Why the Cleveland Clinic Said No to Medical Marijuana

Bret Stetka, MD


January 23, 2019

In the fall of 2018, Ohio joined several other states in granting patients with verified medical conditions legal access to medical marijuana. (Its recreational use remains illegal.) However, in a statement issued earlier this month, the Cleveland Clinic announced that it will not be recommending this treatment to its patients.

Medscape spoke with Paul Terpeluk, DO, medical director of employee health services at the Cleveland Clinic, to hear more about the reasoning behind the decision.

Medscape: For what medical conditions is medical marijuana approved in Ohio? 

Terpeluk: Under Ohio law, certified physicians may recommend medical marijuana only for the treatment of the following qualifying medical conditions: AIDS, amyotrophic lateral sclerosis, Alzheimer disease, cancer, chronic traumatic encephalopathy, Crohn disease, epilepsy or another seizure disorder, fibromyalgia, glaucoma, hepatitis C, inflammatory bowel disease, multiple sclerosis, pain that is either chronic and severe or intractable, Parkinson disease, positive status for HIV, post-traumatic stress disorder, sickle cell anemia, spinal cord disease or injury, Tourette syndrome, traumatic brain injury, and ulcerative colitis.

Further information is available at the website for Ohio's Medical Marijuana Control Program.

Medscape: Where does the evidence stand on the clinical use of marijuana?

Terpeluk: There is little verified, published research that supports marijuana—in forms such as vaporizers, edibles, oils, tinctures, and patches sold in dispensaries—as a medical treatment. Most "evidence" is based on anecdote rather than on large double-blind, placebo-controlled clinical trials.

However, there is a significant amount of scientific literature that unequivocally shows that marijuana use has both short- and long-term deleterious effects on physical health, most profoundly on cardiovascular and respiratory health.

Medscape: What led Cleveland Clinic to come out against its clinical use? 

Terpeluk: Since Ohio's medical marijuana dispensaries went live last month, patients as well as the general public have asked many questions about its use.

Our patients deserve a clear, reasoned explanation as to why their Cleveland Clinic physicians will not be offering recommendations for medical marijuana or signing up for a "Certificate to Recommend" from the State Medical Board of Ohio.

Medscape: Is there any research currently underway in this area at Cleveland Clinic? 

Terpeluk: Marijuana research is extremely difficult and hard to fund. The federal government classifies marijuana as a Schedule 1 drug, which the Drug Enforcement Administration defines as "drugs, substances, or chemicals ...drugs with no currently accepted medical use and a high potential for abuse."

Medscape: Do you see promise for individual compounds found in marijuana?

Terpeluk: The federal and Ohio governments should support drug development programs that scientifically evaluate the active ingredients found in marijuana that can lead to important medical therapies. Such US Food and Drug Administration (FDA)-approved products are already available—most recently for epilepsy—and more are in various stages of research and development.

In June, the FDA approved Epidiolex (Greenwich Biosciences, Inc.) for the treatment of seizures in two rare forms of severe childhood-onset epilepsy. It is the first FDA-approved drug to contain a purified compound, cannabidiol, derived from marijuana. Previously, the FDA had approved dronabinol and nabilone, both of which contain synthetic versions of tetrahydrocannabinol, to treat chemotherapy-related nausea and to increase appetite in patients with AIDS.

To be clear, there is a difference between medications and "medical marijuana" in the popular sense of the term. In 2017, the National Institutes of Health supported 330 projects totaling almost $140 million on cannabinoid research.

These are the types of marijuana-derived medicines Cleveland Clinic supports and prescribes.


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