Doctors who write recommendations for medical marijuana have developed an unfortunate reputation. Ask any Angeleno how easy it is to get the drug and you’ll likely hear about storefront practitioners who pointedly ask clients about “back pain.” Wink, wink.
It’s a notion, however, that masks the reality that any physician in California — from the highest-paid Beverly Hills doctor on down — could approve the use of the drug for his or her patients under state law.
But the health risks and medicinal properties of marijuana are still being studied, and until the drug makes its way through standard channels of scientific research, writing recommendations for it is a risk many providers don’t want to take.
Marijuana is classified by the U.S. Food and Drug Administration as a Schedule I substance, meaning that it is defined by federal law as having “no currently accepted medical use” and has a “high potential for abuse.” Other Schedule I substances include heroin and LSD.
It’s a classification with which many medical experts disagree.
The National Institutes of Health and the American College of Physicians believe that marijuana should be further studied as a federally approved drug. And some doctors say the classification doesn’t line up with what is already known.
“I think it doesn’t match the scientific evidence at this time,” said Dr. Igor Grant, a professor and the executive vice chair of the department of psychiatry at the University of California, San Diego, School of Medicine. “There certainly are good indications that [marijuana] may be useful in some things.”
Grant is also the director of the Center for Medicinal Cannabis Research (CMCR) at the University of California, San Diego, which was established in 2000 to study the potential medical benefits of marijuana as well as the inherent risks. The center conducted some of the first significant clinical trials of marijuana since the early 1990s.
In a report released this year by the center highlighting the results of 10 years of research, experts found hope in the drug’s potential.
“One of the most promising is the treatment of what’s called painful peripheral neuropathy,” said Grant. “People suffer burning, tingling, painful sensations in their feet and hands and arms related to diseases like AIDS, diabetes and spinal cord injuries.”
While treatments for these symptoms exist, including anti-depressants and anti-epileptic medication, Grant said, they don’t always work, and some patients report negative side effects.
Larry David tackles medical marijuana on an episode of “Curb.” Story continues after the jump.
Marijuana also holds promise in treating painful muscle spasms associated with diseases like multiple sclerosis, he said.
“[Muscle spasms] can affect people’s ability to walk and write and do activities of daily life,” said Grant. “It’s another area where marijuana may be useful.”
But, like any other drug — legal or not — marijuana isn’t without risks.
“Everything we ingest has some risks,” said Dr. Itai Danovitch, who serves as the director of addiction psychiatry services in the department of psychiatry and behavioral neurosciences at Cedars-Sinai Medical Center. “The question is, how do the risks appear for each person?”
Current research suggests that about 8 to 10 percent of people who use the drug will develop an addiction. Danovitch also points to research reporting that the use of marijuana might be a trigger for mental health disorders.
“For people who have underlying risk of things like schizophrenia,” he said, “it appears to unmask that in 1 to 2 percent of the population.”
The acute side effects of marijuana — those that take place at the time the drug is used — are fairly commonly known. They include feeling decreased tension, feeling sedated and possibly hungry. For some users, they include feeling more anxious and even paranoid.
The longer-term effects are less clear, although experts agree that there’s little evidence of a lasting negative impact on the brain. And while marijuana smoke can be irritating to the lungs, it has never been proven to cause lung cancer.
Until the risks and benefits of marijuana are fully understood, though, it’s unlikely that doctors practicing in large medical or academic institutions will be willing to incur the risk of writing a recommendation for patients.
First of all, Danovitch said, marijuana isn’t stocked in most hospitals formularies, which serve as pharmacies to patients.
“Marijuana is definitely not in Cedars’ formulary,” he said.
There are also currently no state or federally regulated growers, aside from some used for federal research, which means that doctors have no way of knowing for certain what they are prescribing.
Additionally, Grant said, there is no uniform way to administer marijuana.
“Smoking is not a route of administration that’s going to be acceptable for some patients, and not in a lot of settings,” he said. “In hospitals, for instance, you have oxygen tanks, or [in] homes with young children, where you may be worried about secondhand smoke.”
And of course, there’s always the question of the feds.
“It’s not legal under federal law for doctors to prescribe or recommend marijuana,” said Joel Hay, a professor of pharmaceutical economics and policy at the University of Southern California, “so a lot are very leery about doing that — I would argue, the more reputable ones.”
Hay added that doctors practicing out of academic institutions would put their institution at risk by prescribing a federally illegal drug.
“Any doctor that works at an academic medical center like USC or UCLA wouldn’t do this,” he said, “because they would jeopardize all federal funding that institution receives.”
But medical marijuana advocates — activists and researchers alike — believe in the promise of the drug — that, eventually, it has the potential to reach the mainstream as a legitimate way of treating illness and disease.
“From a medical standpoint,” said Grant, “what I would favor is much more serious research on marijuana itself, with much larger clinical trials, and then looking to how the benefits can be delivered ultimately in a different way.”