Medical Marijuana: A Physician’s Perspective
- By Trudie Mitschang
FEW SUBSTANCES have been as hotly debated as medical marijuana. Opponents claim it’s addictive, carcinogenic and a gateway to more serious drug use. Proponents, on the other hand, say its benefits outweigh the risks, citing it as an effective treatment for everything from cancer, anorexia, AIDS and chronic pain to migraines, arthritis and insomnia. Enter David Casarett, MD, MA, a palliative care physician and researcher who has found himself on both sides of the debate. The author of Stoned: A Doctor’s Case for Medical Marijuana, Dr. Casarett is a professor of medicine at Duke University and the chief of palliative care at Duke Health.
BSTQ: Where did the idea for your book originate?
Dr. Casarett: The idea came from a patient — a retired English professor — who came to me for help with managing symptoms of advanced cancer. She asked me whether medical marijuana might help her. I started to give her my stock answer: Marijuana is an illegal drug that doesn’t have any proven medical benefits, etc. But she pushed me to be specific, in much the same way she probably used to push her students. Eventually, I admitted I didn’t know, but I’d find out. My book is the result of that research.
BSTQ: What is the biggest misconception about marijuana in the medical community?
Dr. Casarett: Probably that it offers no medical benefits. Actually, there have been some good studies that have shown very real benefits for some symptoms. True, there isn’t as much evidence as I’d like. But, there will be more. New research is coming online every year, and we’re gradually figuring out whether and how marijuana works.
BSTQ: What changed your personal perspective on marijuana?
Dr. Casarett: The moment came when I realized there were medical benefits. For me, that flipped the debate. Now we were talking about a substance that has benefits and risks, not just risks. And, in my mind, that put cannabis in the same box as many other legal drugs I prescribe. Once I realized medical cannabis offers benefits, the question became whether, when and how to use it safely, rather than how to ban it.
BSTQ: What is the most prevalent misinformation on both sides of the debate?
Dr. Casarett: From pro-cannabis groups, there are two. One is, because cannabis is a flower, it’s perfectly safe. Heroin is derived from poppies, which are also flowers. Heroin isn’t safe. Also, procannabis groups advise using cannabis to cure cancer. I met a woman in Denver who put all of her hope in cannabis oil to treat her curable lymphoma; she died six months later. From the anti-cannabis groups, I worry about case reports of risks. For instance, there are reports of people who used cannabis right before they had a stroke. That’s a correlation, but it doesn’t mean cannabis caused the stroke. It’s easy to get those sorts of case reports published.
BSTQ: What’s your opinion on theories that cannabis can be used to cure opioid addiction?
Dr. Casarett: There are some theoretical advantages of replacing opioid addiction with cannabis. Cannabis is also addictive, but without the risk of fatal overdose. Still, you have to be careful when talking about replacing one drug with another. The opioid epidemic is one example. Many physicians argued 15 years ago that we needed to do a better job of treating pain and shouldn’t be concerned about addiction. We know how that turned out: more opioid prescribing, more availability and, when we tightened the reins, patients went from legal Oxycontin to illegal Oxycontin to heroin. If we get a lot of people to switch from opioids to cannabis, maybe there will be other problems down the road.
BSTQ: What do you think the future holds for medical marijuana?
Dr. Casarett: For me, some of the most exciting advances in the science of medical marijuana are related to what marijuana tells us about the endocannabinoid system, which is the system of hormones, neurotransmitters and receptors in all people. We don’t know a lot about what that system does, but we do know marijuana works by tapping into that system. The cannabinoids in marijuana trick the body by mimicking naturally occurring endocannabinoids like anandamide. While it’s fascinating to think about what marijuana could do, and although clinical trials of marijuana are essential, the really neat science of the future may focus on that endocannabinoid system: what it does, how it works and how we can use it to promote health.
