Over the past few years, there has been a sea change in how state governments and some physicians think about marijuana as a medicine.
Most recently, the American Medical Association's House of Delegates approved a policy recommending that the federal government review its classification of marijuana. Its current designation, as a Schedule I controlled substance, limits the ability of researchers to evaluate the drug's usefulness as a medical therapy, the AMA said. The new AMA policy states that the goal of the reclassification should be to ease the conduct of clinical research and the development of cannabinoid-based medicines and alternative delivery models.
But the policy also clearly states that the request for a federal review should not be seen as an endorsement of state-based medical cannabis programs or the legalization of marijuana.
The AMA joins other medical and public health organizations in favoring a reclassification of marijuana to encourage research. But the AMA's size and clout means people are taking notice of this recommendation, said Bruce Mirken, a spokesperson for the Marijuana Policy Project, an organization that advocates for the decriminalization of marijuana use.
“This shift is very significant, even though it was done with what you could safely call characteristic caution,” Mr. Mirken said.
Although the AMA's position won't by itself cause a swift and dramatic political shift, Mr. Mirken said the AMA's previous opposition to a change in Schedule I classification was often seized on by opponents. “They can't really say that anymore,” he said. “That, in the big picture, is significant and it may make it easier for more laws to be passed on the state level.”
Since 1996, laws that allow for some type of medical use of marijuana have been enacted in 13 states: Alaska, California, Colorado, Hawaii, Maine, Michigan, Montana, Nevada, New Mexico, Oregon, Rhode Island, Vermont, and Washington. Additional states have enacted “symbolic” laws that recognize the value of medical marijuana but do not protect individuals from arrest, according to the Marijuana Policy Project, and more states are considering medical marijuana laws.
Another development that could open the door for more states to pass medical marijuana exceptions is a recent memorandum from the Department of Justice essentially advocating a hands-off policy on medical marijuana use in states where it is allowed. In the memorandum, issued in October, the DOJ told federal prosecutors in states with laws authorizing the medical use of marijuana not to focus their resources on enforcing the federal prohibition on marijuana. For example, the prosecution of cancer patients who use marijuana as part of a recommended treatment regimen is “unlikely to be an efficient use of limited federal resources,” according to the document.
In California, where medical marijuana has been legal for more than a decade, some physicians feel they are in a precarious position. The California law states that physicians will not be punished for recommending marijuana to a patient for medical purposes. But even with the latest DOJ memo, federal enforcement is not uniform or predictable.
“That's a very uncomfortable position for a physician,” said Dr. Melvyn Sterling, a palliative care specialist in Orange, Calif. Dr. Sterling said he would prefer to see the federal government explicitly decriminalize the prescription of medical marijuana so that physicians could feel free to prescribe whatever medication is most beneficial to patients.
Dr. Sterling said that he feels comfortable recommending marijuana as a treatment when his patients need it, but that he recommends it very rarely. “For the most part we have in our therapeutic armamentarium wonderfully effective drugs, and we're not dependent upon cannabinoids,” he said.
In states that do allow physicians to recommend marijuana as a medical treatment, physicians should use caution, said Dr. Georges C. Benjamin, executive director of the American Public Health Association, which was an early supporter of more research into the medical use of marijuana. As with any other therapeutic option, physicians need to be thoroughly familiar with the drug, its utilization and side effects, contraindications, and drug-drug interactions.
“We ought to treat this like any other therapeutic drug,” he said.
It is harder to follow that advice in California, where the onus is on patients to follow up with their physician when using marijuana as medicine, according to Dr. Denise Greene, a psychiatrist and addiction specialist in the Los Angeles region. In California, physicians may “recommend” that patients obtain marijuana to treat a medical condition; the patient then takes that recommendation to a dispensary. At most dispensaries, that “recommendation” does not need to be renewed or updated, she said.