There are two sides to the coin, as you might imagine.
More and more, doctors around the nation are beginning to understand that marijuana has valid medical uses. Even the American Medical Association (AMA) has said that the plant does have some valid therapeutic benefits. Yet in some states where it is legal—for either medical use or recreational use or both—a growing number of doctors say that it is too readily prescribed.
Dr. Emily Gibson teaches medicine and says that her students often ask her to prescribe medical marijuana for their stress symptoms from the grueling pace of medical school. Gibson doesn’t understand how people so readily accept marijuana when they scrutinize prescription drugs so completely. “I’m perplexed by how easily this plant is given a pass by young and old, rich and poor, professional or blue collar, or liberal or conservative,” Gibson says.
Some patients abuse the practice by exaggerating symptoms just to obtain legal access. Doctors complain that some of their fellow physicians prescribe it to everyone, because it is very easy to find at least one symptom in every patient that can be treated with marijuana. Medical marijuana opponents also say that some doctors use it as a get-rich-quick scheme—the physician spends 10 minutes with the patient, identifies a symptom, signs the medical marijuana card, and the prescription is written. Some doctors even place newspaper ads touting special discounts on writing prescriptions.
Stanford Medical School’s Keith Humphreys served as President Obama’s senior drug policy advisor. He claims a small number of doctors are issuing the overwhelming majority of prescriptions and are blatantly abusing the system in California. Humphreys goes on to say that what is happening in California is happening nationwide.
“As a cash-only business without any meaningful oversight, a medical marijuana practice is a dream come true for those who graduated at the bottom of their medical school class. And it’s pretty clear that dispensaries are using the medical marijuana law as a way to sell recreational marijuana. A deep-pocketed industry with lobbyists has been created to supply recreational users under medical cover. Many doctors feel their profession is getting a black eye,” Humphreys said.
Even if doctors don’t have a sinister intent, a new study shows that the large majority (90 percent) aren’t considered prepared enough to make proper recommendations. Why? Because they learn nothing about cannabis in medical school—there’s no formal education. Most states require that a person have a current medical license and take a single course.
Here’s the other side of this argument.
There are safeguards in place that strike fear into physicians who might be considering overprescribing any medication. There is a palpable legal risk. Medical marijuana proponents say doctors who overprescribe have been around long before medical marijuana ever hit the mainstream.
Many doctors will tell you that overprescription is more about the doctor than it is about the drug. If a doctor is going to overprescribe, they’re likely to overprescribe anything, regardless of what the drug is and regardless of any legal or ethical consequences.
After all, overprescription has been happening for decades. The phrase “deep-pocketed industry with lobbyists” also aptly describes the extremely lucrative pharmaceutical industry. Just look at the unnecessary medications prescribed to older Americans. Researchers who have studied this situation, called polypharmacy, estimate that one-quarter of older Americans in their sixties take at least five prescription drugs, and that doubles when you’re in your seventies. Incredibly, doctors frequently encounter elderly patients who take a whopping 20 medications for everything from gastric reflux to insomnia.
Marijuana “prescription” abuse by doctors is handled just like any other substance. Doctors have been reprimanded by state boards for improper issuance of recommendations, and some have even lost their medical licenses. In one Colorado case, a physician prescribed cannabis to a 20-year-old woman he had never met or examined. The woman was pregnant, nearly full term. He lost his license.
Many doctors and patients make the argument that marijuana is indeed wholly under-prescribed. Despite its known impact on conditions like epileptic seizures and a whole host of other ailments, there are several hurdles in place, all thanks to the United States government, that keep research from progressing forward.
Because marijuana is still an illegal Schedule I drug on the federal level, medical marijuana is not an FDA-approved drug. Insurance companies won’t pay for drugs that are not approved by the FDA, so many patients are being left without a way to pay for their treatment.
The Schedule I classification also makes it nearly impossible to do any kind of meaningful clinical trial to further research on positive outcomes of medical marijuana. All of this presents a circular argument that medical marijuana proponents find ludicrous. Take the opioid crisis as one example. Opioids are legal but marijuana isn’t. Recent regulations have limited doctors’ ability to prescribe opioids, but nevertheless, the drugs are still legal, and still greatly overprescribed.
Certainly, opioids are effective in controlling pain, but these dangerous drugs are highly addictive and responsible for thousands and thousands of deaths each year. The opioid crisis is a national epidemic. Marijuana has also been shown to be effective in reducing pain. Unlike opioids, there is not a single known case of a marijuana overdose death. Many credible researchers and doctors have said that cannabis shows promise as an opioid alternative. Much more research is needed, but the research isn’t supported or funded because of the drug’s federal illegal status.
Finally, because it is still a schedule I drug, physicians still can’t “legally” prescribe marijuana at the federal level, yet it is recommended by doctors in 23 states on a daily basis. Attorney General Jeff Sessions’ recent rollback of the Cole memo puts even more pressure on physicians who are ethically prescribing marijuana.
The 2014 Obama administration memo directed U.S. attorneys “not to focus federal resources in your states on individuals whose actions are in clear and unambiguous compliance with existing laws providing for the medical use of marijuana.” Instead, the US Justice Department focuses on criminal enterprises related to marijuana, a much higher priority in the grand scheme.
Now that the Cole memo has been revoked, these attorneys have the power to go after doctors or any individual who might be abusing the system. Up until now, federal prosecutors have in effect looked the other way, and doctors are more fearful that they will begin to be more scrutinized. Therefore, most are likely not to risk shedding light on themselves by overprescribing.
Is overprescription of marijuana something to worry about, given the massive overprescription of more dangerous, albeit legal, drugs? Most medical use supporters say that marijuana could be used so much more to help people.
Supporters of medical cannabis also say that the current process in place ensures legitimate medical marijuana use. Physicians are supposed to thoroughly examine the patient and write a recommendation letter stating that the patient qualifies for medical use. Physicians do not dispense marijuana—only licensed dispensaries can.
Doctors definitely have to be careful with recommendations. They’re wary about being fined or having medical licenses revoked and they’re equally concerned about being accused of fraud and malpractice charges. All doctors face patients who seek out prescriptions they don’t need, regardless of the drug, and it’s up to the doctor to stand firm and just say ‘no’.
In 2013, in a New England Journal of Medicine poll conducted on nearly 1,500 doctors in multiple countries, 76 percent said they’d prescribe medical marijuana for certain ailments. Doctors who were proponents cited the known therapeutic effects of cannabis for nausea, pain relief and appetite stimulation. They were also concerned about the known dangers of narcotics. Keep in mind this poll was in 2013, and the opioid epidemic has skyrocketed since then.
Certainly there were some physicians who opposed medical marijuana, citing two main reasons: (1) lack of scientific evidence and (2) negative side effects of the hallucinogenic compounds like THC.
But doctors who were proponents cited one main reason why they were so overwhelmingly favorable towards prescribing marijuana, and that was patient choice. Patient choice should matter. The question is, how much?
Please don’t take anything you read here as medical or legal advice. If you need medical or legal advice, consult a doctor or lawyer. The articles and content that appear on this website have been written by different people and do not necessarily reflect the views of our organization.