Sarah See Stith and Jacob Miguel Vigil, both from the University of New Mexico (Department of Economics and Psychology, respectively), recently penned a letter to Science regarding some of the federal barriers to studying cannabis by researchers.
I first noticed this letter via a post on the website Science Alert, “Scientists claim the US government is still limiting cannabis research“. However, what struck me as problematic was this quote:
“This has created a truly unique and an unnecessary paradox in modern medicine, in which physicians are authorising treatments to patients, and patients are regularly using medication without a scientific basis of knowledge on patient outcomes, forced rather to rely only on scientifically invalid or anecdotal information,” say Sarah Stith and Jacob Vigil from the University of New Mexico.
Now, this quote is taken to another source, which quotes it from the original press release from the University of New Mexico (see here). [As a side note, it’s odd that Science Alert does a good job of linking to the original Science letter, but the press release itself fails to do so. You can read the author’s letter here.]
What is my problem? Physicians do not actually recommend medical marijuana for patients (or ‘authorize treatment’ as the authors put it). Physicians can only certify that patients have one of the listed qualifying medical conditions (see the NM patient application here for the exact wording).
So, physicians are not actually prescribing marijuana to patients, but merely certifying that patients have a certain medical condition or symptom approved for the use of medical marijuana under the state law. Presumably, this is a loophole for physicians since they cannot legally prescribe a drug that is still technically a Schedule I drug according to the federal government, as opposed to Marinol(R) (Dronabinol) or Cesamet(R) (Nabilone), which are FDA-approved cannabinoid drugs.
Of course, this distinction is silly, as physicians are functionally prescribing patients to smoke marijuana, and can hardly claim morally otherwise.
This brings me to another point and the authors (Stith and Vigil) do not follow their line of reasoning when they say, “patients are regularly using medication without a scientific basis of knowledge on patient outcomes, forced rather to rely only on scientifically invalid or anecdotal information”. Should medical marijuana physicians be held morally responsible for recommending a drug to patients under the conditions just as described? Further, the physicians recommending medical marijuana are very unlikely to be the patient’s general practitioner or specialist treating the patient’s underlying disease or condition, but a physician to specializes in recommending medical marijuana. One might think this creates a conflict of interest, where the physician puts the profits of clinical visits above what might be good for the patient’s health.
Case in point: A 2013 performance audit by the Colorado Department of Public Health and Environment found that just 16 physicians had recommended medical marijuana for 60% of patients with one physician having recommended 8,400 patients. This is out of a total number of about 100,000 medical marijuana patients. The audit also found evidence that some physicians have other financial ties to medical marijuana businesses, further creating conflicts of interest.
To be fair, the authors’ letter in Science is actually quite short and far more measured and reasoned than the press release. It focuses upon the main issues of barriers to researcher access to study marijuana and the lack of realistic potency from NIDA-approved marijuana that must be used by researchers. I completely share their concerns in this regard. I also understand from personal experience how easy it is to lose scientific nuance when converting ideas to a press release. Nevertheless, I’m concerned that there is not sufficient discussion about these issues either among scientists or the public.