Doing No Harm: Physicians Should Just Say No to the Medical Use of Marijuana

By Steve Adelman, MD

As an addiction psychiatrist, I have seen marijuana do far more harm than good. So with the medical use of marijuana in Massachusetts now legal under state law, what should physicians do?

Last week, I attended a chilling presentation from Dr. Kevin Hill, an addiction psychiatrist at McLean Hospital, at a meeting of the Massachusetts chapter of the American Society of Addiction Medicine on the topic “Medical Marijuana: What is the Proper Role of the Addiction Physician?”

As we all know, the people of Massachusetts have spoken: last November, 63% of the voters endorsed Question 3, “The Medical Use of Marijuana.”

Since that time, the Department of Public Health has been scurrying to operationalize the so-called medical use of cannabis in the Commonwealth. The community of physicians has been scratching its collective head and wondering, “What in the world are we going to do about patient requests to become certified to purchase, or grow, so-called medical marijuana?”

I use the terms “so-called” and “medical marijuana” together, because there is scant scientific evidence to support the use of marijuana as a medication.

The US Food and Drug Administration has yet to approve any “smokable” medications. The Drug Enforcement Agency classifies marijuana as a Schedule 1 substance. Schedule 1 substances are defined by the DEA “as drugs with no currently accepted medical use and a high potential for abuse. Schedule 1 drugs are the most dangerous drugs of all the drug schedules with potentially severe psychological or physical dependence.”

Many users of marijuana become addicted, suffering withdrawal symptoms when they attempt to stop, and experiencing a variety of impairments as a result of chronic use. They continue using because they feel worse when they don’t use. Frequent use of marijuana by young people may impede the development of the brain (which continues until the mid 20s), interfering with education and work performance.

I am not taking a position on the legalization of marijuana, but I am taking a position against the medicalization of marijuana. I strongly believe that it is misguided. Although small numbers of individuals with intractable, debilitating medical conditions may derive some benefit from the use of marijuana “when all else fails,” so-called medical marijuana laws open up a floodgate to entrepreneurs who will profit from the sale of this valuable addictive substance.

All patients with certificates who are covered by MassHealth or by Social Security Disability Insurance (SSDI) will have the option of growing their own. There will be massive amounts of diversion to non-patients, and the price of marijuana will drop. The health and well-being of the greater public will be jeopardized for the relief of a few, and for the profit of the unscrupulous.

Physicians who have taken a pledge to “do no harm” should simply steer clear of the emerging Massachusetts medical marijuana debacle and “just say no.”  As physicians contending with the increasing demands of a complex and unevenly funded healthcare system, we should focus our attention on providing evidence-based care to patients, and sidestep getting involved in a social movement that is medical in name only.

Dr. Adelman is director of Physician Health Services, Inc., a corporation of the Massachusetts Medical Society. For more information, visit www.physicianhealth.org. Opinions expressed here are his own, and do not necessarily reflect those of the Massachusetts Medical Society or Physician Health Services.

  1. Susan Laster, MD says:

    I completely agree with Dr Adelman. I think it was irresponsible that our state allowed lawmakers and voters to involve themselves in telling physicians what to prescribe and how to prescribe it, especially without data to support its use. I simply do not understand how marijuana escaped the scrutiny, science, safeguards and oversight already in place for all the other medication we prescribe. As scientists we should insist on data. To prescribe a medication before it has been studied is negligent. Furthermore, it is completely nonsensical that this one prescribed substance will have its own dispensaries. If marijuana is considered a medication, shouldn’t it be packaged and dispensed at pharmacies by pharmacists in child proof containers, like every other medication? If the public wanted to legalize marijuana the way alcohol is legal, then the bill should have been drafted as such. If the public wanted to use marijuana as a medication, then lawmakers should have forced the public to wait for the studies to show the dosing, toxicities, risks, and benefits, as is done for every other medication we prescribe.

  2. Ed Gogek, MD says:

    Having taken part on this discussion, we might all be missing the point. If the Massachusetts law is like Arizona’s, Montana’s, etc, patients won’t be asking us to write marijuana recommendations. Pot-smokers all know it is just a subterfuge to legalize pot. In each state a handful of docs decide to earn their living by handing out recommendations to anyone who pays their fee. In Arizona, 24 doctors have written 75 percent of the recommendations. In Montana, I believe it is just 8 doctors. Most of these “patients” aren’t real patients; they’re just pretending to be. They pretend to be sick and the pot docs pretend to treat them. We won’t be seeing any of these people. What legitimate doctors should object to is that our profession and the health care system in general is being involved in a grand diversion scheme.

  3. Alan Wartenberg MD says:

    I do not disagree that “medical” marijuana is a bad idea. However, some bad ideas become laws. As an Addiction Medicine physician, I believe that those of us with expertise in this area have an obligation to assist patients in making informed choices about their use of marijuana, just as we do about their use of alcohol and tobacco. In my prior consultation practice, physicians who were planning to start stimulant medication frequently referred patients to us for a substance use/abuse assessment. I think that we could serve a similar role for physicians who are consulted for a recommendation regarding marijuana “treatment” for their patients.

  4. Ed Gogek, MD says:

    Dr Adelman’s use of the term “so-called” is spot on. The marijuana lobby is simply using people’s gullibility and compassion as a back-door route to legalization. It is medical in name only. However, physicians should do more than just say no. When I worked on the political campaign to oppose “medical marijuana” in Arizona, people kept asking me, “Where are the doctors on this issue?” And, in fact, we could not get physicians to take a stand and fight alongside us while the public they care for were being conned into passing a measure that harms the public health. One robocall to the state’s voters coming from the state AMA and outlining Dr Adelman’s objections to this law would have defeated the measure at the ballot box in Arizona and probably in Massachusetts as well. Physicians are very politically active on issues that affect how we are paid. We should consider becoming equally involved in matters that so clearly affect the public health, especially when the public is so obviously being misled.

  5. Excellent, direct article. Biggest problem today is the mixed messages our kids get that tend to blend truth and fiction. It’s in our best interest to show our succeeding generation how to use facts as a foundation to lead purposefully as they will eventually be making decisions about the quality of our lives.

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