Marijuana–The Only Drug Without FDA Approval

It seems that the first television advertisement for medical marijuana has hit the California airwaves without a whimper.  The first TV commercial just ran on a Sacramento station.

Having experience in many clinics from the Oregon border to the Mexican border, I can confirm that in most of California, medical marijuana is commonplace.  It does not seem to be tremendously difficult to obtain, and I have attended many patients have valid prescriptions for it.

There is a list of conditions for which it is alleged to help, which is as long as your arm.  Hearing about these conditions where cannabis is the preferred treatment usually causes me to smile, and I suspect that the list continues to grow with each new patient who wishes to use this remedy.  

Several of the conditions on the list seem to be some sort of Generalized Anxiety Disorder.  Anybody can easily meet the criteria for one of these complaints just by citing the symptoms that are part living everyday life in the USA in the 21^st century.  I know that I could, just by working for a living as a psychiatrist.  But I’m really not inclined to imbibe.

Although it sounds like I’m exaggerating and trying to make a joke of the subject, I am telling the truth — I have never heard of anyone who decided they wanted to get medical marijuana and was unable to obtain it.  I have never heard of anybody who decided it was cheaper to grow your own and did not find immense success in doing so. I heard it was a remarkably hardy plant. By now, I’m sure some of my readers are going to turn up their noses and brand me as a goody-goody stick-in-the-mud who doesn’t know what she is talking about because she has never tried it.

Perhaps I need to clarify my position.  I am a firm believer that all Americans have the right to attain intoxication in whatever way they choose, so long as they don’t harm or endanger anyone else by their actions.

I’ve long believed that marijuana should be legalized, or at least decriminalized, and the reasons it has not would probably get me branded as a conspiracy theorist.  Let me just say that the country would be better off if we – at the very least – treated marijuana as we treat tobacco and alcohol and we stop throwing people in jail for possessing or growing this plant.

That being said – I think marijuana is NOT good medicine.  There are countless other ways to treat any complaint that is on the list of allowable conditions for marijuana prescriptions, and all of them safer and more effective than the wacky weed.

What bothers me is that marijuana seems to be the only prescription drug that has not been subjected to stringent testing for safety and efficacy, has not had such research data submitted to the FDA for approval, has not even been approved by the FDA, and is not subject to all the regulations of standard prescription drugs.

Any advertisement for a prescription drug is required to submit to some very stringent laws, and include numerous disclaimers.

Fans of Steve Martin may remember an essay entitled “Side Effects,“ which ran in the New Yorker (April 13, 1998 ) and was later part of his stand up comedy act.  Martin lists numerous side effects of a fictional joint pain medication – the chief one being  joint pain. (No, this is not a marijuana joint.  However if you are currently smoking a joint, you are allowed to giggle uncontrollably).

The list of side effects is voluminous and Martin wrings every last absurd laugh out of each of them – including:

• May cause stigmata in Mexicans
• There may be a tendency to compulsively repeat the phrase, “No can do!”
• This drug may shorten your intestines by twenty-one feet.
• May cause compulsion to stand up in Catholic Mass and yell “I’m gonna whup ya wit’ da ugly stick!”

And on and on and on …for a long time.  Very funny stuff.

You don’t necessarily have to be eating “giggle grass” brownies to laugh at this. But Martin is right on the button – those package insert disclaimers are long and sometimes frightening.

But wait – medical marijuana has package inserts?  Ummm … no.  Dosage directions?  Ummm … no.

And nobody seems to have required any verbal disclaimers for this TV advertisement.

This may not worry people who seek such services, but without any disclaimers – or perhaps “downers” in the slang of the users – I don’t consider this to be perfectly ethical and moral and maybe not even legal.

This is the other side of the coin in what many doctors call “Politically Correct Medicine.”  There is such an outcry by “We The People” to legalize marijuana, and politicians don’t have the guts – pardon me, the intestinal fortitude – do alienate a block of voters.  So we have a wishy-washy policy that allows the people who want marijuana to have it with little risk of serving prison time.

It may get votes, but it’s bad medicine.

