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Can Fam Physician
Vol. 53, No. 1, January 2007, pp.22 - 23
Copyright © 2007 by The College of Family Physicians of Canada
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Debates

Is there a role for marijuana in medical practice?

YES

Mark A. Ware, MB BS, MRCP (UK), MSC
Assistant Professor in Anaesthesia and Family Medicine at McGill University in Montreal, Que, Associate Medical Director of the MUHC Pain Centre, and a practising pain physician. He receives salary support from the Fonds de la recherche en santé Québec and holds grants from the Canadian Institutes of Health Research

Drs Kahan and Srivastava assert that marijuana is prescribed "under the guise of medical treatment" and objectto "disguising itas medical therapy." This refusal to accept that some patients use cannabis as part of medical care runs contrary to current medical opinion, including the Canadian Medical Association’s position.1 Under the Marihuana Medical Access Regulations, cannabis is not prescribed.

Drs Kahan and Srivastava claim that cannabis use causes "pleasant psychoactive effects that are easily confused with direct analgesia." Cannabinoids have complex central actions, including analgesia. Are pleasant side effects a valid reason to withhold the drug from chronically ill patients?

They list a number of risks, many of which are controversial. The carcinogenic potential of cannabis is not supported by clinical evidence. Exposure to smoked cannabis (50 joint-years; equivalent to 1 joint daily for 50 years) is not independently associated with increased risk of aerodigestive cancer; light cannabis use (<1 joint-year) might actually reduce risk of lung cancer.2 The anticancer properties of cannabinoids are fascinating.3 Cognitive effects of cannabis disappear after cessation of heavy use (50 joint-years).4 The risk for fatal accidents might actually be reduced compared with controls following cannabis use.5 No evidence of abuse of prescription cannabinoids has been found.6

Most cannabis research has been conducted under a paradigm of prohibition, and the study of risks is not yet balanced by much-needed research on benefits. All drugs have risks. To reject the therapeutic potential of cannabis and cannabinoids on the grounds of toxicity and potential abuse is to throw the baby out with the bath water.

Footnotes

These rebuttals are responses from the authors who were asked to discuss "Is there a role for marijuana in medical practice?" in the Debates section of the December issue (Can Fam Physician 2006;52:1531-3 [Eng], 1535-7 [Fr]). In these rebuttals, the authors refute their opponents’ arguments.

References

  1. Canadian Medical Association Office for Public Health. Medicinal use of marijuana. Ottawa, Ont: Canadian Medical Association. Available from: www.cma.ca/index.cfm/ci_id/3396/la_id/1.htm. Accessed 2006 Nov 24.
  2. Hashibe M, Morgenstern H, Cui Y, Tashkin DP, Zhang ZF, Cozen W, et al. Marijuana use and the risk of lung and upper aerodigestive tract cancers: results of a population-based case-control study. Cancer Epidemiol Biomarkers Prev 2006;15(10):1829-34.[Abstract/Free Full Text]
  3. Guzman M. Cannabinoids: potential anticancer agents. Nat Rev Cancer 2003;3(10):745-55.[Medline]
  4. Pope HG Jr, Gruber AJ, Hudson JI, Huestis MA, Yurgelun-Todd D. Neuropsychological performance in long-term cannabis users. Arch Gen Psychiatry 2001;58(10):909-15.[Abstract/Free Full Text]
  5. Bates MN, Blakely TA. Role of cannabis in motor vehicle crashes. Epidemiol Rev 1999;21(2):222-32.[Free Full Text]
  6. Calhoun SR, Galloway GP, Smith DE. Abuse potential of dronabinol. J Psychoactive Drugs 1998;30(2):187-96.[Medline]

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Réfutation: La marijuana a-t-elle sa place dans la pratique médicale?: NON
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This Article
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