BY DANIEL GAITAN | daniel@lifemattersmedia.org

As use and acceptance of medical marijuana grows across the nation, medical systems must develop institutional guidelines to help protect doctors and patients.

Standards would provide physicians a “uniform approach” to certifying seriously ill patients seeking marijuana, according to physicians Ilana Braun and Lida Nabati of the Dana-Farber Cancer Institute in Boston. They addressed the issue during the American Academy of Hospice and Palliative Medicine Annual Assembly in Chicago. Such standards could also provide physicians some legal protections and much-needed education about the drug.

Although there are medical marijuana programs in 23 states and in Washington, D.C., many physicians are reluctant to certify patients for fear of breaking federal law and concern about the drug’s safety and effectiveness.

“This is a controversial topic,” Nabati said. “It’s legally complicated, so even if it’s legal in the state you’re practicing, it is federally illegal. That’s not expected to change any time soon.”

Prescription Vs. Certification

A common misconception among patients is that physicians prescribe marijuana to them. But doctors practicing in states with medical marijuana laws may only certify them to obtain the drug.

Certified patients then seek out the drug from dispensaries that carry only non-pharmaceutical grade marijuana.

“The concept of recommending marijuana really came out of the California initiative,” Nabati said. California was the first state to legalize marijuana for patients suffering from cancer, ALS and HIV/AIDS.

“We’re not writing a prescription, this is a certification, a recommendation that the potential for benefit likely outweighs the risk,” Nabati said.

Some doctors at the conference expressed concern that their patients may not be able to find consistent, unadulterated marijuana. Others said they are not comfortable certifying because they did not know enough about the drug and fear the Drug Enforcement Agency.

Nabati said prosecution of providers is unprecedented in states with medical marijuana programs.

“The current national political environment is favorable for marijuana,” she said. “There have been statements that there would not be DEA efforts and energy to prosecute patients using it under their own state law. Doctors are recommending, not writing the prescription, so we’re a little bit removed from the patient’s use of this substance that is still considered illegal.”

Still, the “favorable environment” may change under a different administration, she cautioned.

The U.S. pharmacopeia listed marijuana as a legitimate medical compound until 1941. In 1970, the federal government listed marijuana as a Schedule I controlled substance, alongside heroin and LSD, meaning it has no medically accepted use and high potential for abuse.

Non-Pharmaceutical Grade Marijuana

Marijuana intended for medical use is not held to the same standards as pharmaceutical-grade drugs, Nabati said, a fact that worries some hospice and palliative care physicians.

Therefore, patients are often left on their own to figure out correct dosage and their ideal form of consumption.

“How can they know what to use?” Nabati asked. “It really is the dispensary employees who are likely going to be providing patients guidance and directing them to different products.”

Medical cannabis may come in the form of edible oils, cookies, vapor or cigarettes. Common side-effects may include cough, throat irritation, decreased concentration and fatigue. Most products are not covered by health insurance.

Not Marijuana Of ‘Yesteryear’

Because marijuana is a Schedule 1 drug, there is little research on the risks, benefits and quality of marijuana for dying patients, Braun said. More “robust” studies are needed because clinical trials tend to have short duration and small enrollment.

Braun also highlighted how the average THC concentration in a marijuana leaf has increased over time through genetic engineering. Effectiveness, therefore, may have changed.

“In the 1970s, there was about 3 percent concentration,” Braun explained. “By the 1980s, there was about 4 percent. Today, the average concentration of THC in a leaf is about 15 percent.”

In Massachusetts, THC concentration at dispensaries can run as high as 30 percent. “This is not the marijuana of yesteryear.”

– Image courtesy WikiMedia Commons