There are some real problems here that nobody seems to have the guts, incentive, or even curiosity to look at.
1.  I am unaware of proof of the efficacy of marijuana on the numerous conditions generally cited.  I remember long ago and far away, that marijuana was studied for efficacy on chronic pain, and that it has often been used on chronic conditions that are terminal and for which there may be no curative treatment, such as cancer.  I have not seen any studies of how it would specifically improve a medical condition. Perhaps even more telling, I have not seen a single study on how its use would take a non-functional person and assist that person in becoming more “functional.” Terminal patients who are on a unidirectional and inexorable road to death should probably get whatever makes them end life in maximal comfort.  Some may argue this but I have no problem with it.  There are cases on record where reputable treatment facilities – like real hospitals – have given terminal patients LSD.  It’s not the most highly recommended treatment, but it may be a humane one, in some cases. On the other hand, nobody seems to have done any kind of serious study on marijuana’s functionality in the people who have what are generally considered “benign” or at least “non-terminal” conditions. I have a strong memory of a debate that happened in France when I was working in neurosurgery.  It seemed a bit cold to me, granted, but somebody actually raised the question of how the government could support a specialty that did not generally improve functionality or ability to work, considered by many to be one necessary sign of a fruitful life. But wait — there’s more.  I remember many years ago that I had a heated discussion with a California doctor who was a marijuana “expert.”  He said it was potentially a great mood stabilizer for bipolar (manic-depressive) illness, but there was one real problem.  He was working on a way to dose it through a respiratory route — which we know has far more efficient assimilation into the system than an oral one. The problem he was finding was that once people started with marijuana, they rarely stopped at the minimum effective dose, but rather kept on going to intoxication.
2.  Even assuming that marijuana is effective and helpful, it is absolutely NOT without risk.  It interacts with drugs.  I know of no way to predict this except by checking in the databases available to doctors and pharmacists.  As for telling if it has already happened, it is important to look at the patient. Clinically.  To talk to the person sitting there in the office with you.  This is rarely done, but it is one of my passions. Even in the absence of interactions, there is a syndrome of chronic marijuana use.  People look “cloudy.”  Some call it “brain fog.”  Users frequently have judgment problems, sometimes even memory problems.

But perhaps the single hallmark of a problem is “amotivationality.”  These people sit and tell me that they are trying to do things that do not work.  They don’t have the motivation to get decent grades in school and graduate, or to start a business.  All kinds of things just don’t happen.

There is this strange sort of indifference that has been clearly linked to the chronic use of marijuana.  I tell this to my patients and they simply do not believe me. I recently saw a patient who grows his own marijuana, a guy in his fifties who is trying to start a business (with neither counsel nor planning, as far as I can tell) , and just cannot seem to make it work.  He is sleeping on the porch of a friend’s house, and cannot figure out why he is not doing more in life.  Although he was unsure what prescriptions he was on, and did not know what pharmacy they were from, and had troubles with names and dates, we found his prescription and I continued him on what seemed safer to give him than to stop. I also felt it my duty to inform him that his problem was — at least in good part — an amotivational syndrome secondary to marijuana.  He did not want to hear it, and tried to play games in what is an all too common scenario.

I told him basically NO prescription medication interactions had been systematically studied to my satisfaction with marijuana, although I did remember a study I had read some years ago, citing that in general, ALL psychotropic medications, especially antidepressants, are considerably less effective– at least a half or a third — less effective, when coupled with some marijuana.  And although he could or would not attempt to quantify, my guess is he was using plenty. He said he would get the blood tests I ordered and come back to see me, mainly because I was an “interesting personality.” If this is what we have done to psychopharmacology, a topic I have studied with great ardor, then like Rodney Dangerfield, I simply “don’t get no respect.”  If patients actually continue medical care because I am an “interesting personality,” I simply will continue to remain one. The real problem is that people care so little about what they put into their body.  There is good information available.  People are just so fed up with their lives, I think, that they want what feels good right away. Me, I think anything that calls itself  “medical” ought to be subject to the laws and regulations that control this over regulated business. I find myself thinking — for the first time in a long time — there may be some good in all that.