Medical Cannabis: A guide to the clinical and legal landscapes
If your patient expresses interest in medical marijuana, you’ll find evidence on maximizing benefit while minimizing risk. But be cautious: Data are often contradictory.
PRACTICE RECOMMENDATIONS
› Educate patients about the effects of the physiologically active therapeutic compounds in Cannabis; this is critical to prevent overconsumption of products with high levels of tetrahydrocannabinol. B
› Screen patients for serious mental health concerns before recommending or certifying medical Cannabis; this is essential because the rate of psychiatric hospitalization is increased in bipolar disorder and schizophrenia patients who use Cannabis heavily. B
› You can recommend medical Cannabis and certify patients for its use with the certainty that the risk of overdose or serious adverse effects is exceedingly low. A
Strength of recommendation (SOR)
A Good-quality patient-oriented evidence
B Inconsistent or limited-quality patient-oriented evidence
C Consensus, usual practice, opinion, disease-oriented evidence, case series
Based on recent observational data from New York Cannabis dispensaries, cancer patients pursing Cannabis to treat chemotherapy-induced symptoms report that (1) either products with a high concentration of THC or products that contain THC and CBD in a 1:1 ratio are most effective and (2) products in 1:1 ratio of THC and CBD are most tolerable.
A legal system at oddsover the status of medical Cannabis
The core legal issue underlying medical Cannabis is a contradiction between federal and state laws.
At the federal level. The federal government regulates the lawful production, possession, and distribution of controlled substances through the Controlled Substances Act (CSA).12 The CSA is the basis for categorizing certain plants, drugs, and chemicals into 5 schedules, based on the substance’s medical use, potential for abuse, and safety or dependence liability.13 Under the CSA, marijuana (along with substances such as heroin and methamphetamine) is categorized as Schedule I14; ie, the substance
- has high potential for abuse,
- has no accepted therapeutic medical use in the United States, and
- lacks acceptable safety for use under medical supervision.
Despite waxing and waning efforts to protect states from federal prosecution, any use of a Schedule-1 substance violates federal law.15
In June 2018, a bipartisan group of federal lawmakers introduced a bill designed to amend the CSA and guarantee the rights of states and territories to self-determine marijuana regulation. The bill established a so-called STATES (Strengthening the Tenth Amendment Through Entrusting States) Act that “amends the Controlled Substances Act (21 U.S.C. § 801 et seq.) so that—as states and tribes comply with a few basic protections—its provisions no longer apply to any person acting in compliance with state or tribal laws relating to the manufacture, production, possession, distribution, dispensation, administration, or delivery of marijuana.”15
Continue to: The bill was referred to the Senate...
