Medical Marijuana: What Should Palliative Care Specialists Know?

by Chad D. Kollas, MD FACP FCLM FAAHPM

Read the full article from the summer issue of AAHPM Quarterly.

No matter where you live, if you’ve practiced palliative care long enough, one of your patients has asked you about medical marijuana. “Does it help pain? Does it help nausea or poor appetite? And, perhaps the scariest question for some of us, “Will you prescribe it for me?”

In a surprising move in November 2009, the American Medical Association changed its position on medical marijuana, calling for changes to encourage research about its potential benefits. Other influential medical specialty societies subsequently published similar position statements.

Intrigued by that trend, I co-presented a session about medical marijuana at the Academy’s 2011 Annual Assembly in Vancouver. Several attendees expressed interest in the topic and agreed that AAHPM should consider a position statement about medical marijuana. This article represents a written update of that presentation, and it revisits a controversial question: Should AAHPM consider creating a policy statement about medical marijuana?

1 thought on “Medical Marijuana: What Should Palliative Care Specialists Know?

  1. Here is the abstract of a paper that I am prestnting at the American Psychiatric Meeting in October. I was a medical marijuana patien last year when I was getting radiation and chemotherapy for stage 4 stomach cancer. It is the only thing that got me through. So, yes, I think that we should be brave and endorse this concept.

    In 2008, a referendum authorizing legal use of marijuana for medical purposes was passed 63% to 37% in Michigan. This law permitted authorization of an exemption from state anti-marijuana laws for patients who were certified by a physician as suffering from: (a) cancer, glaucoma, or positive status for human immunodeficiency virus (HIV), acquired immune deficiency syndrome (AIDS), hepatitis C, amyotrophic lateral sclerosis, Crohn’s disease, agitation of Alzheimer’s disease, or nail patella.
    (b) a chronic or debilitating disease or medical condition or its treatment that produces one of more of the following:
    (i) cachexia or wasting syndrome;
    (ii) severe and chronic pain;
    (iii) severe nausea;
    (iv) seizures, including but not limited to those caused by epilepsy; or
    (v) severe or persistent muscle spasms, including but not limited to, those which are characteristic of multiple sclerosis; or

    In practice, a limited number of physicians have taken a very broad approach to certification, particularly with respect to “pain”, and “nausea.” As of 12/2011, 126,912 patient registrations had been issued in Michigan, which has a population of about 10,000,000, or to over 1.25% of the population. In 2011, the new state attorney general has concluded that while medical marijuana possession is legal, its sales through dispensaries is illegal. Marijuana remains illegal under federal law.

    Increasingly, patients seeking mental health treatment are being seen initially already having been prescribed medical marijuana or have it prescribed during mental health treatment. Multiple interactions between cannabis and psychotropic medication have been documented. In addition, there is a large body of evidence indication that cannabis use may be associated with onset of psychosis and other psychiatric conditions and that it can exacerbate existing conditions.

    On the other hand, there is a large body of evidence indicating that medical marijuana is beneficial in a variety of medical conditions and that it may be superior to other available treatments for some patients. There is also a body of largely anecdotal evidence suggesting that cannabis may be beneficial for some psychiatric conditions, including anorexia nervosa, obsessive compulsive disorder and chronic insomnia.

    This workshop will discuss the official positions of the APA, AMA and other organizations on medical marijuana. It will also explore the implications for psychiatric practice of medical marijuana laws and the plusses and minuses of medical marijuana law as implemented in Michigan. Ample time will be provided for participants to share their clinical experiences, to ask questions, and to make comments.

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