Physician-Experts on Medical Marijuana: Not a First-Line Therapy

More than 100 physicians gathered recently at MMS headquarters to take part in a history-making discussion about what the legalization of medical marijuana in the Commonwealth means to them as healthcare providers.

Throughout the half-day CME event, Medical Marijuana: Regulations, Responsibilities, and Communication, physician panelists presented various clinical scenarios in which marijuana certification could be considered. One of the experts, Alan Ehrlich, MD, an assistant professor of family medicine at University of Massachusetts Medical School, polled the audience about whether they’d certify patients in given circumstances. Though physicians’ opinions varied as to how they’d approach each circumstance, two consistent themes emerged.

Medical Marijuana is Not  a First-Line Therapy

 “Marijuana does not fix MS,” emphasized Ehrlich. “Make sure they’re getting treated for the underlying disease.” Multiple sclerosis is not the only qualifying condition in which this notion applies. Whether a patient is suffering from cancer, glaucoma, ALS, MS, or chronic pain, physicians must determine whether patients are undergoing treatments to manage their disease before turning to marijuana to help manage symptoms of their disease, or in some cases side effects of other treatments.

When it comes to marijuana several panelists noted, people often hold biases at extreme ends of a spectrum: that it’s either completely harmless or a drug that sends users on the road to ruin.

Neither of those absolutes hold true, but there are real risks to certain patients that physicians need to take into account, according to Kevin P. Hill, MD, MHS, director of Substance Abuse Consultation Service, Division of Alcohol and Drug Abuse at McLean Hospital and an assistant professor of Psychiatry at Harvard Medical School.

For example, an estimated nine  percent of adults who use marijuana become addicted, which translates to about 2.7 million people out of current users. In addition, patients predisposed to mental-health problems may be prone to marijuana use triggering a worsening of those issues.

MDs Must Consider the Context and “Whole” Patient

Ultimately, the question isn’t whether marijuana use is risky, noted Ehrlich, but how dangerous it may be when compared to other risks, such as a patient not being able to stick with therapy due to intolerable side effects. Alternatively, if a patient drives for a living and has a condition that would call for using marijuana during the day, the relative risks increase.

As with recommending any treatment for patients, physicians have to look at it in the full context of patients’ lives, noted Riley M. Bove, MD, a neurologist with Partners Multiple Sclerosis Center at Brigham and Women’s Hospital. “We always have to look at the patient as a whole person,” she said.

 –Debra Beaulieu-Volk

Links to videos:

 

Alan Ehrlich, MD, assistant professor of family medicine at the University of Massachusetts Medical School, discusses the evidence of the efficacy and harms of medical marijuana.

 

Kevin P. Hill, MD, MHS, director of the Substance Abuse Consultation Service at McLean Hospital in Belmont, Mass., discusses substance abuse, addiction, and other adverse effects of marijuana.

 

Riley M. Bove, MD, neurologist and faculty member of the Partners Multiple Sclerosis Center, discusses the evidence regarding the use of marijuana for patients with multiple sclerosis.

See all videos and slide slows from the half-day MMS CME event, Medical Marijuana: Regulations, Responsibilities, and Communication

 

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