The vast majority of doctors would prescribe medical marijuana to ease the pain of an older woman suffering from advanced breast cancer, according to a survey conducted by the New England Journal of Medicine (NEJM).
In its February edition, the NEJM presented its readers with a hypothetical scenario of 68-year old patient named “Marilyn” whose breast cancer had metastasized to her lung and spine. Marilyn, who lives in a state where medical marijuana is legal, asked her primary care doctor if using marijuana would alleviate her chronic pain, nausea and fatigue.
The results of the online survey, published in the May 30 edition of the NEJM, found that 76 percent of the 1,446 doctors who responded would give Marilyn a prescription for medical marijuana.
“We were surprised by the outcome of polling and comments,” wrote Jonathan N. Adler, MD, and James A. Colbert, MD, in their report on the survey.
“Where does this strong support for medicinal marijuana come from? Your comments show that individual perspectives were as polarized as the experts’ opinions. Physicians in favor of medicinal marijuana often focused on our responsibility as caregivers to alleviate suffering. Many pointed out the known dangers of prescription narcotics, supported patient choice, or described personal experience with patients who benefited from the use of marijuana. Those who opposed the use of medicinal marijuana targeted the lack of evidence, the lack of provenance, inconsistency of dosage, and concern about side effects, including psychosis.”
Many doctors expressed mixed feelings about prescribing marijuana, but said they would do it.
“I believe that physicians who prescribe medicinal marijuana should do so only when conservative options have failed for fully informed patients treated in ongoing therapeutic relationships. As federal gridlock prevents much-needed research, patients such as Marilyn deserve the potential relief that medicinal marijuana affords,” said Dr. J. Michael Bostwick, a professor of psychiatry at the Mayo Clinic who presented the “pro” side of the argument for the NEJM survey.
“Although marijuana probably involves little risk in this context, it is also unlikely to provide much benefit. Simply to allow a patient with uncontrolled symptoms of metastatic breast cancer to leave the office with a recommendation to smoke marijuana is to succumb to therapeutic nihilism,” said Gary M. Reisfield, MD, and Robert L. DuPont, MD, who argued against giving a marijuana prescription to Marilyn.
“There is little evidence to support the use of smoked marijuana for Marilyn’s nociceptive pain, and less still for her other symptoms. Smoked marijuana is a nonmedical, nonspecific, and potentially hazardous method of drug delivery.”
Some doctors expressed a reluctance to enter the debate over marijuana’s legal status or to become the “gatekeepers” for marijuana use.
“Why should physicians, already burdened with deciding on the risks and benefits from the long-term use of controlled substances, specifically opioid analgesics and benzodiazepine tranquilizers, be given yet another type of agent with risks, albeit generally minimal, from long-term or excessive use,” wrote John Hermos, MD, a physician in Brookline, MA. “Legalize and regulate the sale of marijuana and let the patient, and the non-patient, decide on his or her own benefits and risks.”
A majority of Americans now favor legalizing the use of marijuana. A national survey by the Pew Research Foundation found that 52% believe the use of marijuana should be made legal while 45% say it should not.
Voters in Washington and Colorado voted last year to decriminalize marijuana. Medical marijuana is legal in 18 states and the District of Columbia.