Legalization of medicinal marijuana is growing more common in the US. According to the American Cancer Society, scientists report that the cannabinoid delta-9-tetrahydrocannabinol (THC) can aid in relieving pain and nausea, reduce inflammation, and perform as an antioxidant. A review published in the journal Therapeutic Advances in Medical Oncology revealed promising evidence for using medicinal marijuana to treat a number of conditions, including chemotherapy-induced peripheral neuropathy, gastrointestinal distress, and sleep disorders. Many potential bioactive benefits of cannabis often outweigh the risks of using it. However, medicinal use of marijuana requires the authorization and involvement of a physician, a number of whom either have ethical objections to using medicinal marijuana or question the lack of scientific evidence to support it.
Physicians are increasingly getting requests from patients for access to medicinal marijuana. Yet, with a lack of guidance from professional societies and regulatory boards, many physicians feel unsure and/or uncomfortable with how to proceed. Lack of scientific evidence supporting the efficacy and risks of medical marijuana fuels the former, and a conscientious objection to prescribing marijuana informs the latter (ie, philosophical, cultural, or religious reasons). Statutory protection for conscientious objection differs in varying legal jurisdictions, so physicians must be aware of the laws within their state. Given the ever-changing legal status of marijuana, all physicians should be familiar with their state’s legal status regarding medical marijuana. In states where medicinal marijuana is legal, physicians must learn the myriad ways in which their participation is required. Despite legalization for medicinal use in many states, marijuana remains an FDA Schedule I drug. As such, prescribing marijuana for medicinal use is considered illegal and could result in revocation of Drug Enforcement Administration licensure, as well as criminal charges. However, the FDA has approved one cannabis-derived drug (Epidiolex) and three synthetic cannabis-related drugs (Marinol, Syndros, and Cesamet). In states where medicinal marijuana is legal, physicians can serve to either recommend its use or attest that patients have a qualifying condition for legally accessing medicinal marijuana. With regard to ethical dilemmas, the latter option might be more comfortable for certain physicians.
Patient demand for medicinal marijuana is continually growing. A study from the healthcare technology company Veriheal found that medical marijuana sales in Florida reached nearly $1.23 billion in 2020, while even greater numbers were reached in California and Colorado. By 2030, medical marijuana sales in Florida are projected to surpass $6 billion. Physicians would be well-served to read up on scientific studies that currently exist regarding the efficacy and risks of medicinal marijuana and to consider how they feel about either recommending medicinal use or attesting to it. Given the upward trend of patients requesting medicinal marijuana, knowing where they stand on the subject now will be invaluable for physicians in the months and years ahead.