On Nov. 6, Missouri voters will consider three proposals to legalize the use of marijuana for medical purposes. The Kansas City Medical Society encourages voters to study the issue and make an informed decision.
Currently, 31 states and the District of Columbia have legalized medical marijuana. Nine states have legalized full recreational use. Patients report individual stories of how medical marijuana has helped them with conditions such as chronic pain.
We still know too little about medical marijuana. It has not undergone the rigorous level of study and clinical trials that is typically conducted for any medication before it is released to the public.
A comprehensive review of thousands of studies last year by the National Academies found conclusive evidence of modest therapeutic effect of cannabis ingredients on only three conditions: in the treatment of chronic pain, most often neuropathy; in reducing muscle spasms related to multiple sclerosis; and in treating chemotherapy-induced nausea and vomiting.
Available prescription medicines may perform just as well or better, the study noted. The study examined many other conditions, but found the evidence of marijuana’s effects to be insufficient or non-existent for them.
Even for the three conditions for which modest therapeutic effect has been noted, additional evidence is not available to guide a physician on when, how much and for whom it should be prescribed in the context of other already available treatments. The research simply has not been done.
Let us compare how, if legalized, the prescription of medical marijuana would work.
A patient is diagnosed with diabetes. Her treatment is determined by the physician using protocols based on years of research. The medications prescribed have been tested on thousands of people. The medication is dispensed by a licensed pharmacist who has completed years of education. She can have confidence and expects that the treatment is proven effective and the medication prescribed is safe. The physician follows an established standard of care.
In contrast, the patient sees her physician for chronic pain and is interested in medical marijuana. All the physician can do is certify her to obtain marijuana. She would then go to a retail store to purchase the marijuana from an agent who lacks the extensive training of a pharmacist. There is no prescription for how much and how long with no specific expectation of results — because the testing does not exist.
And that’s the problem with medical marijuana. We just don’t know enough about it. Medical organizations have asked the U.S. Drug Enforcement Administration to reduce its classification as a controlled substance so the needed scientific research can be conducted.
In the meantime, we are risking the health of the public by indiscriminately increasing the accessibility of marijuana. States that have legalized marijuana for medical or recreational use have seen jumps in marijuana-related traffic deaths and emergency room visits. Youth marijuana use has increased, and regular use of marijuana in youth is linked with development of schizophrenia and other psychoses.
The Kansas City Medical Society joins the American Medical Association, the Missouri State Medical Association and many other national, state and local medical organizations in opposing the proposed legalization of medical marijuana.
The public wouldn’t accept the widespread introduction of an experimental medication that hadn’t undergone rigorous testing for safety and effectiveness. Why should medical marijuana be an exception?
Joshua M.V. Mammen, a physician, is president of the Kansas City Medical Society. He is a guest author for the Lee’s Summit Health Education Advisory Board, a mayor-appointed, volunteer board that promotes and advocates community health by assessing health issues, educating the public and government agencies, developing plans to address health issues, encouraging partnerships and evaluating the outcomes.
Joshua M.V. Mammen, M.D., is president of the Kansas City Medical Society.