Marijuana remains probably the most highly abused drug in America. The arguments for and from the legalization of marijuana continue steadily to escalate. This piece isn’t meant 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 should not be prescribed controlled substances.
Unfortunately, many physicians tend to be up against the dilemma of whether to prescribe controlled substances to patients who drug test positive for marijuana. This is particularly the case in states which 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 any accepted medical use in the U.S. The very fact remains that all state laws have Federal oversight, as mentioned in the Supremacy Clause of the Constitution. “The Supremacy Clause is a clause within Article VI of the U.S. Constitution which dictates that federal law is the supreme law of the land. Under the doctrine of preemption, that will be on the basis of the Supremacy Clause, federal law preempts state law, even once the laws conflict.”(1)
When a physician becomes aware a patient is using marijuana, alternate methods of therapy should really be implemented apart from prescribing controlled substances. Physicians must also take steps to refer the patient for treatment and cessation if any illegal drug use is revealed, including marijuana. How many CBD gummies should I take for sleep? Physicians must also bear in mind that the marijuana produced today is a lot more potent than the past and using high potency marijuana in conjunction with controlled substances isn’t safe for patients.
Is there such a thing as FDA approved medical marijuana? You will find two FDA approved drugs in the U.S. containing a synthetic analogue of THC (tetrahydrocannabinol), that will be the principal chemical (cannabinoid) in charge of marijuana’s psychoactive effects. A manufactured 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 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, called cannabidiol or CBD, which doesn’t support the psychoactive properties of traditional marijuana and doesn’t create a high. If this drug receives FDA approval, it will make history being the first approved drug containing CBD in the U.S.
Additionally, DEA has issued a special registration to an investigation 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 being an accepted medical treatment in the U.S. Patients who smoke or ingest marijuana need to be aware they are breaking Federal law and could be prosecuted under Federal statutes. Furthermore, physicians should really be testing for marijuana use and if detected, they need to not prescribe controlled substances, regardless of their diagnosis and the patient’s symptoms, depending on current Federal statutes.