The issue of medical cannabis poses a challenge not only to lawmakers and law enforcement, but also to doctors. Currently there is not enough information available about the health impacts of medical cannabis, and doctors find themselves pressured by the public and unprepared to make ethical and informed recommendations. The challenge of being both informed and supportive of their patients affects rheumatologists in particular. In an analysis recently published by the journal Arthritis Care and Research, further research into medical cannabis was advocated for as a way to resolve some of the challenges that this topic poses to practicing physicians.
In states where it is legal to receive medical cannabis, the most commonly awarded complaint is for “severe pain.” This pain is usually musculoskeletal in nature, and often cites elements of rheumatoid arthritis. As such, it is likely that the issue of medical cannabis affects rheumatologists more than any other kind of medical practitioner.
Perhaps the greatest challenge posed to rheumatologists and other doctors is the lack of current understanding about medical cannabis. While it is widely accepted that cannabis use causes impaired cognitive function and motor skills, the extent to which these effects occur has yet to be examined in detail. Furthermore, evidence suggests that cannabis use may be associated with risks for psychological illness, cancer, and other associative behaviors such as smoking tobacco. As it stands, medical cannabis does not meet the minimal pharmacotherapy standards that are usually strictly adhered to when evaluating the use of other therapies. This current lack of concrete medical evidence makes it extremely difficult for doctors to advise their patients on how and whether or not to use medical cannabis.
Furthermore, in some jurisdictions doctors are asked to take medical responsibility for patients that use medical cannabis. One example of this comes from Canada in which doctors must make detailed prescriptions about the dose, frequency, and duration of cannabis use. The problem of not enough knowledge in these matters is further compounded by issues of ambiguous terminology that leave wide gray areas of open interpretation as to what exactly constitutes a “medical need.”
In the recent analysis published by the journal Arthritis Care and Research, it was noted with some dismay that over half of the prescriptions written for medical cannabis in the state of Colorado are issued by 15 doctors. Physicians are well aware that many of the patients that come to them with inquiries about medical cannabis have been recreational users in the past. Similar to the gray area about what constitutes a “medical need,” the guidelines about whether or not to prescribe cannabis to a patient with motives for recreational use are also unclear.
To conclude, the challenges posed by the issues of medical cannabis impact doctors in ways that they may not yet be equipped to handle. Certainly in the future, matters pertaining to the health and ethical aspects of medical cannabis must be integrated into the medical school curriculum and more research must be completed to keep current doctors informed.
By Sarah Takushi