Marijuana remains probably the most highly abused drug in America. The arguments for and contrary to the legalization of marijuana continue steadily to escalate. This piece is not meant to set the stage for a legalization debate about marijuana. Instead, I would like 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 tend to be up against the dilemma of whether to prescribe controlled substances to patients who drug test positive for marijuana. This is specially the case in states that have modified state laws to legalize marijuana. These changes in state law do not 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 with no accepted medical used in the U.S. The actual fact remains that state laws have Federal oversight, as 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 is the supreme law of the land. Beneath the doctrine of preemption, that is on the basis of the Supremacy Clause, federal law preempts state law, even when the laws conflict.”(1)
Each time a physician becomes aware that the patient is using marijuana, alternate types of therapy ought to be implemented other than prescribing controlled substances. Physicians must also take steps to refer the patient for treatment and cessation if any illegal drug use is revealed, including marijuana. What do CBD gummies do? Physicians must also keep in mind that the marijuana produced today is significantly more potent compared to past and using high potency marijuana together with controlled substances is not safe for patients.
Is there anything as FDA approved medical marijuana? There are two FDA approved drugs in the U.S. containing an artificial analogue of THC (tetrahydrocannabinol), that is the principal chemical (cannabinoid) responsible for marijuana’s psychoactive effects. A synthetic version of THC is contained in the FDA approved drugs Marinol (Schedule III) and Cesamet (Schedule II) which are prescribed to treat nausea for cancer patients undergoing chemotherapy. Marinol is also prescribed to stimulate the appetite of cancer and anorexia patients (2). The FDA is overseeing trials being conducted on Epidiolex (3), a drug manufactured by GW Pharmaceuticals and developed to reduce convulsive seizures in children. The drug contains cannabinoids from marijuana, known as cannabidiol or CBD, which does not contain the psychoactive properties of traditional marijuana and does not make 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 a research 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 is not federally approved being an accepted medical treatment in the U.S. Patients who smoke or ingest marijuana need to keep yourself updated that they are breaking Federal law and could 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 their diagnosis and the patient’s symptoms, as per current Federal statutes.