Medical Marijuana: Legitimate Therapeutic Choice?
By Barbara Bronson Gray
WEDNESDAY, Feb. 20 (HealthDay News) -- Imagine a 68-year-old woman with advanced breast cancer, looking for a better way to ease her chronic pain, low appetite, fatigue and nausea. Should she or shouldn't she be prescribed marijuana?
That's the question physicians debate in the "Clinical Decisions" section of the New England Journal of Medicine released online Feb. 20.
According to the hypothetical case study in the journal, a woman named Marilyn has metastatic breast cancer that has spread to her lungs and spine. She's taking chemotherapy and two anti-nausea drugs that just aren't working. Despite taking 1,000 milligrams (mg) of acetaminophen, such as Tylenol, every eight hours, she's in pain. At night, she sometimes takes 5 to 10 mg of oxycodone, a narcotic pain reliever similar to morphine, to help relieve the pain so she can sleep.
Marilyn lives in a state where marijuana is legal for personal medicinal use, and her family stands ready to grow it for her.
Why not let Marilyn try it?
One reason not to, in the view of one of the "con" argument's authors, Dr. Robert DuPont, is that it probably wouldn't help her. "Although marijuana probably involves little risk in this context, it is also unlikely to provide much benefit," said DuPont, a clinical professor of psychiatry at Georgetown Medical School in Washington, D.C., and the first director of the National Institute on Drug Abuse under Presidents Nixon, Ford and Carter.
Marijuana is a dry, shredded mix of flowers, stems, seeds and leaves of the hemp plant Cannabis sativa. People usually smoke it as a cigarette or in a pipe. It's the most commonly abused illegal drug in the United States, according to the U.S. National Library of Medicine.
In an interview, DuPont said that because smoked marijuana has not been reviewed and approved by the U.S. Food and Drug Administration for safety, effectiveness and purity, it would be inappropriate for a physician to prescribe it. "It would divert the attention away from an effective medical treatment and get her into something that's at best voodoo," he said.
The cannabis (marijuana) plant contains hundreds of pharmacologically active compounds that could interact with the medications Marilyn's now taking, DuPont said. It's impossible to know the chemical make-up or potency of a given dose, he noted, adding, "Medical marijuana has no dose. There is nothing else in medicine like that."
DuPont said it's also uncertain how Marilyn might react to the experience of smoking marijuana. He said the drug could affect her ability to think effectively. And just the act of smoking, coupled with the impact of the cancer on her lungs, could reduce her ability to get oxygen to her brain, he added.