Pubdate: Tue, 27 Aug 2013 Source: San Francisco Chronicle (CA) Copyright: 2013 Hearst Communications Inc. Contact: http://www.sfgate.com/chronicle/submissions/#1 Website: http://www.sfgate.com/chronicle/ Details: http://www.mapinc.org/media/388 Author: Laura Davies Note: Laura Davies is a psychiatrist for California Pacific Medical Center. DOCTORS AREN'T GATEKEEPERS "Medical marijuana" is a catchphrase. One, as a physician, I am mystified by, given the lack of robust evidence or FDA approval of marijuana as medicine. Despite Sanjay Gupta's recent endorsement, there are no high-powered, placebo-controlled studies demonstrating unique efficacy for marijuana over any other medicine for any indication, and there are a number of drawbacks to the use of it. Legalizing marijuana on a nonmedical basis is a different question. Physicians should not be the gatekeepers for something that, at this point, is not established medicine. In 2003, California Senate Bill 420 (yes, that is the correct number) established guidelines for the use of marijuana as outlined in the Compassionate Use Act. That act, passed as Proposition 215 with 55.6 percent of the vote in 1996, allowed seriously ill residents, with the recommendation of a physician, to use marijuana for medical purposes "without fear of criminal liability." The conditions under which SB420 guidelines allow marijuana use are a disparate and sloppy list, with a mixture of diagnoses and symptoms. The bill does not specify whether the cancer must be serious or a quickly removed mole. It is unclear how using marijuana will improve the ability of patients to conduct many "major life activities." SB420 also provided for developing a state identification card system to be administered by each county. San Francisco offers its marijuana card through the Department of Public Health. A doctor has to fill out a form much shorter than that for any temporary disability, leave of absence or insurance. The doctor merely stamps his or her name, address and license number, writes in the patient's name, then signs at the bottom. There is no requirement to specify what the condition is, or whether it is expected to be temporary or permanent. Doctors are responsible for the therapies they prescribe. Recommending a therapy outside of FDA approval places one at high risk for malpractice, with little defense. Approving marijuana for minors is even riskier. We have ample data that marijuana has a detrimental effect on brain development. There is also a well-recognized syndrome of low motivation and achievement. How can marijuana be an acceptable option for minors? Teens who use marijuana don't go as far in school or achieve as much at work. Teens and young adults who are regular users have worse attention, slower psychomotor speed and poorer memory. Earlier age of use of marijuana is related to poorer cognitive function and later increased use of marijuana. Designating marijuana as just for medical use does not protect teens from abusing it. In fact, there is a high use of medical marijuana use among teens in substance-abuse treatment. A study in Denver showed that 74 percent of the teens in treatment had used medical marijuana without a prescription, and most had used it an average of 50 times. According to the California Medical Association, "cannabis may be effective for the treatment of pain, nausea, anorexia and other conditions, but the literature on this subject is inadequate, dosage is not well standardized ... ." Also, data for medical use of cannabis is "very limited." For severe nausea and emesis, there is a cannabis-derived pill that is FDA approved: dronabinol. There may be reasons to decriminalize marijuana, and there are public health arguments on both sides of that issue. However, expecting physicians to prescribe or recommend an unapproved drug without clear evidence of efficacy is inappropriate. Should citizens wish to legalize marijuana, they should do so without hiding behind a specious medical justification. - --- MAP posted-by: Jay Bergstrom