Medicinal Marijuana – An Oxymoron?

April 1, 2014 is going to be April Fool’s Day for Canadian Physicians as the Government of Canada’s new policy on medicinal marijuana comes into effect. By all accounts, producers of marijuana around the country are preparing themselves to supply marijuana to the thousands of Canadians who will now have to obtain this through the authorization or prescription of a physician.

There are going to be a few snags. There are currently over 25,000 Canadians licensed to grow marijuana for “personal use”. This practice is apparently going to have to stop, although how this will be enforced is not clear. Will these persons suddenly find themselves under investigation? The numbers of people affected is significant, as Hugh Adami outlines in this Ottawa Citizen article: http://www.ottawacitizen.com/health/Medicinal+marijuana+Numbers/9483148/story.html It was in consideration of the statistics outlined here that I began to contemplate what a mess this is all going to be. Adami does point out that there is at least one physician who will be willing, for an immodest fee, to do the authorization paperwork. Intriguingly, the doctor is a psychiatrist and there are at present NO psychiatric indications for “medicinal marijuana”. Actually, there are NO psychiatric indications for marijuana, no matter what adjective is used to describe it.

The Canadian Psychiatric Association does not presently have a policy related to “medicinal marijuana” but the American Psychiatric Association has one which can be found here: http://www.psych.org/advocacy–newsroom/position-statements There is also a background document which outlines the research, or lack of it, for the benefits of marijuana as medicine.

I like the statement. It’s fair, outlining those circumstances where there is some evidence that marijuana may be of benefit, but the position statement also is clear that there are significant risks in using marijuana for any reason.

As a clinician, my experience with cannabis is as a drug of abuse. In the population that I treat, adolescents, there are significant risks. There is good evidence that adolescents who use cannabis regularly suffer learning deficits that can endure even after cessation. There is evidence that cannabis use is associated with both earlier onset of psychotic illness and more frequent relapses. And, of course, there is always the risk of addiction, debilitating on its own and very difficult to recover from.  The impact of cannabis use when young can last into adulthood. The backgrounder to the APA Position Statement outlines the risks fully, including the references, and is an excellent resource for anyone seeking clarification regarding the risks of marijuana use. The research into these risks is not one-off studies. It is extensive and includes international trials and meta-analyses, much more robust than any of the research into the clinical benefits for those medical conditions where marijuana may be indicated.

I am also intrigued by the fact that, if you use Google to seek out articles regarding the safety of marijuana versus the safety of alcohol, you will inevitable find many more websites outlining how “safe” marijuana is compared to alcohol. However, if you seek out evidence-based articles, the conclusion that you reach will be different. This “Facts for Families” article from the American Academy of Child and Adolescent Psychiatry debunks a number of myths about marijuana – myths offered as facts by other flashier websites. https://www.aacap.org/aacap/Families_and_Youth/Facts_for_Families/Facts_for_Families_Pages/Marijuana_and_Teens_106.aspx

To me, the discussion that either alcohol or cannabis is “safe” engages us in a debate equivalent to the discussion that “unicorns” are fierce. Here is a consideration of “unicorns”: http://bestiary.ca/beasts/beast140.htm

As we move toward this day of reckoning for “medicinal” marijuana users, one question I have for legislators is: Why was regulation of marijuana never considered? We regulate alcohol and there is evidence that the regulation of alcohol has promoted more responsible use, and decreased to some degree the access of alcohol to minors. I am sure that the sarcasm of all these quotation marks has not been lost on the reader, but here is a fact that convinced me that regulation(no quotation marks) is the way to go. The Economist reported that since marijuana was legalized in Colorado, the state has collected $185 million in taxes related to its sale – who needs medicinal?

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