Doctors: Too many risks for medical marijuana

JONESBORO — Several Jonesboro health professionals said the risks associated with the proposed medical marijuana issue on the state ballot far outweigh potential benefits. They acknowledge marijuana may have some positive effects — like easing pain, increasing appetite and decreasing pain — but that legalization for medicinal purposes is unnecessary because a similar drug already exists in pill form. And, the act of smoking generally is considered harmful.

“As a physician, we do not encourage people to smoke — anything,” Craighead County health director Dr. Joe Stallings said. “Cigarettes, pipes, cigars, marijuana. Just because it’s marijuana doesn’t mean it doesn’t cause lung damage and difficulty breathing. Physicians should not recommend or accept smoking for health purposes of any drug.”

Dr. Shane Speights, a hospitalist at St. Bernards Medical Center, said his biggest reason for opposing the measure is that a pill form already exists. “Nobody has said that,” he said. “If it’s this life-saving drug, it’s already available. It’s already been tested, it’s already been approved. And so all this is, is an attempt for people to have recreational marijuana that they can grow in their back yard and smoke. No credible medical professional organization says that smoking marijuana should be something that you can do.”

Speights said there is evidence of pain control when the cannabinoid hits the receptors in the brain, but smoking marijuana reduces that benefit. “Because now you’re taking in all those carcinogens and all those toxins that are just going to make things worse,” he said.

One of the most common pill-form drugs comparable to marijuana is Marinol. Dr. Tom Frank, a clinical pharmacist with the University of Arkansas for Medical Sciences (UAMS) Area Health Education Center (AHEC), said although Marinol is readily available, it’s not widely used. He suggested that might speak to the true effectiveness of it compared to other medications used, for example, to combat nausea. Stallings said few patients request drugs like Marinol.

“Doctors can prescribe it, but people do not want it,” he said. “Apparently a lot of people would like to have marijuana in a smokeable form because they have a lot of problems, and the way that the issue is worded on the ballot it is so vague it could be any vague medical problem that patients might want to be prescribed medical marijuana. I don’t think it’s wise to smoke, and I don’t think we’re going to offer anything by legalizing marijuana that we don’t already have.”

To the argument that a natural, plant-based drug is better than some of the man-made chemicals, which often carry nasty side effects, Frank rebutted: “Strychnine and arsenic are natural, too.”

Speights said other illegal drugs such as cocaine may have the potential to kill pain, but that does not justify legalizing them for such uses. And while marijuana may be less addictive than other substances, the argument that it is not addictive is a myth, Speights said.

“Is it as addictive as cocaine? No,” he said. “Is it as addictive as nicotine? No. But it is addictive.”

Frank said he has philosophical objections to the way the proposed act handles a scientific matter. “We’re in an evidence-based era of health care where we try to take randomized controlled trials of groups to compare treatment or no treatment, or treatment A against treatment B, and be able to make an informed estimate as to whether a particular therapeutic intervention is going to be something that’s beneficial for the patient or not,” he said. “The way this act is written, I’m concerned that these people are basically going to be an individualized clinical trial every time they engage in this therapy.”

He added there would be no safety net of a trial review committee. Frank noted supporters rely heavily on anecdotal information. “Lots and lots of folks have stories to tell — and some of them are very compelling stories — but they don’t include data. They just include stories,” Frank said.

The answer to solving the apparent divide is more and better trials to try to meet any unmet health-care needs, he said. He also thinks the measure is written too broadly, and said the projected outcomes of the marijuana use should be better defined.

“From my perspective, professionally, it’s just a blank space,” he said. “What we need is the kind of information we would have in the package insert of a drug, where if you take X dose you get Y serum level, and you can expect in a 200 pound patient that you’re going to get these kinds of results.”

Yet another concern is how the dispensaries would operate.

“We already have places that you go to have drugs dispensed. They’re called pharmacies,” Frank said. “And you have professional people that are there” to help guide each patient’s use of the drug.

Also needed is more study of marijuana’s interactions with other drugs. “We don’t know what the implication is, if someone’s smoking marijuana on the other drugs that they’re taking,” he said. “Might it speed their seizure drugs to faster metabolism, or might it slow down an antidepressant that they’re taking? We just don’t know.”

Speights said another major concern was provisions for children under 18 to obtain medical marijuana. “That was a problem for me because there’s no pediatric data at all,” he said. Source: November 9, 2012

Source: November 9, 2012

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