What are your thoughts on the merits of medical marijuana? Do you think it should be legalized? My newspaper has run a series of stories recently about its supposed benefits. I really don't know what to think. Can you help me sort this out?
This is a question that is becoming more frequent, as more and more states are legalizing the use of marijuana, or cannabis, for medical purposes. The answer is not a short and simple one, and there are a number of important items that should be considered. At a minimum, however, we believe that a great deal of caution is in order.
When we think about marijuana as a possible medicine, an appropriate question is whether it is "good medicine." Does it provide medical benefits? Is it safe? Are there other established treatments that can provide the same desired benefits? Marijuana has been reported as a source of relief from nausea, poor appetite, glaucoma, and certain forms of pain for decades, and there is evidence that it can help some individuals in some cases. Most recently, marijuana oil has been suggested as an anti-seizure treatment. One of the main problems we have in terms of being able to judge whether marijuana is an effective treatment is the fact that most of the available evidence is anecdotal. The actual research on medical benefits of marijuana is sparse and mostly of low quality. This dearth of data is due in large part to the fact that the U.S. federal government classifies marijuana as a Schedule I controlled substance, which penalizes trafficking in marijuana and makes scientific research difficult to conduct.
While there's not a wealth of data on the medical benefits of marijuana, there is a tremendous body of information that details the problems associated with marijuana use. (You can read more about some of those problems in our Family Q&A "Perspectives on the Legalization of Marijuana." As with any drug, however, the question of medical marijuana's safety is not a question of absolute safety but one of benefits versus risks. Furthermore, it's clear that certain modes of marijuana consumption, such as smoking, are simply not healthy.
Another problem regarding medical marijuana is that it's impossible to know what exactly you are getting. Because of the difference in plant strains and growing conditions, each "lot" of cannabis contains different amounts of various compounds, some which may bring about a particular effect, some which appear to do nothing, and some which may be toxic at varying levels.
Because of uncertainties surrounding benefits, risks, and product quality, the question naturally arises whether other treatment options are available that don't rely on marijuana. For example, anti-nausea drugs already exist that can help cancer patients deal with nausea and loss of appetite. For those who don't respond to those drugs, Marinol may be helpful. Marinol contains a synthetic form of the main active compound (THC) found in marijuana. Proponents of medical marijuana claim that some patients don't respond to existing drugs but do respond to marijuana, and that medical marijuana should be made available for those individuals. Nevertheless, there is no condition for which medical marijuana is considered a first-line therapy.
Obviously, the debate over the therapeutic virtues of marijuana is far from over, but other matters remain to be addressed.
For one thing, marijuana's psychotropic effects are a matter of moral concern to many. If medical marijuana can get you "high," doesn't that make it inherently bad? On this we would draw attention to two points. First, a number of conventional, non-controversial therapies (such as morphine and even some allergy medicines) have effects on consciousness and awareness, but we don't consider them morally impermissible when used to properly treat certain problems or health conditions. By the same token, medical marijuana need not be morally problematic on the basis of psychotropic effects alone. That said, the Bible instructs us that we should not become drunk (Ephesians 5:18). While this injunction refers specifically to alcohol, we believe the principle extends to other substances, and the use of marijuana for purposes that are not primarily therapeutic but rather simply to "get high" are morally prohibited. An additional consideration is that not all strains and preparations of medical marijuana have the same effect on consciousness, and some (such as marijuana oil) are even touted as having little or no psychotropic effect.
On a similar note, marijuana's potential for abuse (a very real problem, despite some arguments to the contrary) isn't necessarily a cause for moral objection if it is used in an appropriate context. After all, we don't forbid the use of opioids even though they have a huge potential for abuse. We feel this moral objection is mitigated when medical marijuana is used by patients for whom other tried and tested forms of therapy have been shown not to work, and it is recommended by an ethical, responsible physician. The fact that these conditions are not met by many who currently use marijuana (ostensibly for medical purposes) is a source of great concern.
