This is a follow-up to my previous blog post on the decision by the DEA not to reclassify medical marijuana. I came upon this piece in the Scientific American Blog by “a resident physician specializing in mental health.” He writes that every day he “screens patients for substance use. . . . During my medical training, I’ve learned which substances to worry about, and which ones matter less.”
Alcohol “is usually the first substance” he asks about. Whether it is the “roughly 88,000 deaths in the US each year” from excess alcohol consumption or the effects when heavy drinkers attempt to cut back and go into alcohol withdrawal, alcohol is a very serious problem.
It’s not only alcohol that clinicians worry about. Cocaine can cause heart attacks, kidney failure, and complications during pregnancy like placental abruption. Methamphetamine can trigger an assortment of responses, from hyperthermia to violent agitation to cardiogenic shock. Opioids like morphine can plunge patients into respiratory failure and kill them. Intravenous drug use puts patients at risk for hepatitis, endocarditis, or even brain abscesses.
But, for most health care providers, marijuana is an afterthought.
We don’t see cannabis overdoses. We don’t order scans for cannabis-related brain abscesses. We don’t treat cannabis-induced heart attacks. In medicine, marijuana use is often seen on par with tobacco or caffeine consumption—something we counsel patients about stopping or limiting, but nothing urgent to treat or immediately life-threatening.
The federal government’s scheduling of marijuana bears little relationship to actual patient care. The notion that marijuana is more dangerous or prone to abuse than alcohol (not scheduled), cocaine (Schedule II), methamphetamine (Schedule II), or prescription opioids (Schedules II, III, and IV) doesn’t reflect what we see in clinical medicine.
The doctor also notes a 2015 systematic review of studies from around the world suggesting cannabis therapies that may help patients in various ways, including “treating chronic pain, muscle spasms, debilitating side effects of chemotherapy like nausea, and weight loss from HIV infection.” He notes that “dozens of US states have listened to such findings in recent years and passed legislation approving the use of medical marijuana.”