Marijuana remains the most highly abused drug in America. The arguments for and against the legalization of marijuana continue steadily to escalate. This piece isn’t meant to set the stage for a legalization debate about marijuana. Instead, I want 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 that 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 without accepted medical use within the U.S. The very fact remains that all state laws have Federal oversight, as previously mentioned in the Supremacy Clause of the Constitution. “The Supremacy Clause is just a clause within Article VI of the U.S. Constitution which dictates that federal law may be the supreme law of the land. Beneath the doctrine of preemption, that is based on the Supremacy Clause, federal law preempts state law, even once the laws conflict.”(1)
When a physician becomes aware that a patient is using marijuana, alternate methods of therapy ought to be implemented besides prescribing controlled substances. Physicians should also take steps to refer the individual for treatment and cessation if any illegal drug use is revealed, including marijuana. How should I eat CBD gummy bears? Physicians should also remember that the marijuana produced today is much more potent compared to the past and using high potency marijuana together with controlled substances isn’t safe for patients.
Will there be such a thing as FDA approved medical marijuana? You can find two FDA approved drugs in the U.S. containing a manufactured analogue of THC (tetrahydrocannabinol), that is the principal chemical (cannabinoid) accountable for marijuana’s psychoactive effects. An artificial version of THC is contained in the FDA approved drugs Marinol (Schedule III) and Cesamet (Schedule II) which are prescribed to take care of nausea for cancer patients undergoing chemotherapy. Marinol is also prescribed to stimulate the appetite of cancer and anorexia patients (2). The FDA happens to be overseeing trials being conducted on Epidiolex (3), a drug manufactured by GW Pharmaceuticals and developed to lessen convulsive seizures in children. The drug contains cannabinoids from marijuana, called cannabidiol or CBD, which doesn’t retain the psychoactive properties of traditional marijuana and doesn’t produce a high. If this drug receives FDA approval, it would make history being the first approved drug containing CBD in the U.S.
Additionally, DEA has issued a special registration to an investigation laboratory at the University of Mississippi to cultivate various strains of marijuana for clinical trials (4). This research will continue, but around this writing, ingesting or smoking botanical marijuana or the cannabis plant itself isn’t federally approved being an accepted medical treatment in the U.S. Patients who smoke or ingest marijuana need to be aware they are breaking Federal law and could possibly be prosecuted under Federal statutes. Furthermore, physicians ought to be testing for marijuana use and if detected, they ought to not prescribe controlled substances, regardless of these diagnosis and the patient’s symptoms, according to current Federal statutes.