Kathleen Louden

April 29, 2013

CHICAGO — Illinois should not legalize cannabis, and physicians should not write recommendations for patients to use marijuana for medical purposes, because it is a dangerous, addictive drug and is not approved by the US Food and Drug Administration (FDA), a group of addiction medicine physicians said during a press conference here.

"Marijuana should not be approved outside of FDA-approved channels," said Stuart Gitlow, MD, MPH, president of the American Society of Addiction Medicine (ASAM), which sponsored the news conference here during the society's 44th Annual Medical-Scientific Conference.

Dr. Gitlow reiterated ASAM's position against "medical marijuana" days after the Illinois House of Representatives passed a bill that would legalize medicinal cannabis in the state if approved by the Illinois Senate.

To be medication, marijuana would need proper consideration by the FDA as to its risks and benefits, dosage, and timing of the drug, he said.

"There is no such thing as medical marijuana," Dr. Gitlow stated.

Marijuana "Unstable and Unpredictable"

Another speaker, Andrea Barthwell, MD, an addiction medicine specialist and a coauthor of ASAM's white paper on the legalization of marijuana, called cannabis "unstable and unpredictable" and said that the drug should be subject to the same standards that apply to other medications.

Dr. Stuart Gitlow

She told Medscape Medical News that the Illinois bill, known as the Compassionate Use of Medical Cannabis Pilot Program Act, does not require the same standards.

"Under the Illinois bill, you have to be certified to obtain physician-recommended marijuana only once," Dr. Barthwell, a former deputy director for demand reduction in the White House Office of National Drug Control Policy, said in an interview. "If you get a prescription for a narcotic painkiller, when you finish the prescription, you have to go back to the physician."

Narcotic painkillers are schedule II controlled substances. Marijuana remains a schedule I controlled substance in the United States, meaning the Drug Enforcement Administration (DEA) finds that it has no currently accepted medical use, lacks accepted safety for use under medical supervision, and has a high potential for abuse.

Marijuana is the most common illicit drug causing dependence in the United States, according to a 2011 survey from the Substance Abuse and Mental Health Services Administration.

The Illinois Compassionate Use of Medical Cannabis bill proposes implementation of a 4-year pilot program aimed at protecting "patients with debilitating medical conditions, as well as their physicians and providers, from arrest and prosecution" for using marijuana for medical reasons, such as to control pain or nausea.

Dr. Andrea Barthwell

The bill allows use of cannabis in any form, including smoking, which Dr. Barthwell and other speakers said is unsafe because it exposes the smoker to carcinogens.

If the bill is enacted, Illinois would become the 20th state, along with the District of Columbia, to allow the medical use of marijuana.

In another argument against the proposed legislation, John Peterson, MD, president of the Illinois Society of Addiction Medicine, said during the press conference, "For every disease and disorder for which marijuana has been recommended, there is a better, FDA-approved medication."

Such medications, he said, include dronabinol (Marinol, AbbVie), an oral synthetic cannabinoid approved to treat nausea and vomiting associated with cancer chemotherapy and to treat appetite loss and wasting in people with AIDS.

However, some people with vomiting reportedly have problems swallowing a pill. In addition, advocates of legalization of medical marijuana say some patients do not get any relief from available medications or derive greater benefit from marijuana than from other medicines.

When asked by Medscape Medical News at the press conference to comment on this suggestion, Dr. Gitlow said, "There are probably very few patients for whom marijuana is the only drug that makes them feel better. Is it worth the risk to our society to give one person an intoxicant to help them feel better — while not getting better — and put our entire society at risk by making that intoxicant available to all?"

Opposing Views

That argument was disputed by Christopher Fichtner, MD, a public health psychiatrist in Riverside, California, and a former Illinois state mental health director, who is a member of the Marijuana Policy Project, which lobbies to legalize marijuana for seriously ill patients.

When asked by Medscape Medical News to comment by telephone, Dr. Fichtner, who was not involved with the ASAM press conference, said, "The idea that marijuana is very dangerous is pure fiction. Just like anything, there can be abuse. It's up to the individual to use it responsibly."

He also disagreed with another argument raised during the press conference, that the dose of marijuana cannot be regulated. In California, which legalized medical cannabis in 1996, marijuana products undergo laboratory testing for potency and purity, and the products carry a label that states the amount of tetrahydrocannabinol, the active ingredient, according to Dr. Fichtner, who said he does not write medical marijuana recommendations.

"The physicians I know who make recommendations view marijuana as safer than opioids and a lot of our over-the-counter medications, such as anti-inflammatories," he said. "Plus, a lot of people who are taking marijuana as their primary relief for pain are greatly reducing their use of opioid narcotics."

Illinois' Compassionate Use of Medical Cannabis Pilot Program Act lists approximately 30 debilitating medical conditions, including cancer, AIDS/HIV infection, cachexia, and spinal cord diseases, for which patients would be eligible for the program. The bill would allow a person with one of these physician-diagnosed conditions to possess up to 2.5 ounces of usable cannabis during a 14-day period.

David Ostrow, MD, PhD, president of the American Academy of Cannabinoid Medicine and a former psychiatrist specializing in addiction medicine in Illinois, said that he considers the number of eligible conditions listed "very restrictive."

Dr. Ostrow, who was not involved in the press conference, told Medscape Medical News that the proposed allowable amount of cannabis is reasonable.

"Some people need a lot of marijuana to ease their symptoms," he said.

Dr. Ostrow added that physicians who write marijuana recommendations should follow best medical practices. He believes they also should receive training regarding safe and effective use of marijuana to treat medical conditions, stating that such training is available from the American Academy of Cannabinoid Medicine.

During the ASAM press conference, former DEA administrator Peter Bensinger said that 2.5 ounces of marijuana is "almost a dealer quantity, equivalent to 183 joints." He said that if this high amount is allowed, it will lead to patients giving away or selling some of the drug.

Dr. Gitlow reports that he is a consultant to Orexo AB, a pharmaceutical company headquartered in Uppsala, Sweden. None of the other sources report any relevant financial relationships. Dr. Gitlow is executive director of the Annenberg Physician Training Program in Addictive Disease, which has multiple program sites. Dr. Barthwell is director of Two Dreams Outer Banks Drug and Alcohol Treatment Center in North Carolina.

American Society of Addiction Medicine (ASAM) 44th Annual Medical-Scientific Conference. Press Conference. Presented April 25, 2013.

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