Collaboration in Civic Spheres

Prescription Pot Could Be a Real Bummer, UW Doc Argues

by Matt Rosenberg November 5th, 2013

In a new editorial for the journal General Hospital Psychiatry, a University of Washington and Veterans Administration doctor argues the scientific literature shows that prescribing smoked marijuana for chronic pain isn’t smart because it can cause a range of harmful mental and physical effects or heighten risks. A Mayo Clinic doctor offers a counterpoint, arguing medical pot can make sense as part of a careful treatment program. Meanwhile, Washington is looking at tough new restrictions on medical weed, as legal recreational pot comes to market here.

Although medical and now recreational marijuana are legal in Washington that doesn’t mean it’s now smart for doctors to prescribe pot for pain relief, argues a University of Washington physician who heads the addiction psychiatry program there, and the Center of Excellence in Substance Abuse Treatment and Education for the U.S. Veteran’s Administration Puget Sound Health Care System in Seattle. In the new editorial for General Hospital Psychiatry, titled “Marijuana Not Ready For Prime Time As An Analgesic,” Dr. Andrew J. Saxon argues that based on a review of the scientific literature, prescribing pot for chronic pain “is currently fraught with a number of concerns.”

He says a series of published research findings – footnoted in his article – indicate that smoked marijuana:

  • can have “unpredictable acute and chronic effects on mood and emotional state;”
  • can be associated with new “mood disorders and psychosis;”
  • does worsen depression, bipolar disorder, and symptoms of existing psychosis;
  • increases risk of “suicidal ideation” in men;
  • results in addiction for one in ten new users;
  • causes “cognitive impairments” that undercut learning, and harm motor vehicle operational safety;
  • causes “chronic cough and sputum” and “widespread airway inflammation” when smoked regularly;
  • and elevates risk of a heart attack in the first hour afterward by a factor of almost five.

  • Saxon adds that cannabinoids, particularly “pharmaceutically pure forms, certainly do show some promise as medications for chronic pain…and definitely deserve considerably more investigation. However, in view of the tangible harms…now is not the time for psychiatrists or other physicians to be prescribing or recommending non-pharmaceutical smoked marijuana for management of chronic pain.”

    Saxon’s critique comes as independently, a new vibe may be harshing the mellow that had been wafting around medical marijuana in Washington. Proposed new regulations from state agencies stemming from 2012 voter approval of recreational pot, would include a sharp reduction in allowable medical stashes for patients from 24 to three ounces, plus – as KING5-TV reported recently – the end of legal medical home-growing and collective gardens, and a new requirement that medical herb be dealt only in the new and few recreational pot sales venues that obtain a medical sales “endorsement” from the state.

    Washington voters first approved medical pot via Initiative 692 in 1998, codified in the state law RCW 69.51 which says it can be prescribed for pain related to conditions including cancer, HIV/AIDS, hepatitis C, anorexia, multiple sclerosis, epilepsy, acute glaucoma, and Chrohn’s Disease. And currently, as Governing magazine reports in a mapped feature, Washington and Colorado are the only two U.S. states allowing legal recreational pot use, while 18 more states plus the District of Columbia permit medical use.

    Looking at the broader landscape, of legal marijuana for recreational use following voter approval in Washington in November 2012 of Initiative 502, Dr. Roger Roffman, an emeritus professor from UW’s School of Social Work, has asserted that the state and public health experts must work extra hard to ensure that broad message of tolerance and choice doesn’t actually contribute to worsened health outcomes tied to pot use, especially among the young.

    Public Data Ferret’s Washington State+Public Health archive

    In a paper he published last June in the “open access” science journal Frontiers of Psychiatry, Roffman said in the wake of I-502 we’ll need to pay close attention in Washington state to possible increases in the use of pot by those under 21; to potentially more frequent negative impacts on school performance; to dependency trends and the need for effective treatment; and to the rate of traffic accidents where marijuana is determined to be a factor. It will also be increasingly important, Roffman added, to see that there is “more accurate knowledge held by the public concerning marijuana’s effects on health and behavior.”

    Our report on Roffman’s concerns includes citations of six additional university or government studies we found that warn of physical, mental and developmental health risks from marijuana use.

    However, in counterpoint to the new editorial by Saxon against now medically prescribing smoked marijuana, Mayo Clinic doctor J. Michael Bostwick argues in the same edition of General Hospital Psychiatry in another editorial that there is a place now for medical pot to treat chronic pain resulting from multiple sclerosis, rheumatoid arthritis, and pain accompanying HIV/AIDS and cancer.

    Such prescriptions need to be part of a broader treatment plan that includes “specific objectives” plus “informed consent” covering risks and benefits, and regular reviews of the drug’s effectiveness, says Bostwick. Risks exist; more research is needed; and “cannabis mills such as those described in Colorado” where one quick visit leads to a prescription filled at the next-door dispensary, aren’t good practice; writes Bostwick. But he emphasizes that doctors already must insist on honesty and closely monitor their patients for problematic consumption of alcohol, nicotine and prescription opiates, so it is no stretch to apply the same standards of counsel and treatment to prescription pot.

    Bostwick concludes, “…consideration of cannabis’ appropriate use for chronic pain cannot – and should not – be contemplated in fastidious isolation from the reality that no perfect, universally legal alternative solutions for dispelling chronic pain exist….Medical marijuana should be available as one more tool at physicians’ disposal for carefully and deliberately building effective analgesic programs for their patients.”


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