Marijuana-Legal, But Not by Prescription

OPINION

What are the pros and cons of marijuana use? Dr Andrew Saxon gives his viewpoint on why he is against medical marijuana but in favor of legalization of recreational use of marijuana. What's the difference? Dr Saxon is Professor and Director of the Addiction Psychiatry Residency Program in the Department of Psychiary and Behavioral Sciences at the University of Washington and Director, Center of Excellence in Substance Abuse Treatment and Education (CESATE) at the VA Puget Sound Health Care System in Seattle.

On medical marijuana

There is no good evidence that marijuana is the best treatment for any particular medical condition and any evidence that we have about its effectiveness is very scant.

Marijuana is a plant material with hundreds of different chemical constituents in that plant, most of which have never been studied. The concentrations of those constituents vary greatly from plant to plant. If a physician recommends botanical marijuana to a patient, we really don't know exactly what the patient is getting. We don't know the dosages or the quantities.

Thirdly, at least in Washington State (and possibly others), medical marijuana is something of a sham. The average age of people getting medical marijuana is in their 20s. The most common reason people get medical marijuana is for pain. At least in Washington State if you follow the letter of the law, people are not supposed to be getting medical marijuana unless any other proven treatment for pain has been tried and has been found ineffective. Most people who are getting it are not using it the way the law was written, so it is somewhat of a fraudulent system.

On legalized recreational marijuana

Marijuana is not a beneficial or good thing and it is not recommended. There are many risks to marijuana use. It causes some memory impairment and other cognitive problems; it affects psychomotor performance and makes doing tasks such as driving difficult and dangerous; and it may have several long-term negative impacts on health. The evidence we have for psychiatric patients using marijuana-whether they have schizophrenia, depression, bipolar disorder, or substance use disorders-is that they tend to be worse off than patients who are not using it.

However, there are some societal harms from making marijuana illegal. Millions of Americans want to use and will use it. As President Obama famously said “It’s important . . . for society not to have a situation in which a large portion of people have at one time or another broken the law and only a select few get punished.”

By keeping it illegal, we are spending a lot of money on criminal justice activities that probably don't do any good. We are arresting many young people, particularly young men of color who then have a criminal record that affects their ability to function the rest of their lives because it's harder to find employment; sometimes they lose the right to vote; and it's harder for them to find a place to live.

We should be more rational the way we approach this because people want to get it. Instead of having criminals sell it, let's have above board enterprises produce and sell it as it works in Washington State. Only state-approved sellers can grow it and provide it to the state-approved stores; the marijuana the is sold in these stores has to be tested by an outside lab to make sure that it doesn't have contaminants; and they have to specifically state how much tetrahydrocannabinol (THC) is in that sample and how much cannabidiol is in that sample which will be put on the product label.

Further reading:

Anderson DM, Hansen B, Rees DI. Medical marijuana laws, traffic fatalities, and alcohol consumption. J Law Economics. 2013;56:333-369.

Anderson DM, Rees DI, Sabia JJ. Medical marijuana laws and suicides by gender and age. Am J Public Health. 2014;104:2369-2376. http://ajph.aphapublications.org/doi/abs/10.2105/AJPH.2013.301612

Bachhuber MA, Saloner B, Cunningham CO, Barry CL.Medical cannabis laws and opioid analgesic overdose mortality in the United States, 1999-2010. JAMA Intern Med. 2014;174:1668-1673. http://archinte.jamanetwork.com/article.aspx?articleid=1898878