SMOKING : SLOWLY TAKING YOUR BREATH AWAY
( continued from page 17 ) “ So , doctor , do you recommend medical marijuana for me ?”
The Federation of State Medical Boards clearly supports that the decision to recommend marijuana for certain medical conditions is at the professional discretion of the physician . 12 In cases where I am inclined to recommend medical marijuana , it is always consistent with what I am legally allowed to do , always patient-centered , always patient-specific .
In summary , marijuana for medicinal purposes is not simply a substance to be prescribed , but a complex class of therapies that must be managed and adjusted in collaboration with individual patients in the context of a therapeutic patient-physician relationship . 13 Decisions about marijuana should not be subject to social or political biases . Physicians have a professional obligation to educate ourselves on marijuana and cannabinoids , so that , rather than avoiding the elephant in the room , we can integrate sound medical judgment in developing patient-centered treatment plans for the numerous conditions for which cannabinoids can be beneficial and begin to feel comfortable asking our patients :
“ Have you ever thought about medical marijuana for your condition ?”
References :
1
ASAM Public Policy Statement on Cannabis Adopted by the ASAM Board of Directors October 10 , 2020
2
Lu HC , Mackie K . An Introduction to the Endogenous Cannabinoid System . Biol Psychiatry . 2016 ; 79 ( 7 ): 516-525 . doi : 10.1016 / j . biopsych . 2015.07.028
3
Andrea Braun , Tabea Engel , Juan Antonio Aguilar-Pimentel , Andreas Zimmer , Thilo Jakob , Heidrun Behrendt , Martin Mempel . Beneficial effects of cannabinoids ( CB ) in a murine model of allergen-induced airway inflammation : Role of CB1 / CB2 receptors . Immunobiology , Volume 216 , Issue 4 , 2011
4
Mackie , K . Mechanisms of CB1 receptor signaling : endocannabinoid modulation of synaptic strength . Int J Obes 30 , S19 – S23 ( 2006 ). https :// doi . org / 10.1038 / sj . ijo . 0803273
5
Turcotte C , Blanchet MR , Laviolette M , Flamand N . The CB 2 receptor and its role as a regulator of inflammation . Cell Mol Life Sci . 2016 ; 73 ( 23 ): 4449-4470 . doi : 10.1007 / s00018-016-2300-4
6
Incze MA , Slawek D , Cunningham CO . What Should I Know About Medical Cannabis ? JAMA Intern Med . 2020 ; 180 ( 4 ): 624 . doi : 10.1001 / jamainternmed . 2020.0018
7
FDA approved label for Epidiolex . https :// www . accessdata . fda . gov / drugsatfda _ docs / label / 2018 / 210365lbl . pdf
8
FDA approved label for Marinol . https :// www . accessdata . fda . gov / drugsatfda _ docs / label / 2005 / 018651s021lbl . pdf
9
FDA : Understanding Unapproved Use of Approved Drugs “ Off Label ” https :// www . fda . gov / patients / learn-about-expanded-access-and-other-treatment-options / understanding-unapproved-use-approved-drugs-label
10
Mack A , Joy J . Marijuana as Medicine ? The Science Beyond the Controversy . Washington ( DC ): National Academies Press ( US ); 2000 . 10 , PHARMACEU- TICALS FROM MARIJUANA . Available from : https :// www . ncbi . nlm . nih . gov / books / NBK224399 /
11
AMA Code of Medical Ethics . https :// www . ama-assn . org / delivering-care / ethics / code-medical-ethics-overview
12
Model Guidelines for the Recommendation of Marijuana in Patient Care , Federation of State Medical Boards ( 2016 )
13
Glickman A , Sisti D . Prescribing medical cannabis : ethical considerations for primary care providers . Journal of Medical Ethics 2020 ; 46:227-230 . https :// jme . bmj . com / content / 46 / 4 / 227
Dr . Murphy practices pain management and addiction medicine in Kentucky and Southern Indiana . He serves on the AMA ’ s Substance Use and Pain Care Task Force and on the gratis faculty of the University of Louisville School of Medicine . He is the current President of the Kentucky Society of Addiction Medicine and a former President of the Greater Louisville Medical Society . All views expressed are his own and do not represent the opinions or positions of any group or organization .
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