Pubdate: Sun, 14 Nov 2010
Source: Steamboat Pilot & Today, The (CO)
Copyright: 2010 The Steamboat Pilot & Today
Contact: http://www.steamboatpilot.com/submit/letters/
Website: http://www.steamboatpilot.com/
Details: http://www.mapinc.org/media/1549
Referenced: http://www.mapinc.org/drugnews/v10/n890/a06.html
Author: John R. Sharp

WHY I DON'T PRESCRIBE MARIJUANA

Steamboat Springs -- I read with interest your story about the
Steamboat mom who is treating her 13-year-old son's autism with
marijuana ("An alternative treatment," Oct. 31, 2010). The use of
cannabis for treating patients is not new, and U.S. physicians
prescribed it until the 1930s when marijuana was classified as a high
abuse-potential drug. In 1974, marijuana was placed in the Schedule I
(illegal) category of dangerous drugs. However, public referendum
balloting allows for a medical prescription use of marijuana in 16
states.

So why does traditional Western medicine not prescribe marijuana for
patients like this unfortunate child in your newspaper article? Since
I have declined requests to write a marijuana prescription, I would
like to answer that question for your readers.

The science of traditional medical practice is based on randomized,
double-blinded, controlled clinical trials and there have not been any
such trials with marijuana. There are very small case studies that
show more marijuana benefit than there is, because of small study
size, bias within the studies because of confounding variables
including co-morbid disease and tobacco and alcohol use as well as the
bias of political agendas concerning legalization.

Marijuana is effective in lowering intra-ocular pressure in glaucoma
patients, but it takes smoking a dozen joints a day to be as
efficacious as drugs that already are available. There is no evidence
that marijuana is more efficacious than other available prescription
medications on neuropathic pain, chronic wasting and nausea with
chemotherapy. There is no evidence that autism is effectively treated
with marijuana. Anecdotal stories of individual case effectiveness are
not accurate measures of a medication's safety or effectiveness.

On the other hand, marijuana has well-documented abuse and dependence
risks: 10 percent of regular users become addicted, compared to 15
percent with alcohol and 26 percent for opiate drugs. Moreover, just
as many fatal accidents are marijuana related as alcohol related.
Marijuana increases heart rate, increases pre-term miscarriages, and
the risk of a heart attack is five times greater in the hour after
smoking a joint.

In 2010, the Yampa Valley Medical Center emergency room has seen an
epidemic of abdominal pain and cyclical vomiting in young people using
marijuana. Clinical studies of the use of marijuana in this cyclical
vomiting condition show that marijuana use actually aggravates the
condition and produces a cycle of more marijuana producing more
vomiting. Even attempts to wean off the marijuana produce a temporary
increase in vomiting. Treatment begins with absolute cannabis avoidance.

When Coloradans approved Amendment 20 in 2000 for the use of medical
marijuana, a small-scale enterprise was envisioned, not the vast
entrepreneurial enterprise that confronts us. Only 3 percent of
medical marijuana users are people with cancer, and only 1 percent
have HIV/AIDS. Ninety percent have "severe chronic pain." Seventy
percent of the 70,000 cards are issued to males between the ages of 24
and 34. About 55,000 of the cards issued are written by 15 physicians,
and of these, five have been disciplined by the Colorado Medical
Practice Board.

Marijuana is not subject to clinical safety and purity analyses. There
is no standardized dosage. There is no post-marketing surveillance to
assess adverse reactions. This lack of safety information and proof of
efficacy opens the physician to negligence when he/she prescribes this
drug for a patient who has an adverse outcome. I expect we will see
malpractice suits brought by a patient injured from their own personal
use of "prescribed" marijuana or by a person injured as a result of a
patient's use of prescribed marijuana.

The vast majority of physicians will not prescribe marijuana. The
current situation in our state is socio-political, not a medical
debate, and these tactical maneuvers are designed to legalize the
drug. To expect your medical community to "step to the plate" in this
issue is a bit naive in light of our Hippocratic oath to "above all do
no harm." Please leave me and my colleagues out of it.

Reference: Newsletter of the Colorado Physician's Health Program 
(CPHP) and comments by Doris C. Gundersen, M.D., Medical Director of 
CPHP., Volume 9, Issue 1, Summer 2010.

John R Sharp, M.D., Steamboat Springs
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