... This is madness.

A primary care physician added:

With the known or suspected dangers associated with marijuana use, such as increased risk for schizophrenia and cardiac conditions, it seems extraordinarily irresponsible to substitute one addictive substance for another with unproven benefit.