Medical Marijuana in Colorado: The Study and Background
The use of marijuana as medicine has taken off in the past decade, as 18 states now feature laws that legalize its use for medical purposes. Although marijuana is a charged political and social issue, physicians have been relatively silent in their views on using this substance in treating patients.
Kondrad and Reid's study addresses physicians' attitudes toward medical marijuana in Colorado, a frontline state in the battle over the use of cannabis. This review describes the findings from their study and examines possible reasons why the majority of physicians have unfavorable views of medical marijuana.
Kondrad E, Reid A. Colorado family physicians' attitudes toward medical marijuana. J Am Board Fam Med. 2013;26:52-60.
Cannabis has been used both as medicine and for recreation for centuries, yet marijuana been controversial in the United States at least since the turn of the 20th century. The use and regulation of medicinal marijuana remains contentious in many states. The arguments for and against the legal status of marijuana grew even hotter last fall, when the voters of Washington and Colorado approved initiatives to broadly legalize the possession of marijuana.
To many, the line between authorization of the use of medical marijuana and outright legalization is already blurred. As of now, 18 states and the District of Columbia have passed laws legalizing the use of medical marijuana. The current study describes how its use can explode when restrictions are lifted. The researchers note that the number of applications to Colorado's medical marijuana registry was 300 per month before October 2009, when the US Department of Justice published a directive that it would not pursue convictions for individuals who used marijuana for medical reasons. After this announcement, the rate of registry applications skyrocketed to 1000 per day, so that now more than 2% of Colorado's population is part of the registry.
Estimates of medical marijuana use are more difficult in other states. For example, California does not operate a patient registry. However, the National Organization for the Reform of Marijuana Laws, hardly a nonpartisan group, estimates that 2%-3% of Californians use medical marijuana. This translates into a possible 1 million individuals.
Whereas the prevalence of medical marijuana use remains a little hazy, there are some good data on why patients are prescribed cannabis. The most common indications for the use of medical marijuana among 1700 patients in California were pain, insomnia, and anxiety. These data are mirrored in the current study: In Colorado, 94% of patients receiving medical marijuana have chronic pain, and 17% have muscle spasms.
Although the past decade has seen a strong increase in the use of medical marijuana, between 1991-1992 and 2001-2002 the rate of overall marijuana use among all US adults had remained steady at an estimated 4%. Nonetheless, the rate of marijuana abuse or dependence increased by 25% during this same period to 1.5% of all US adults, with higher rates among persons of color accounting for nearly all of this increase.
The use of marijuana is particularly concerning among adolescents. In a nationwide survey taken between 2005 and 2008 of adolescents aged 12-17 years, the prevalence of marijuana use was 13%. One quarter of adolescents who used marijuana met criteria for either marijuana abuse or dependence. Native Americans were at particularly high risk for abuse and dependence, whereas African Americans had lower rates of these outcomes than both Native American and white adolescents.
There are no definitive data that the passage of medical marijuana laws in certain states has increased the overall use of marijuana or the risk for marijuana abuse or dependence, although one study found that adolescents in these states have a more accepting view of marijuana and use it at higher rates than in states without these laws.[7,8] The lack of solid data regarding the wider implications of medical marijuana use allows advocates on either side of the marijuana debate to make sweeping, yet poorly informed, statements in support of their positions.
Physicians' voices have been largely missing from the medical marijuana debate, even though they are the ones writing the prescriptions. The current study examines attitudes and beliefs regarding medical marijuana from one of the nation's hotbeds of cannabis controversy: Colorado.
Medscape Family Medicine © 2013
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