BRATTLEBORO — In 2004, the Vermont Legislature passed S.76, the bill authorizing medical marijuana. This law allows for marijuana, grown by dispensaries, to be distributed to Vermont residents.
The process is as follows: the patient qualifies for a card from the state; a prescriber writes a letter, not a prescription; the patient takes it to a dispensary, not a pharmacy, and pays out of pocket, not through health insurance, for the marijuana.
The indications according to the state for the use of this product are cachexia, pain, and vomiting. The cost to the user is determined to be the same as the current street value of illegal marijuana.
So what is the evidence that marijuana works for these conditions?
Frankly, besides anecdotal reports from people using pot, there is very little empirical evidence.
* * *
Three diagnoses are listed as possible indications in Vermont's state regulations for medical marijuana treatment: multiple sclerosis, HIV, and cancer.
But according to its website, the National Multiple Sclerosis Society believes that THC (tetrahydrocannabinol, the active ingredient in marijuana) is not helpful in treating MS.
There are certainly no psychiatric indications such as ADHD, anxiety, or depression that warrant this intervention, and yet as a psychiatrist I am continually being asked to facilitate patients receiving THC.
A typical example is the patient who just left my office: a 25-year-old, unemployed male who has smoked pot daily for 11 years.
He smokes because he is treating his insomnia and anxiety - “It's the only thing that works,” he says - and yet he came to see me for anti-anxiety and sleep medications. There is, by the way, growing evidence that pot actually increases anxiety, rather than treating it.
For some reason, marijuana is regarded as safe. “No one ever dies from marijuana,” I am often told.
Well, that is surely up for debate. For example, the American Lung Association states that marijuana smoke has twice the carcinogens of tobacco.
Adolescent pot smokers are also certainly risking permanent brain damage. A research article from New Zealand, published in 2012, reviewed the changes in intelligence for adolescents who smoked marijuana daily.
The median, irreversible drop in IQ for this population was nine points. For people with an average IQ of 100, that is a 9-percent drop. And researchers say this drop was accompanied by significant changes in memory and attention.
* * *
There is a proposal that a marijuana dispensary be placed in Windham County. Perhaps we need it because, according to the state, we currently have double Vermont's average density of marijuana green-card holders.
How can it be that Windham County has so many cachexic, vomiting people in chronic pain? Could it instead have anything to do with the presence of Suboxone and methadone programs, combined with high disability rates and the high unemployment rate?
So why would the Vermont legislature build a pharmaceutical system outside of the traditional well-regulated health-care system? Surely, the most-likely reason is to open the door to legalization of pot.
Frankly, if that is the legislature's long-term intent, I wish lawmakers had not placed this initial step onto the backs of prescribers. At present, we are being asked to be involved in a system that has limited regulation, no assurance of quality or dosing, very sparse evidence for the clinical justification, and very limited knowledge of the long-term health consequences.
Marijuana actually contains in excess of 500 chemicals, so we are not even sure that THC is the one that provides the alleged medicinal properties. And this system has been built for clinical purposes even though THC is already available in the form of Marinol, an FDA-approved prescription available in Vermont.
Vermont should stop supporting broad access to medical marijuana clinics. Instead, if the governor and his colleagues believe that marijuana has medicinal value, they should limit the number of prescribers able to recommend it and encourage the Food and Drug Administration to conduct adequate clinical trials to assure THC's efficacy and safety or have the courage to legalize marijuana for all.
Simply put, stop co-opting the medical profession into supporting controversial public policy.