Maine Voices:

MARIJUANA STILL UNPROVEN FOR MANY ILLS

The Conditions a Rheumatologist Addresses Have No Studies Showing the
Drug Is Effective in Their Treatment.

PORTLAND - Medical marijuana prescribing is now legal in 14 states,
with Maine the latest to join the growing social movement to legalize
pot for medicinal use.

Prior to the vote last November and as the mechanisms for distribution
are finalized, there has been a relative silence from the medical
establishment on the pros and cons of prescribing marijuana to treat
various medical conditions.

In my own practice in rheumatology, I am increasingly asked, "Will you
prescribe marijuana for me?"

In trying to decide whether to prescribe marijuana, I read Maine LD
975: The Maine Marijuana Act. I wanted to evaluate the indications
which might apply to my patients.

As a rheumatologist, I treat patients with osteoarthritis and
fibromyalgia syndrome, as well as a diverse group of immune system
disorders including rheumatoid arthritis, lupus, ankylosing
spondylitis and vasculitis.

Many of these conditions may be painful and chronic. Some of them are
life-threatening and may require life-long treatment.

What's Covered in Law?

Since my patients are already asking me for prescriptions for medical
marijuana, I looked to see if these conditions were specifically
identified in the current law.

They were not. They seem to fall under the catch-all category of the
medical marijuana law as: "Debilitating medical conditions," defined
as "a chronic disease or medical condition that produces intractable
pain -- pain that has not responded to ordinary medical measures for
more than 6 months."

In other words, the patient tells me their pain is intractable,
therefore medical marijuana is indicated.

When I reviewed the literature and looked for well-designed trials
establishing medical marijuana's effectiveness in pain as it relates
to osteoarthritis, a common form of arthritis affecting more than 20
million Americans, there were no trials to evaluate. None.

Fibromyalgia syndrome, a disorder that affects an estimated 6 million
patients? None. Vasculitis? None.

Rheumatoid arthritis? One small Canadian study published in 2006 found
marginal benefit with an oral spray form of marijuana called Sativex
involving 55 patients.

That's it, for a chronic painful disorder that affects 1 percent of
the U.S. population.

Yes, there are a number of small, placebo-controlled studies assessing
the effectiveness of marijuana in cancer pain, chemotherapy-induced
nausea, multiple sclerosis and glaucoma.

Yes, there are animal studies that hint at beneficial effects on the
immune system with marijuana.

Yes, it has historically been difficult to perform adequate studies
due to the classification of marijuana as a Schedule 1 drug by the
federal government.

Yes, there may be future studies someday documenting the effectiveness
of marijuana on various rheumatologic diseases.

But, alternatively, these future studies may show no effectiveness, or
potential deleterious unforeseen side-effects, or interactions with
other medications commonly prescribed.

What research is out there is painfully thin. There is much we just
don't know.

The prescribing of medical marijuana is a unique and curious social
phenomenon.

It has been incorporated into my prescription options not through
approval by the Food and Drug Administration, not through vigorous
placebo-controlled trials, but through the ballot box.

Desires in Conflict

The majority of Maine voters decided to have it available as a medical
option.

Paradoxically, most patients want their doctors to evaluate scientific
evidence and prescribe medications that are found scientifically to be
effective and safe in well-controlled studies.

The use of medical marijuana, in my specialty of medicine at least,
fails this test. For now, I won't be prescribing it.

But as a physician, I look forward to the time when well-designed
studies answer the critical question: Is medical marijuana an
effective treatment for my patients?