An Ethical Framework to Manage Patient Requests for Medical Marijuana

Michael Redinger, MD, MA; Nicole Fledderman, BS; Parker Crutchfield, PhD

Disclosures

J Am Board Fam Med. 2020;33(1):147-151. 

In This Article

Abstract and Introduction

Abstract

An increasing number of states are legalizing marijuana use for medicinal purposes despite marijuana use remaining criminalized at the federal level and continued Schedule I status by the US Food and Drug Administration. Many of those states in which medical marijuana is legal require physician involvement to facilitate patient access. In addition, physicians may have ethical objections to medical marijuana use or may not believe there is adequate scientific evidence to support its use. The constellation of these factors creates an ethical quandary for physicians when approached by patients for assistance in accessing medical marijuana. This article provides an ethical framework that provides guidance to physicians in managing these patient requests taking into consideration the above ethically relevant factors.

Introduction

Over the last 2 decades, an increasing number of states and municipalities have legalized marijuana use for medicinal purposes, despite marijuana use remaining criminalized by the federal government and continued Schedule I status by the US Food and Drug Administration (FDA).[1–5] This legal and regulatory setup has complicated the practice of physicians who receive requests for medical marijuana from their patients, as many statutory processes require some degree of physician participation for patients to access marijuana legally.[3–4] Controversy over the medical benefits and harms of marijuana and the appropriateness of legalization has created ethical dilemmas for physicians. But there has been insufficient guidance from professional societies, regulatory boards, or medical ethicists.[4–5] Further, they do not take into consideration that the ethical duties of physicians may vary due to the degree of physician participation in the process depending on the state of practice, because there is legitimate scientific disagreement about the efficacy, risks, burdens of medical marijuana treatment, or when the physician has a conscientious objection to facilitating patient access to marijuana. This article is intended to provide an ethical framework for physicians who receive legitimate patient requests for assistance in obtaining legal medical marijuana, excluding requests made for the purposes of recreational use or diversion.

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