Marijuana continues to be the most highly abused drug in America. The arguments for and contrary to the legalization of marijuana continue to escalate. This piece isn’t intended 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 remains forbidden by Federal law and patients who self-medicate or abuse marijuana should not be prescribed controlled substances.
Unfortunately, many physicians tend to be faced with the dilemma of if to prescribe controlled substances to patients who drug test positive for marijuana. This is specially the case in states which 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 in the U.S. The very fact remains that state laws have Federal oversight, as mentioned 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 could 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 when the laws conflict.”(1)
When a physician becomes aware that a patient is using marijuana, alternate methods of therapy must be implemented other than prescribing controlled substances. How many CBD gummies should I eat?
Physicians also needs to take steps to refer the in-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 a lot more potent than the past and using high potency marijuana along with controlled substances isn’t safe for patients.
Is there any such 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) in charge of marijuana’s psychoactive effects. A manufactured 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 can also be 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 cut back convulsive seizures in children. The drug contains cannabinoids from marijuana, known as cannabidiol or CBD, which doesn’t contain 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 around 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 they are breaking Federal law and might be prosecuted under Federal statutes. Furthermore, physicians must be testing for marijuana use and if detected, they should not prescribe controlled substances, regardless of these diagnosis and the patient’s symptoms, as per current Federal statutes.