Medical marijuana works for some HIV and cancer patients in situations where no other drug is effective, and patients and physicians should not be prosecuted for using it, according to an internist who said he has prescribed it for more than a dozen patients.
Dr. Josiah D. Rich said that the American College of Physicians took a reasonable stance on the issue in its recent position paper, "Supporting Research Into the Therapeutic Role of Marijuana."
The ACP backs research into potential therapeutic roles for marijuana and states forcefully that physicians who prescribe or dispense medical marijuana and patients who use it in accordance with state law should be shielded from federal criminal prosecution.
Rhode Island legalized medical marijuana about 2 years ago, creating a program in which physicians fill out approval forms and the patient registers for permission to grow a small number of plants, said Dr. Rich, professor of medicine and community health at Brown University, Providence.
He has prescribed marijuana mainly for HIV patients, but also for one cancer patient "who was having a lot of trouble with chemotherapy," he said.
"Patients I have prescribed it for are patients who are using it already," Dr. Rich said. "For some, it is absolutely crystal clear that this is a medicinal use--they've tried all the other pills and have various side effects. For them, it's a godsend."
Other patients for whom he has prescribed medical marijuana might not be benefiting from it medically, but "they believe it has medicinal purposes for them," and that's enough, Dr. Rich said.
The position paper noted that "marijuana has been smoked for its medicinal properties for centuries," but that there is not good research on its efficacy in many conditions. 'Although the indications for some conditions (e.g., HIV wasting and chemotherapy-induced nausea and vomiting) have been well documented, less information is available about other potential medical uses," which could include treatment of glaucoma, neurologic and movement disorders such as multiple sclerosis, spinal cord injuries or other trauma, and pain, the position paper said.
"To date, much of the research into the medicinal properties of marijuana has been on oral and smoked forms of THC [tetrahydrocannabinol]. The pharmacokinetics of oral and smoked THC differ greatly and therefore have varying implications," the position paper said.
The ACP urged review of marijuana's status as a schedule I substance "and its reclassification into a more appropriate schedule, given the scientific evidence. …