I may be fairly unique for someone who went to college and med school in the 1960s and 1970s in that I have never used any drugs, including marijuana, and never intend to. However, looking at the reliable information available concerning the pros and cons of marijuana use, I find there is a net benefit in some cases.
In recent years synthetic marijuana has been available for severe nausea and appetite loss in the form of Marinol (dronabinol). Prior to my retiring 3 months ago I had a few occasions to prescribe Marinol to AIDS patients and others suffering from severe nausea. Per patient reports, the medication is only slightly better than available prescriptions but is useful because rotating strong anti-emetics seems to work better than staying on the same one long term.
This essay was triggered by a couple of recent letters to the editor, one of which I believe to be very misleading.
The goal in medicine is to provide a therapeutic and not a toxic (or intoxicating) effect of any medication that is prescribed. With marijuana the therapeutic dose is very close to the intoxicating dose. This is a problem if a user plans to drive a car or be employed in an area that requires full alertness and physical coordination (something most employers expect). Oral fluid (saliva) and blood tests can be performed to assess how much THC (the most psychoactive form of marijuana) is in the body, but unlike alcohol breath and blood tests, the THC tests give neither precise nor uniform results in assessing whether impairment is present. I fear that testimonials claiming THC is a “wonder drug” come mostly from those who are experiencing intoxicating levels rather than levels that a medical practitioner would recommend.
In spite of the difficulty in determining a safe level of marijuana, it has been found to be beneficial in treating some types of chronic pain, severe nausea, spasticity and rare forms of seizures. There is evidence that it also treats chronic anxiety conditions such as post-traumatic stress disorder.
Marijuana does have dangers. Most concerning to me is the altered brain development in children. It is also known to decrease motivation and can lead to addiction. Regular use can contribute to psychosis.
I believe society would benefit from decriminalizing marijuana so it can be studied and used more freely. Safe recreational marijuana may be an impossibility but more studies may be helpful.
Donald G. Flory, M.D.,