Other issues abound. One is the matter of legality. While at least 20 states have enacted laws to legalize the medical use of cannabis, it remains a Schedule I controlled substance according to federal law. Individuals who traffic in marijuana face the possibility of penalties, regardless of whether a particular administration chooses to enforce federal law.
Another thing to think about is the risks that people will be exposed to if marijuana is legalized in your state. The physical, psychological, cognitive and social problems that can arise from marijuana use, short-term and long-term, have been detailed elsewhere, and they are not insignificant. Likewise, marijuana's potential as a "gateway drug" leading to stronger drug use is also a matter of concern, especially if it is used inappropriately for recreational purposes.
An additional consideration in the medical marijuana debate is the abuse of laws intended to regulate its use. In states where medical marijuana has been legalized, there are numerous instances where the laws regulating marijuana's use have been abused or skirted. For example, a 2013 audit by the Colorado Department of Public Health and Environment found that of the 903 physicians throughout Colorado who had recommended medical marijuana, just twelve of those physicians were responsible for endorsing half of the state's 108,000 medical marijuana cards.State of Colorado Medical Marijuana Regulatory Performance Audit; June 2013 . Retrieved March 11, 2014, from http://www.leg.state.co.us/OSA/coauditor1.nsf/All/C9112BFFDE1559CE87257BA5007AE40F/$FILE/2194B%20MedMarijPart2%20June%202013.pdf One doctor alone added 8,400 individuals to the state's medical marijuana registry.Ibid. Another doctor recommended over 500 marijuana plants for a single patient, while yet another physician recommended 75 ounces to a patient. Recommendations of this sort are dubious at the very least.Ibid.
Another abuse of the laws regulating medical marijuana can be seen in the number of reported uses for the substance. While proponents of medical marijuana legalization often lobby the public by suggesting that it will be used primarily to provide relief to cancer, glaucoma, or HIV/AIDS patients, medical marijuana registries often tell another story. In Colorado, only 3 percent of people on the state's medical marijuana registry were listed as cancer patients; only 1 percent each were listed as using marijuana for glaucoma or HIV/AIDS.Colorado Department of Public Health and Environment Medical Marijuana Statistics. Retrieved March 11, 2014, from http://www.colorado.gov/cs/Satellite/CDPHE-CHEIS/CBON/1251593017044 Yet an amazing 94 percent of individuals on the registry reported using medical marijuana for "severe pain,"Ibid. a qualifying condition that is highly subjective. At one point it was reported that 70 percent of individuals on Colorado's medical marijuana registry were males, with the majority of those being between the ages of 25 and 34 yearsGundersen, D. (summer, 2010). Medical Marijuana – A Prescription for Trouble? In CPHP News. Retrieved May 6, 2014, from http://www.cphp.org/documents/CPHP-news-summer-2010.pdf – the demographic that is most likely to struggle with addictions. Please understand that we do not in any way diminish the suffering of those with cancer, glaucoma or HIV/AIDS, and we recognize that chronic pain is, for many, an agonizing and debilitating condition. We would assert, however, that abusing the system that regulates medical marijuana makes a mockery of those who earnestly seek medical treatment to alleviate their suffering.
This leads us to acknowledge one other major consideration – that the ultimate goal of many proponents of legalized medical marijuana is the legalization of marijuana for recreational use. No matter where you stand on this issue, it would be disingenuous to deny that attempts to legalize medical marijuana have been used by many as a foot-in-the-door approach to legalizing recreational marijuana, which we contend is a no-win situation for society. Read more about why we oppose the legalization of marijuana for recreational use.
In summary, while we don't have a great deal of information about the medical benefits of marijuana, there is a lot of research showing the problems marijuana poses to individuals and to society. While the debate about medical marijuana is likely to continue for some time, we urge great caution where the issue of legalization is concerned.
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