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Medical Marijuana and the American College of Physicians
The American College of Physicians (ACP) recently released a landmark position paper titled: Supporting Research into the Therapeutic Role of Marijuana
The ACP is the largest specialty organization with nearly as many doctors as the American Medical Association. The ACP’s 124,000 doctors specialize in internal medicine and related subspecialties, including cardiology, gastroenterology, pulmonary medicine, oncology, and infectious diseases. The ACP publishes Annals of Internal Medicine, the most widely cited specialty journal in the world. Among its member-physicians, ACP recognizes achievement through fellow and master awards, which are the FACP or MACP behind some doctors’ names.
Position 1 supports increased research not only looking for bad effects; but also looking for therapeutic benefit. Typically, federal research money is available only to researchers looking for harm from marijuana. The ACP reminds politicians that ethical funding promotes science rather than politics.
Position 2 encourages non-smoked delivery of THC. Even though marijuana smoking does not cause cancer, it can cause chronic bronchitis with smoker’s cough and chest pain. But, the ACP did its homework on vaporizing or heating cannabis without combustion. They concluded, “Vaporization of THC offers the rapid onset of symptom relief without the negative effects from smoking.” For more on vaporization, please see www.alternativesmagazine.com/31/bayer.html
Position 3 supports the current process for obtaining federal research grade marijuana to maintain standardization. This sounds reasonable on the surface except there is only one source of research cannabis in the US, which the Drug Enforcement Agency (DEA) zealously controls. Did the ACP fail to think this through so Position 3 contradicts Position 1? Or, is this a tempest in a teapot? Once cannabis moves out of Schedule I, doctors with a standard DEA license can legally handle it and may be able to import standardized research grade cannabis from Dutch pharmacies. It is absurd to think the federal marijuana farm in Mississippi can deliver the entire American supply. The University of Massachusetts has already applied to grow cannabis for research. Others will follow.
Position 4 is the main course. It urges review of marijuana’s status as a Schedule I controlled substance and its reclassification into a more appropriate schedule, given the scientific evidence regarding marijuana’s safety and efficacy. This means patients could get a prescription for medical marijuana just like medical codeine or other controlled drugs. The ACP reminds us, “compared to other licit and illicit drugs, including alcohol, tobacco, and cocaine; dependence among marijuana users is relatively rare and appears to be less severe than dependence on other drugs.”
The understatement of the year is their observation, “A clear discord exists between the scientific community and federal legal and regulatory agencies over the medicinal values of marijuana, which impede the expansion of research.”
What ACP describes as “discord” is more accurately, fear. And, it is this cowardice among regulators that kills patients. The profitable industries that depend on the war on drugsparticularly urine drug testingignore the war’s casualties. My prescription is for patients and doctors to fix our medical politics by removing control from the profiteers.
Position 5 embraces a political reality check in spite of our country’s misguided war on marijuana. The ACP supports excepting or exempting physicians and patients from criminal or civil liability when medical marijuana is used as permitted under state laws like Oregon’s. It would buy us time to resolve federal issues.
Mercifully, the ACP concludes, “The science on medical marijuana should not be obscured or hindered by the debate surrounding the legalization of marijuana for general use”. That principle alone would do a great deal to make cannabis more available to patients who may benefit.
Medical cannabis remains controversial because too many are complacent or addicted to the financial gravy train of urine drug testing, compulsory treatment, and other aspects of the war on drugs. As the Business sections of our newspapers tell us, doctors are no longer valued by universities as teachers or clinicians because the bottom line is federal research money. This reinforces the public perception that 21st century doctors are more likely advocates for their employer rather than their patient. When politics ignores science and the DEA determines medical choice, patients and those doctors who remain patient advocates must act.
The ACP should have written this a decade ago. Their tardiness reinforces the maxim that doctorslike politiciansmay eventually “get it” but tend to follow rather than lead. In spite of this, the ACP deserves thanks for another wake-up call. Doctors must always advocate for patients rather than prostitute their allegiance to the highest bidder. Sadly, patient advocacy is becoming rare. The ACP should not have to remind doctors to be scientists with integrity. When politics threatens medical choice, doctors and patients need to stand together. When medical choice vanishes, it is hard to regain. Medical marijuana provides an unfortunate example.
Richard “Rick” Bayer, MD, FACP is board-certified in internal medicine, a Fellow in the American College of Physicians (FACP), practiced, and lives in Oregon.
Site updated Fall 09