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 designed to set the stage for a legalization debate about marijuana. Instead, I need caution practitioners whose patients under their care test positive for marijuana. Marijuana use continues to be forbidden by Federal law and patients who self-medicate or abuse marijuana shouldn’t be prescribed controlled substances.
Unfortunately, many physicians in many cases are faced with the dilemma of whether or not 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 continues to be an illegal Schedule I controlled substance without accepted medical used in the U.S. The very fact remains that most state laws have Federal oversight, as stated in the Supremacy Clause of the Constitution. “The Supremacy Clause is really a clause within Article VI of the U.S. Constitution which dictates that federal law may be the supreme law of the land. Underneath the doctrine of preemption, which can be on the basis of the Supremacy Clause, federal law preempts state law, even once the laws conflict.”(1)
Each time a physician becomes aware that the patient is using marijuana, alternate ways of therapy should be implemented apart from prescribing controlled substances. Which CBD gummies should I choose? Physicians also needs to take steps to refer the patient for treatment and cessation if any illegal drug use is revealed, including marijuana. Physicians also needs to bear in mind 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.
Can 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), which can be the principal chemical (cannabinoid) responsible for marijuana’s psychoactive effects. An artificial version of THC is included 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 can be prescribed to stimulate the appetite of cancer and anorexia patients (2). The FDA is currently 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 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 unique registration to a study laboratory at the University of Mississippi to cultivate various strains of marijuana for clinical trials (4). This research will continue, but as of this writing, ingesting or smoking botanical marijuana or the cannabis plant itself isn’t federally approved as an accepted medical treatment in the U.S. Patients who smoke or ingest marijuana need to keep yourself informed that they are breaking Federal law and could possibly be prosecuted under Federal statutes. Furthermore, physicians should be testing for marijuana use and if detected, they will not prescribe controlled substances, regardless of these diagnosis and the patient’s symptoms, according to current Federal statutes.