Marijuana continues to be probably the most highly abused drug in America. The arguments for and from the legalization of marijuana continue to escalate. This piece is not meant to set the stage for a legalization debate about marijuana. Instead, I would like caution practitioners whose patients under their care test positive for marijuana. Marijuana use remains forbidden by Federal law and patients who self-medicate or abuse marijuana shouldn’t be prescribed controlled substances.
Unfortunately, many physicians are often confronted with the dilemma of whether to prescribe controlled substances to patients who drug test positive for marijuana. This is particularly the case in states which have modified state laws to legalize marijuana. These changes in state law don’t change the Federal guidelines that physicians must follow. As a former career DEA agent, I remind physicians that marijuana remains an illegal Schedule I controlled substance with no accepted medical used in the U.S. The actual fact remains that state laws have Federal oversight, as previously mentioned in the Supremacy Clause of the Constitution. “The Supremacy Clause is really a clause within Article VI of the U.S. Constitution which dictates that federal law could be the supreme law of the land. Underneath the doctrine of preemption, which is on the basis of the Supremacy Clause, federal law preempts state law, even when the laws conflict.”(1)
Whenever a physician becomes aware that the patient is using marijuana, alternate types of therapy must be implemented besides prescribing controlled substances. Physicians also needs to take steps to refer the patient for treatment and cessation if any illegal drug use is revealed, including marijuana. Physicians also needs to remember that the marijuana produced today is a lot more potent compared to past and using high potency marijuana together with controlled substances is not safe for patients.
Can there be any such thing as FDA approved medical marijuana? You can find two FDA approved drugs in the U.S. containing a manufactured analogue of THC (tetrahydrocannabinol), which is the principal chemical (cannabinoid) accountable for marijuana’s psychoactive effects. A synthetic version of THC is included in the FDA approved drugs Marinol (Schedule III) and Cesamet (Schedule II) which are prescribed to treat nausea for cancer patients undergoing chemotherapy. Marinol can be prescribed to stimulate the appetite of cancer and anorexia patients (2). The FDA is currently overseeing trials being conducted on Epidiolex (3), a drug manufactured by GW Pharmaceuticals and developed to cut back convulsive seizures in children. The drug contains cannabinoids from marijuana, called cannabidiol or CBD, which does not retain the psychoactive properties of traditional marijuana and does not make a high. If this drug receives FDA approval, it will make history being the very first approved drug containing CBD in the U.S.
Additionally, DEA has issued a unique registration to a study laboratory at the University of Mississippi to cultivate various strains of marijuana for clinical trials (4). This research will continue, but as of this writing, ingesting or smoking botanical marijuana or the cannabis plant itself is not federally approved being an accepted medical treatment in the U.S. Patients who smoke or ingest marijuana need to keep yourself informed that they are breaking Federal law and might be prosecuted under Federal statutes. Furthermore, physicians must be testing for marijuana use and if detected, they need to not prescribe controlled substances, regardless of their diagnosis and the patient’s symptoms, according to current Federal statutes.