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Pain Management Health Center

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Medical Marijuana: Legitimate Therapeutic Choice?


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.

Rather than offering Marilyn marijuana that is smoked, DuPont would prefer she be offered drugs that have been shown to be highly effective for treating nausea and vomiting caused by chemotherapy, such as dexamethasone and aprepitant. Should these not work, he said, he would opt for one of two prescription "cannabinoid" pills that are available: dronabinol (Marinol) or nabilone (Cesamet), which are both approved by the FDA for the same purpose.

DuPont argued that with the oral cannabinoids, the precise dosages have been established and the medications take effect more gradually than does smoked marijuana, and thus would be less likely to cause anxiety or panic.

Dr. J. Michael Bostwick wrote the "pro" argument for offering Marilyn marijuana. Bostwick, a professor in the department of psychiatry and psychology at the Mayo Clinic College of Medicine, in Rochester, Minn., said he told the editors at the New England Journal of Medicine that he could have made the case for either side. He had a family member with substance-abuse issues involving marijuana. "I kept hearing marijuana is harmless and doesn't cause any problems, and yet I was seeing addiction," he said.

Still, Bostwick said he would give marijuana to Marilyn.

"If it would help, why not? I say that, knowing that much of what we do in medicine is empirical, but knowing there are arguments for exploring the possibilities the whole endocannabinoid system might offer," he said. Bostwick explained that there are receptors for cannabinoids in the brain, the gastrointestinal system and immune tissues -- which suggests the body may be designed to accommodate or benefit from marijuana.

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