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.

Dr. Victor S. Sierpina is the WD and Laura Nell Nicholson Family Professor of Integrative Medicine and Professor of Family Medicine at UTMB.

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(10) comments

Michael Moriarty

I believe your reference to Cocaine being a "Schedule 1" drug is in error. It has legitimate medical uses. If I am correct, this should be corrected. There remains a large portion of the population that believes it to be like heroine. Thank you!

Bailey Jones

You are correct. And the fact that pot is considered more dangerous (Schedule 1) than coke (schedule 2) illustrates how crazy this law is.

Surely all of our good conservative friends who wished for hydroxychloroquine and horse wormer to treat COVID can see the value in allowing marijuana use for the many ailments for which it may be effective -

Reducing anxiety

Reducing inflammation and relieve pain

Controlling nausea and vomiting caused by cancer chemotherapy

Killing cancer cells and slow tumor growth

Relaxing tight muscles in people with MS

Stimulating appetite and improve weight gain in people with cancer and AIDS

(https://www.webmd.com/a-to-z-guides/medical-marijuana-faq)

Unfortunately, being a schedule 1 drug also means that it is difficult to do research on its efficacy, so not nearly as much is known about its benefits, as compared to say, horse wormer or hydroxychloroquine.

I believe that taking horse wormer or hydroxychloroquine for COVID is misguided and not supported by science - but it's not illegal. Marijuana should be afforded the same legal protection.

Carlos Ponce

Question for the good doctor: Have you tried prescribing Marinol (dronabinol)? Marinol is an FDA-approved Schedule III drug. It does not contain CBD nor THC but Dronabinol, (delta-9-tetrahydrocannabinol) which according to websites is a "structural twin of the THC molecule".

Bailey Jones

Well, look at you, Carlos, advocating a Big Pharma synthesized version of what any grandma could grow on her patio for free.

BTW, delta-9 THC and CBD are the active ingredients of pot "edibles" that can be bought legally in several states. CBD and a milder component of pot, delta-8 THC, can be bought in several forms at any of the seemingly millions of "CBD Stores" in Texas. Although your governor is trying his best to ban delta-8 sales in the state.

(To correct your comment - Dronabinol (Marinol, Syndros, Reduvo, Adversa) delta-9-tetrahydrocannabinol is in fact, THC, that's what THC stands for - tetrahydrocannabinol. Delta 9 THC is the main intoxicant in pot. Possession of any Delta 9 THC extracts in any form is a felony in Texas, just like heroin, but perfectly legal in 18 states, and "decriminalized" in 13 more.)

Carlos Ponce

Who's advocating, Bailey? I merely asked the doctor a question.

Lizzie Tish

I found this to be quite an interesting read.

https://www.clickondetroit.com/news/local/2022/01/12/study-cannabis-compounds-prevent-coronavirus-from-entering-human-cells/

Bailey Jones

i also saw this. Hemp is truly a useful plant.

Carlos Ponce

Hemp is rich in CBD but low on THC.

Lizzie Tish

We are watching with interest to see the outcome of Austin voters regarding the decriminalization of small amounts of marijuana.

I am also watchful of those lobbyists who will rant against decriminalization, not for morality, but for fear of losing MONEY, once again, putting profits over people. We have friends who are in serious medical jeopardy and in constant pain. From their perspective and their previous trials, the passage of this ballot measure, would greatly enhance their quality of life.

https://www.texastribune.org/2022/01/11/austin-decriminalize-marijuana/

Carlos Ponce

I wonder why Austin even bothers to vote. Liberal DAs won't prosecute so what's the point?

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