An ever-cheerful 83-year-old gentleman I’ve taken care of for years asked me about getting some medical marijuana. He suffered neurological damage from botched brain surgery in another state and tried cannabis gummies with good relief of pain and insomnia.
Another patient with incurable, metastatic breast cancer found an occasional puff of a joint relieved her anxiety and added to her pain relief. However, she was worried that it would show up in her urine drug screen making her ineligible for prescription opiates that she takes.
Yet another patient, with extensive osteoporotic fractures, orthopedic hardware in her pelvis and hips, said she would never take medical cannabis. As a teenager, previously undiagnosed as bipolar, it had made her anxious and paranoid. She continues to have 8 to 9 out of 10 pain despite high-dose narcotics.
Each of these cases poses a dilemma. Medical marijuana isn’t legal in Texas, and although my patients request it, we can only discuss pros and cons. Patients choosing medical cannabis treatment must seek it in one of our neighboring states like Oklahoma or Colorado where it’s available and legal, but interstate transportation is illegal by federal rules.
It’s a tricky situation in terms of access, prescribing practices, indications, contraindications, drug interactions and more. At issue isn’t just Texas law, but federal law. Currently, medical cannabis is legal in 36 U.S. states.
A part of the problem is due to the Drug Enforcement Administration schedule process (dea.gov/drug-information/drug-scheduling). Schedule 1 substances mean “no currently acceptable medical use.” Cannabis is scheduled here along with heroin and cocaine. Thus, it’s rated as more addictive and harmful than dangerous and often deadly Schedule 2 narcotics like oxycodone, fentanyl or amphetamines. Seriously?
This schedule issue severely limits clinical research to demonstrate the actual benefits, risks and potential drug interactions of medical cannabis. This is while millions of the public are using these products and billions of dollars exchange hands in legal sales annually in the United States. Many billions flow into state tax coffers while reducing costs to the public of prosecution and incarceration for low-level cannabis usage. Yet the states and their cannabis businesses aren’t sure federal legalization wouldn’t be a threat to their bottom lines and pharmaceutical companies don’t see a profit opportunity from unpatentable natural products.
So, there’s a “marijuana standoff” and it will likely just get worse as time goes on, according to a recent article in the Wall Street Journal reporting on the poor performance of “Pot Stocks.”
A solution may be the States Reform Act proposed by Congresswoman Nancy Mace from South Carolina to disentangle the paradoxical, contradictory state and federal guidelines.
Simply moving cannabis to a Schedule 2 like hydrocodone or Schedule 3 like codeine would be a simple, rational start allowing objective research with funding that’s peer reviewed, not industry sponsored. This could lead to informing safer public usage and help doctors and their patients make rational, evidence-based, legal therapeutic decisions. Talk to your federally elected representative.