Why are So Many Doctors Reluctant to Prescribe Marijuana?

Now that medical marijuana is legal in 33 states and the District of Columbia, you’d think mainstream physicians would routinely favor prescribing medical marijuana. However, they are not.

In fact, even in Colorado, a recent survey of Family Physicians showed only 19% think physicians should recommend medical marijuana to their patients. A minority believe marijuana is helpful for physical (27%) and mental (15%) health. Most agreed that marijuana poses serious mental (64%) and physical (61%) health risks.

Why is there such a disconnect between doctors and the cannabis world?

Here is my opinion and I’m pretty sure lots of readers aren’t going to like to hear it. Based on my professional relationships within the realm of traditional medicine; here goes.

Marijuana advocates don’t speak the language of doctors. Further, Recreational marijuana advocates are muddying up the communication. Traditional medicine physicians feel most marijuana messaging is directed by recreational interests to non-medical people who are highly vulnerable and desperately motivated to believe miracle curing claims. Recreational MMJ proponents too often cite studies showing numerous and often farfetched health benefits for almost every condition in the ICD-10 Code book of standardized diagnoses. You’ve heard the criticism, “Bud-tenders shouldn’t be handing out medical advice.”

The problem is too many shared studies are junk. Most studies don’t have control groups, almost none are blinded, many have obvious bias by the researchers, participants and publishers. Standard disease definitions are not always defined, etc., etc. Favorable findings are broadly exaggerated while negative findings are ignored. People want to believe positive results so much they accept them as dogma, then inflate them and spread the misinformation.

What do doctors need to see?

Doctors need to see well designed clinical trials on humans. Modern medical practice is based on the administration of defined levels of drugs. Most physicians are not comfortable prescribing a plant product with varying concentrations of active pharmacological compounds.

A common shared claim/belief is that whole plant is better than individual isolates for treating conditions. While this is likely true in some cases, convincing medical data is lacking. The skeptical MD knows whole plant products are not reproducible on a large scale, are not precise and are therefore, not wise to prescribe. Is a beneficial effect the result of a single cannabinoid in that strain, a dominant cannabinoid, a combination of cannabinoids, or is there truth in the “entourage” effect? What role might the terpenes play? Whole plant studies have too many variables to draw consistent conclusions. Like it or not, doctors are going to need to see studies on isolates. Initially as individual isolates and eventually as precise combinations of isolates. Terpenes further complicate studies…

Here is my take-home prescription:

The marijuana plant is a valuable source of useful therapeutics. It’s chemicals lower certain types of pain; have antianxiety, anti-inflammatory and antispastic effects. They improve sleep, enhance appetite and many other important things. However, marijuana’s adverse effects are also well known. It can cause intoxication, precipitate anxiety attacks and adversely affect developing human brains among other things. Medical marijuana research and data needs to be driven by sound science. Recreational marijuana advocates sabotage progress by spreading inflated, biased and inaccurate studies and ideas. Medical Marijuana experts and other scientists need to drive the conversation and take a lead in distributing accurate, fair and unbiased information. Let’s proceed cautiously and “Do no harm” as we learn more about this remarkable plant.

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