Most Docs OK With Medical Marijuana: Survey
Majority would give a prescription to an advanced cancer patient in pain
Dr. Bradley Flansbaum, a hospitalist at Lenox Hill Hospital, in New York City, said he sided with the majority for this particular case.
"I think there's some context that needs to be considered," Flansbaum said. "This was a woman with stage 4 cancer who wasn't responding to [anti-nausea medications]. I'm not saying let's legalize marijuana, but this is a woman at the end of her life, so what's the downside, given that there might be a benefit. In a different situation, medical marijuana might not be so well embraced."
For his part, Bostwick said that while he approved the use of medical marijuana in this case, he feels it's important that the prescription of marijuana as medicine only be done within the confines of an already-established doctor-patient relationship.
"My concern is doctors who see someone once and give them a prescription for medical marijuana. That's bad medicine," Bostwick said.
While many physicians felt as if there was no harm in allowing the breast cancer patient to try marijuana to see if it helped, Dr. Gary Reisfield, who co-wrote the "against" side for survey, expressed concern about a patient with lung disease smoking marijuana.
"Marijuana smoke irritates the airways," he said. The smoke can also cause airway inflammation and symptoms of bronchitis, and decreases the ability of the lungs to fight off fungal and bacterial infections, said Reisfield, chief of pain management services at the University of Florida's department of psychiatry.
What's more, marijuana isn't as safe a drug as many believe it to be. "Heavy marijuana use is associated with numerous adverse health and societal outcomes including psychomotor, memory and executive function impairments; marijuana use disorders; other psychiatric conditions such as psychosis; poor school and work performance and impaired driving performance," he said.
Many of the physicians who responded pointed out that drugs already approved and in use also have the potential for addiction, such as narcotics. "Similar arguments could be made against alcohol, opiates and stimulants," Bostwick said.
For his part, Reisfield pointed out that there are two FDA-approved prescription cannabinoid pills -- dronabinol (Marinol) and nabilone (Cesamet) -- that don't begin working as quickly as smoked marijuana, but provide longer symptom relief without the high of marijuana. They also don't appear to have any addictive properties, he said.
What many doctors would like to see, according to the survey, is more evidence on the use of marijuana as medicine, so they could make a better-informed decision one way or the other.