| One-Minute Clinician

Let’s Tread Carefully with Medical Marijuana

Medical marijuana is probably about one-part science and nine-parts religion at this point. We want to see that balance shift toward science. Only then are physicians’ practices, prescribers’ practices, authorizers’ practices going to be able to shift toward evidence basis. We know that the evidence basis for efficacy for THC is worse than we thought. We know that the safety profile for THC is worse than we thought particularly in terms of cardiovascular mortality and other safety issues, more-drug driving fatalities. There have been many studies including one that my group and I published in Pain Medicine, demonstrating how opioids and THC don’t mix. I just presented a number of different studies showing that marijuana whether medical or recreational may indeed be a gateway drug for many people based upon genetic predisposition to opioid abuse.

So, I don’t believe it is safe based on physical risk factors, cognitive risk factors, and psychiatric risk factors. Again, cannabidiol continues to be seen as perfectly safe, and we’re starting to see more cannabidiol research. Now that cannabidiol is available from the hemp plant, which is finally now legal, we’re getting pure cannabidiol, and we’re seeing some lovely results in pain and other fields. We also have the first pure cannabidiol medicine FDA-approved recently but only for certain pediatric seizure conditions. As far as cannabidiol as an opioid-sparing approach, that research has not yet been done other than we know that for certain pain conditions, there is a synergy with morphine; however, I spent many years in my practice using the combination of buprenorphine and cannabidiol for rapid tapering in two to three weeks with physician guidance. Primary care should avail itself of more education particularly regarding safety issues of whole plant marijuana and THC, and on the growing body of literature on the potential efficacy of cannabidiol.

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