This article appears as a segment of a "Point/Counterpoint" style section in Asclepius Health Journal Spring 2009

Although some people might think that marijuana is generally about as safe as alcohol and safer than cigarettes when used by responsible adults, like alcohol and cigarettes, it should be regarded as an occasionally dangerous drug with slight empirical evidence for broad-spectrum medical use. In California, it operates under a grossly unregulated dosage regimen, and does not belong in the domain of medicine.

Medical marijuana establishes an ugly precedent for how medicine is practiced and medication is prescribed. In 1996, California voters passed the Compassionate Use Act, commonly known as prop 215, allowing patients and caregivers the freedom to use marijuana as directed by a physician. Circumventing the standard �convergence of evidence� system for developing scientific knowledge and justifying the approval of medication, California voters, rather than scientists and doctors, decided that marijuana is useful and safe enough for medical purposes.

Unfortunately, there isn�t much proof for medical use of smoked marijuana beyond anecdotal evidence. After a thorough survey of available research on medical marijuana, the Institute of Medicine (IOM) contends, �the effects of cannabinoids (the psychoactive chemicals found in marijuana) on the symptoms studied are generally modest, and in most cases there are more effective medications.� The report goes on to observe that while some medical marijuana research shows promising results, it is a stepping stone to developing better medications in the future.

Admittedly, there are certain therapeutic benefits to using marijuana, especially for patients on their deathbed. A nurse, preferring to remain anonymous, at a Kaiser hospice for dying patients explained, �many patients prefer to just smoke a bit of weed instead of getting addicted to [prescription pain killers that are like] heroin or Oxycotin before they die.� Indeed, according the US DEA website, 40% of medical marijuana users use the drug to treat chronic pain. However, the common use of a drug to treat or alleviate the symptoms of a certain condition does not indicate that it is the most effective option for managing that condition. For example, caffeine is among the most ingested psychoactive chemicals in the world, yet the leading research indicates that other chemicals, such as modafinil, are more effective for managing chronic fatigue conditions such as narcolepsy.

Even when patients perceive marijuana to be the most effective option for managing their pain, it is not necessarily the right drug for everyone. After all, marijuana is primarily smoked, and users have been well documented developing symptoms of chronic bronchitis and Cellular dysplasia, possibly leading to cancer. For terminal patients, there may be times when the risks associated with smoking marijuana are outweighed by its palliative effects. However, for young and non-terminal patients, it is irresponsible to prescribe a drug that produces foreseeable health hazards akin to the risks of cigarettes. Tobacco is known for its stress-reducing effects, yet most patients suffering from high stress are prescribed safer drugs to address their symptoms. Likewise, the adverse health-related side effects of marijuana should be taken into account before accepting it into the domain of medicine.

In California, medical marijuana is being irresponsibly administered. Unlike normal medications, there is not a common dosage guide for medical marijuana administration. Instead, patients procure a cannabis card, which allows any patient to obtain the maximum amount of marijuana permitted in a given county from a cannabis club, regardless of her or his illness. A patient suffering occasional insomnia can use the exact same amount of marijuana as a patient dying of AIDS or cancer.

As with all other medications, especially psychoactive chemicals, the lowest effective dose should be administered to patients. A UC Davis Medical Center study found that patients reported identical degrees of analgesic effect on neuropathic pain from marijuana �joints� containing 3.5% THC (the major psychoactive chemical in marijuana) as joints containing 7% THC, yet displayed fewer cognitive side effects. In high doses, marijuana is more likely to induce disassociate, hallucinogenic, and paranoid symptoms . Since medical marijuana distribution laws are based on plant weight rather than content of active chemicals, the exact amount of psychoactive compounds being distributed and ingested goes unmeasured and unregulated.

If we intend to update healthcare conventions and push for more �progressive� measures, we need to remember that progressive medicine does not adhere to the criteria of progressive politics. While there are some who support medical marijuana out of beneficence for patients suffering from chronic pain, AIDS, or cancer, others support it simply because they would like to see marijuana become legal for recreational use. If the latter motivation is the prevailing priority, making it a medication first is not an appropriate step on the path to that goal.

The exclusionary process of admitting potentially-medical artifacts into the domain of medicine is not performed because of malevolence towards patients suffering who don�t have access to their preferred medication. Rather, as a precautionary convention, medicine assumes that all interventions are potentially harmful, and only endorses medical artifacts for which considerable evidence indicates that the risks of employing the new drug or therapy are outweighed by assessable benefits. This is not to say that certain doctors do not abuse the ideal standards of the western medical profession. Nonetheless, as prospective medical leaders, we should advocate for only the best artifacts to enter the domain of medicine. If marijuana is to make this transition, at the bare minimum it must adhere to the integrity and methodology of medicine rather than succumbing to a lobby of misguided individuals with ulterior motives.

Published on April 23, 2010 in Science