In September of 2010, ASAM released a statement expressing what many people considered to be a surprising opinion about the legalization of medical marijuana. The document, The Role of the Physician in “Medical” Marijuana, came down largely against the legalization of ‘medical’ marijuana that have been enacted by several states. This seems surprising, since many professionals have expressed the opinion that, while it is mildly addictive, marijuana is safer to use than other common, legal recreational drugs like alcohol and nicotine. In fact, it’s not the legalization of marijuana itself that ASAM and other professionals are objecting to; it’s merely the haphazard way in which the ‘medical marijuana’ system is constructed.
According to this article from Time magazine, only about 10% of those who use marijuana become addicted, as compared to 25% of heroin users and 15% of alcohol users. The overwhelming majority of marijuana use is recreational, and occurs in people who are not (or are not primarily) addicted to it. To this population, marijuana is still illegal, but is also desirable, and they will try to obtain it through the ‘medical’ system where such a system is in place. This leads to the main point of the ASAM paper; though marijuana is supposed to be dispensed in a medical capacity, it isn’t regulated like an ordinary medicine. It hasn’t been tested thoroughly by the FDA; there is a lack of real dosing guidelines, especially for smoked marijuana, where the amount administered is less easy to control; and the potency, usually measured by THC content, can vary widely, making proper dosing even more difficult. There are no specific illnesses which marijuana has been proven to effectively treat. In short, the ‘medical marijuana’ system is not very medically sound.
It seems that the ‘medical’ system is designed largely to exclude the ‘potheads’, those who are addicted to marijuana or only use it recreationally, from obtaining it. As I’ve written previously, patients who are addicted or have a history of addiction act very differently from other patients, and by making a prescription necessary to obtain this drug, the system gives these patients a strong incentive to lie to their physicians, who may not be prepared for this behavior. Physicians untrained in the field of addiction are now having to deal with people who might be suffering from addiction, instead of whichever disease marijuana is meant to cure. This will lead largely to misdiagnoses and over-prescribing of the drug.
This has also shifted some of the focus of the marijuana legalization debate to physicians, who are in no position to deal with it. Since there are no real protocols or procedures for the administration of marijuana in a medical capacity, physicians are being forced to make decisions about its use based on little or no scientific information. They have been made unwilling gatekeepers, which brings with it a great deal of responsibility and liability.
I am not opposed to the federal legalization of marijuana for recreational use; as I mentioned earlier, marijuana is no more dangerous than alcohol or nicotine. With proper regulation, and age-limit laws like those in place for alcohol, I see no particular reason why it shouldn’t be legal. If we’re going to make it legal, though, widespread regulation is absolutely essential. The ‘medical marijuana’ system is largely uncontrolled, ineffective, and full of loopholes which are ripe for abuse.