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Is Marijuana Really Good Medicine for Massachusetts?

by Jason Poquette, BPharm, R.Ph

Our current culture seems crazy about cannabis.  Access to this supposed “wonder weed” is spreading throughout the country, with 20 states now legalizing the purchase for medical purposes, two of which allow the sale for recreational use.  Massachusetts voted in November of 2012 to join the fray, and recently gave official approval to 20 not-for-profit businesses to operate dispensaries for marijuana in the Commonwealth.  

As a pharmacist I am interested in the purported benefits of this popular plant.  Supporters suggest that marijuana is a safe and effective alternative to traditional medication for treating nausea, vomiting, muscle spasms, pain, appetite stimulation, and even symptoms associated with Multiple Sclerosis.  These claims, if true, could mean that legalized access to marijuana for medical purposes is a real win for suffering patients.  What compassionate health care provider could object to that?

But is it really safe and does it really work?  These questions are not as easy to answer as you might think. 

For example, there is a huge difference between the “perceived” benefit of ingesting marijuana and an actual benefit that can be reproduced in unbiased, clinically rigorous, placebo-controlled trials.  The fact is that the available studies on the efficacy of marijuana right now are mixed at best with respect to their proven benefit in treating the symptoms for which they were studied.  I remember a time when quinine capsules were available on my pharmacy shelf to treat leg cramps.  The problem is, after numerous studies, we simply couldn’t prove they really worked any better than placebo.  Eventually they were withdrawn.

Another challenge when trying to establish safety and efficacy is related to the fact that medical marijuana has neither an “approved” dosage nor consistent concentration.  Plant growers can seek to maximize or manipulate the concentrations of THC (tetrahydrocannabinol) or CBD (cannabidiol) to tailor the therapy, but this is a far cry from a truly regulated dose.  Not to mention the fact that the marijuana plant could have upwards of 500 other chemical compounds.  The dose really matters.  And without reliable dosing information our efforts to consistently treat patients with marijuana are wishful thinking at best.

As for safety, when it comes to life-threatening reactions, marijuana seems to have an advantage over other options.  It would appear that very few deaths or near-deaths can be directly attributed to marijuana use.  But safety is about much more than proving something won’t kill you.  Side-effects, drug interactions, warnings and precautions come from careful monitoring, recording and publishing of patient-reported events.  This won’t happen in our present model for marijuana dispensaries.

So what should we think about all this?

Personally I believe the entire movement toward the medical use of marijuana is just a back-door approach to legalization.  If I had my druthers, advocates would simply pursue approval to grow and sell the plant without involving the medical system at all.  It may have medical benefits.  So might carrots and cod liver oil.  But you shouldn’t need a special card to buy it.

Is marijuana addicting?  Well, I prefer to refer to the phenomenon as “dependence” but the answer is probably “yes”…to some degree at least.  But so are hundreds of prescription medications, as well as some non-prescription drugs like nicotine, caffeine, alcohol, decongestant nose sprays and laxatives. 

Can marijuana be abused?  Sure.  And so can many OTC products like cough medicines, pseudoephedrine, diphenhydramine and diet pills. 

The current policies being erected here in Massachusetts and around the country will have virtually no impact on the black-market sale of marijuana in our nation.  Nor do they address the underlying reasons that people seek out recreational drugs in the first place.  I do care about the patients for whom marijuana might truly be helpful.  However, in my opinion, the current model for managing marijuana is not good medicine for Massachusetts.

Jason Poquette, BPharm, R.Ph, is a practicing pharmacist who lives in Whitinsville. His columns comment on drugs and pharmaceutical issues in the news. He maintainss the blog www.The Honest Apothecary. Email him at Jason.thehonestapothecary.com.