Medical Marijuana - The Debate Continues

On Monday, the discussion of Canada’s Schedule I substances was brought up and it got me thinking about how drugs are classified in the U.S. A Schedule I drug in the U.S. is any drug that has a high potential for abuse and has no accepted medical use. Marijuana is listed as a Schedule I drug, however it is legal medicinally in 23 states and in Washington D.C. This disparity has always confused me – it poses several problems for health care professionals, patients, and health care in general. How can the best form of health care be delivered if everyone from the state to federal level is not on the same team?

To get around the federal legal restrictions, physicians can only recommend medical cannabis, not prescribe it. Without doctors’ prescribing power, patients are typically left to decide what to take, which can be harmful if they are not educated on the safest forms of treatment. Some physicians feel uncomfortable recommending medical marijuana because they do not trust the unregulated and uncontrolled safety of the supply chain.

The states that have legalized medicinal marijuana all have different requirements pertaining to dosage forms offered and what qualifies a patient for treatment. They also have different requirements for how much cannabis or cannabis-containing product a person can own. For instance, Texas only legalizes medicinal cannabis oil for epilepsy (no other condition) if they have not responded to any other treatments. However, in California, there is a completely opposite law. Under the Compassionate Use Act (Proposition 215), patients are legally protected if they are diagnosed with an illness where use of marijuana is “deemed appropriate and has been recommended by a physician.”

Two states (Connecticut and Minnesota) have made it legal for pharmacists to dispense medical marijuana. Dispensing centers in these states are pharmacist-led and pharmacists work with patients to determine dosing regimens based on their condition. I got to wondering – how comfortable would you feel preparing a dosing regimen for a substance that has very minimal clinical data and is also classified as illegal by the federal government? Perhaps rescheduling medical marijuana to a Schedule II drug would allow for more clinical studies approved by the FDA. Uncertainties about risks, benefits, and quality control could be answered. But until then, it seems like a gray area will remain.