Pubdate: Wed, 29 Oct 2014
Source: Tallahassee Democrat (FL)
Copyright: 2014 Tallahassee Democrat
Contact: http://static.tallahassee.com/contactus-form/
Website: http://www.tallahassee.com/
Details: http://www.mapinc.org/media/444
Author: Michael W. Forsthoefel

NOT FOR THIS DOCTOR'S PATIENTS

A popular notion is that marijuana is a harmless pleasure, access to
which should not be regulated or considered illegal. Actually,
marijuana is currently an illicit drug of which 12 percent of people
over the age of 12 have a high rate of use. As a practicing physician
specializing in internal medicine, and as a member of the Florida
Medical Association, I see Amendment 2 as both a danger to "patients"
and a hindrance to the ability of quality physicians to provide
quality care.

I never would recommend marijuana to any of my patients. With more
than 400 chemical compounds at varying strengths, it is impossible to
have standardization from one patient to the next, and any potential
side effects or drug interactions could do far more harm than good.
Pharmaceutical companies are required to disclose any potential side
effects or drug interactions; Amendment 2 has no such provision.

There is no doubt that there are compounds in the marijuana plant that
can be helpful. Marinol, a synthesized form of THC, has been produced
and prescribed in the United States since the late 1980s. It has been
used to help cancer and HIV/AIDS patients maintain appetite and to
reduce nausea, without the side effect of euphoria. Furthermore, GW
Pharmaceuticals is in the process of human-testing Epidiolex, a
synthetic from of CBD (the active compound in Charlotte's Web). When
this drug gains FDA approval, it will be sold in standardized dosages
by pharmacies for the treatment of seizures in children.

Should this amendment pass, a physician could merely "recommend"
marijuana to a patient. It would be up to the dispensary worker to
decide the particular strain, amount and method of consumption. It
would be unethical for a physician to send a patient to anyone but a
licensed pharmacist, in a licensed pharmacy, to dispense medication.
Amendment 2 does not articulate the qualifications one must have in
order to dispense pot; it is highly likely that the dealers in the
dispensaries will be "treating" themselves as well as "patients." As
Sir William Osler once said, "A physician who treats himself has a
fool for a patient." The same holds true for drug dealers.

Beyond the problems of distribution, there are physical problems that
cannot be understated. Evidence published in the New England Journal
of Medicine shows an increased likelihood of harmful consequences if
marijuana use is started in adolescence. These effects are known to
include impaired short-term memory and impaired motor coordination,
interfering with driving skills and increasing risk of injury.

Long-term affects of marijuana use can include altered brain
development and cognitive impairment, with lowered IQ scores and
depression among frequent users during adolescence. In high doses,
marijuana exacerbates paranoia and psychosis, especially in those with
a pre-existing genetic vulnerability to diseases such as
schizophrenia.

Just like smoking cigarettes, marijuana smokers are introducing
foreign material into alveoli of the lungs. Smoke, no matter the
source, is an abrasive substance, and there is a probable association
of increased risk of lung cancer and upper digestive tract cancers in
people who use marijuana daily. Chronic bronchitis and pneumonia,
because of the impaired immunological competence of the respiratory
system in marijuana smokers, is also likely among frequent users.
Additionally, just as in tobacco smoke, secondhand exposure to
marijuana smoke likely has significant negative affects, especially in
children who would be exposed to both the smoke and the euphoric
chemical compounds.

While the future of medical marijuana may be unclear, the current
science is not. The American Cancer Society, the American Medical
Association and the Florida Medical Association reject marijuana as a
viable treatment option for any condition. As for my practice, as long
as there is a lack of federal oversight and a lack of pharmacological
evidence, I will not be "recommending" marijuana to my patients.

Dr. Michael W. Forsthoefel has been practicing medicine for 35 years.
He now practices in Tallahassee, specializing in internal medicine. He
is affiliated with Tallahassee Memorial Healthcare and is a member of
the Florida Medical Association.
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MAP posted-by: Matt