For 50 years the smoking of marijuana has been a major issue in our country. The idea that marijuana should be considered a medication is a fairly recent addition to the debate. It is a clever addition, however, because “medicines” are good and should be available to those who need them.
For 50 years the smoking of marijuana has been a major issue in our country. The idea that marijuana should be considered a medication is a fairly recent addition to the debate. It is a clever addition, however, because “medicines” are good and should be available to those who need them. The citizens of Massachusetts have voted that marijuana is a medicine.
If marijuana is a medicine then we all take on roles. Consumers become patients, doctors become certified agents of the government and sellers become dispensaries. Now we all have to decide what to do. Should you request a prescription; should I, as a family doctor, provide prescriptions, and how should we on Martha’s Vineyard regulate the sale and distribution of marijuana?
I had hoped that when medical marijuana was approved in Massachusetts the provisions of the law would have allowed only limited prescribing of the drug. Unfortunately the Massachusetts law, after naming the serious diseases such as advanced cancer and multiple sclerosis in which a marijuana prescription could be considered, then says that it may also be prescribed for “other conditions as determined in writing by a qualified patient’s physician.”
Marijuana is a drug that many people use for relaxation and enjoyment. Although psychological dependence of marijuana occurs, for the great majority of users it is safe. Marijuana is safer than alcohol and alcohol is legal. Unfortunately marijuana is not legal, and at present those who use, buy and sell more than one ounce of marijuana risk arrest and being charged with a felony.
If other states that have legalized medical marijuana are examples, then the majority of prescriptions for marijuana will not be for patients who have grave medical diseases but for those with diagnoses such as anxiety, chronic insomnia and chronic pain. These patients will for the most part be requesting prescriptions because using marijuana makes them feel better.
Prescribing medications is complicated. To do it as safely as possible doctors must know effective doses and duration of effect so that they can determine the correct initial dose and frequency of use with the original prescription and then can adjust in a logical fashion if the dose requires adjustment. Prescribed marijuana has no reliable dosage. In states with legal medical marijuana, patients are generally advised to adjust the amount of marijuana they purchase to obtain the desired result and to repeat the dose as needed. That is no different than buying marijuana on the street and being told to stop smoking when you feel the way that you want to feel.
Paradoxically medical marijuana may put patients at increased risk of dependence, because it is being prescribed for a symptom or diagnosis that is likely to return when the effect of the marijuana wears off. An example is a patient with chronic neck pain. He feels better when he smokes marijuana. When the marijuana wears off, he feels less good. It makes sense given the indication for its use to smoke another joint. It is the continued and prolonged use that is more likely to lead to dependence as opposed to the person who gets home from work and smokes a joint to relax before supper.
I know that doctors will have differing opinions about prescribing medical marijuana. I suggest caution. Marijuana is not a usual medication. It will be difficult to decide the criteria that will result in a prescription for one patient, but not for another.
Medical marijuana is a new frontier for medicine in Massachusetts. In other states doctors (with and without financial backers) have opened up offices with the express purpose of prescribing medical marijuana. That is not encouraging.
What should we do here in Dukes County? I suggest we try to be the last county in Massachusetts to have a dispensary. See what happens elsewhere first. If Dukes County must have a dispensary it should have only one. We should discourage the establishment of any medical office whose primary purpose would be to prescribe medical marijuana. There should be an all-Island selectmen’s meeting to decide which town will have the dispensary.
Finally, the commonwealth should legalize the purchase of marijuana by adults, and thereby end a misguided medical program.
Dr. Henry Nieder is a family practitioner who has a private practice in Oak Bluffs.
Comments
I am glad Dr. Nieder is not
Lloyd Hart Oak BluffsI am glad Dr. Nieder is not going to be prescribing Cannabis as I would never see a doctor that displays such scientific ignorance. First of all Dr. Nieder claims smoking Cannabis has only been an issue for fifty years in America. Clearly the doctor should do some reading up. In 1937 the most ridiculous legislation was passed through congress. It was called the "Marijuana Tax Act" which was created to do one thing and one thing only, eliminate Cannabis as Hemp from the economy entirely so that it could be replaced by wood fiber for paper, cotton and petroleum products like nylon. It was Nixon that illegally placed Cannabis in schedule 1 in the Controlled Substances Act against the recommendations of congress and of Nixon's own Presidential Commission on Cannabis that discovered Cannabis had no toxicological content even when smoked so there could not be a possibility of addiction. In the 1990s the FDA also could not find any toxicological content even when smoke and therefore could not show any possibility for addiction.
"Paradoxically medical marijuana may put patients at increased risk of dependence, because it is being prescribed for a symptom or diagnosis that is likely to return when the effect of the marijuana wears off."
The above statement by Dr. Nieder is a complete fabrication of his own with utterly no scientific basis in fact whatsoever and is more likely due to his own experience prescribing truly dangerous drugs such as Oxycontin that has bread an entire generation oxy junkies that now break into pharmacies to get the drug.
As for emotional dependancy, there is no such thing. With a great deal of the drug war propaganda that Dr. Nieder seems to be buying into for whatever reason emotional dependency has no basis in science whatsoever. Several years ago because Canada established a nation wide medical cannabis program, universities began studying the effects of Cannabis. One study conducted at the U of Saskatchewan found that students that smoked cannabis while studying scored thirty percent better on their tests than students that didn't. Another study conducted at the U of Saskatchewan found that cannabis promoted the increased growth of brain cells.
What Dr. Nieder needs to do is escape his dependency on big pharma's kick backs and do some real science.
Dr.Nieder puts across the idea that we really don't know anything about how to use cannabis as a medicine. Well, I am married into a Asian family that practices traditional Asian medicine. I have in my possession of a copy of the Chinese Herbal Medicine Materia Medica. This book is a complete compilation of thousands of years of study in China of the efficacy of plant based medicine and it's applications and cannabis is listed in this book. The idea that we don't know how to use cannabis as a medicine is a typical aspect of western arrogance and racism and the fact that the US government has banned medical research in the field of medical cannabis.
In Dr. Nieder's first paragraph he pretends that Massachusetts voters were somehow duped into voting for medical cannabis but in reality everyone that voted for medical cannabis knows full well that the drug war caused more damage to an entire generation of children and young adults with it's zero tolerance rules and mandatory sentencing ruining millions of people's lives and radically increasing the prison population in America. These voters also know that with proper regulation cannabis can become a very useful addition to any doctor's war chest to treat a wide variety of ailments. When I was twelve a friend of my older brother made me some cannabis tea to treat my asthma which I was convinced I was going to die from. You see my cousin Jason died from his asthma a couple of years earlier so needless to say I was sure I was next. Well, to my absolute surprise within a brief few moments after consuming the cannabis tea my asthma attack completely vanished and my asthma has never returned to this day. As far as I am concerned that's medical efficacy.
Lastly, Dr. Nieder talks as though he is the last and final authority on the matter when he proposes that we here in Dukes county should be the last county to open a dispensary and we should limit it to just one outlet. Well Dr. Nieder let me give you a real number well documented in this county, 75%. 75% of Dukes County voters voted in the affirmative for medical Cannabis so if you don't want to lose patients to other more open minded doctors I suggest you recognize that number, 75%.
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