Marijuana Use and Health Care

The most abused drug in America is still marijuana. Arguments for and against legalizing marijuana are continuing to grow. This article is not meant to start a legalization debate over marijuana. I would rather see caution practitioners who have patients in their care that test positive for marijuana. Federal law still prohibits marijuana use. Patients who self-medicate with or abuse marijuana should not receive controlled substances.

Many doctors are faced with the difficult decision of prescribing controlled substances to patients who have tested positive for marijuana.

This is especially true in states where marijuana legalization has been changed by their state laws. These state laws changes do not alter the Federal guidelines that doctors must follow. I am a former career DEA agent and remind doctors that marijuana is still illegal Schedule I controlled substance. It has no accepted medical use in the U.S. All state laws are subject to Federal oversight as stipulated in the Constitution’s Supremacy Clause. The Supremacy Clause, an Article VI clause of the U.S. Constitution that states that federal law is supreme law of land, is what is described in the Supremacy Section. The doctrine of preemption is based upon the Supremacy Clause and states are preempted by federal law. “(1)

If a doctor becomes aware that a patient has been using marijuana, alternative therapies should be used. If the patient is using marijuana, doctors should take action to refer them for treatment. Patients are not safe if they consume high-potency marijuana.

Is FDA-approved medical marijuana available? There are two FDA approved drugs in the U.S. containing a synthetic analogue of THC (tetrahydrocannabinol), which is the principal chemical (cannabinoid) responsible for marijuana’s psychoactive effects. Marinol (Schedule II), and Cesamet, which are FDA-approved drugs, contain a synthetic version of THC. These drugs are used to treat nausea in cancer patients who are undergoing chemotherapy. Marinol can also be prescribed to anorexia and cancer patients to increase appetite (2). FDA currently oversees trials for Epidiolex (3), a drug made by GW Pharmaceuticals that was developed to reduce seizures in children. Cannabinoids, also known as CBD or cannabidiol, are found in the drug. They do not have the psychoactive effects of traditional marijuana, and they don’t produce a high. This drug would be the first drug to contain CBD in America if it is approved by the FDA.

DEA also granted a special registration to a University of Mississippi research laboratory to cultivate marijuana strains for clinical trials (4).

Although this research is ongoing, the U.S. government has not approved the ingesting, smoking, or consumption of cannabis plants as a medical treatment. Patients who smoke or inhale marijuana should be aware of the Federal laws that could lead to them being prosecuted. Physicians should also test for marijuana use. If they are found, they should not prescribe controlled drugs, regardless of the patient’s diagnosis or symptoms.