Medical Marijuana: Conflicting State and Federal Statutes Remain a Challenge for Practitioners and Patients

Almost half of the United States have now legalized the medical use of marijuana for conditions that include chronic pain, although it remains illegal under federal law, and regulatory hurdles in the US have impeded the conduct of cannabis research. Two prominent publications currently feature guidance to practitioners in the use of medical marijuana to address these concerns and others. In April of this year, the Federation of State Medical Boards (FSMB) unanimously adopted a set of policy recommendations developed by a 2015 workgroup that are intended to provide guidance to practitioners in the use of medical marijuana in treatment. A summary of these recommendations was published online earlier this month in The Journal of the American Medical Association (JAMA). Authored by FSMB President and CEO Humayun J. Chaudhry, DO, MACP, and colleagues, the summary addresses the dilemma confronting prescribing practitioners in the face of conflicting state and federal regulations regarding the use of marijuana. In 2013, the US Department of Justice advised states and localities that have authorized marijuana use to implement enhanced regulatory and enforcement systems to guard against resultant threats to public safety and health. Although the evidence for the efficacy of medical marijuana in the treatment of medical conditions including chronic pain remains scant, heightened public interest in the question creates a challenge for practicing clinicians.

The 10 recommendations adopted by the FSMB include measures designed to ensure rigorous patient evaluation and informed decision-making; careful and complete documentation of treatment plans that include marijuana; regular re-assessment of patient response to treatment; registration with the appropriate oversight agencies or registries; special attention to patients with known or suspected substance abuse histories; and freedom from conflicts of interest including affiliation with a dispensary or cultivation center.

Separately, the June edition of the Journal of Pain carries an article from the American Pain Society also providing guidance to clinicians on medical marijuana for pain conditions. Lead by author Seddon Savage, MD, medical director, Silver Hill Hospital Chronic Pain and Recovery Center, and with coauthorship by PAINWeek faculty member Michael Schatman, PhD, CPE, DASPE, the article reviews clinical, research, and policy issues related to herbal cannabis to counsel clinicians in advising and caring for patients who use it. From the article abstract, “Whether or not individual professionals support the clinical use of herbal cannabis, all clinicians will encounter patients who elect to use it and therefore need to be prepared to advise them on cannabis-related clinical issues despite limited evidence to guide care.”

To access the painweek.org library of information on medical marijuana, tap here.

Read a news summary of the recommendations here, with access to the journal article and the full FSMB guidelines, here.

The article abstract from the American Pain Society may be read here.

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