Marijuana remains the absolute most highly abused drug in America. The arguments for and from the legalization of marijuana continue to escalate. This piece is not designed to set the stage for a legalization debate about marijuana. Instead, I want 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 faced with the dilemma of whether to prescribe controlled substances to patients who drug test positive for marijuana. This is very the case in states that 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 continues to be an illegal Schedule I controlled substance with no accepted medical use in the U.S. The very fact remains that most state laws have Federal oversight, as stated in the Supremacy Clause of the Constitution. How long does it take for CBD gummies to start working? “The Supremacy Clause is just a clause within Article VI of the U.S. Constitution which dictates that federal law may be the supreme law of the land. Underneath the doctrine of preemption, that is based on the Supremacy Clause, federal law preempts state law, even once the laws conflict.”(1)
Each time a physician becomes aware a patient is using marijuana, alternate methods of therapy should be implemented besides prescribing controlled substances. Physicians must also take steps to refer the in-patient for treatment and cessation if any illegal drug use is revealed, including marijuana. Physicians must also keep in mind that the marijuana produced today is much more potent compared to past and using high potency marijuana along with controlled substances is not safe for patients.
Is there any such thing as FDA approved medical marijuana? There are two FDA approved drugs in the U.S. containing a synthetic analogue of THC (tetrahydrocannabinol), that is the principal chemical (cannabinoid) in charge of marijuana’s psychoactive effects. A synthetic version of THC is contained in the FDA approved drugs Marinol (Schedule III) and Cesamet (Schedule II) which are prescribed to treat 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 lessen convulsive seizures in children. The drug contains cannabinoids from marijuana, referred to as cannabidiol or CBD, which does not support the psychoactive properties of traditional marijuana and does not create a high. If this drug receives FDA approval, it will make history being the very first approved drug containing CBD in the U.S.
Additionally, DEA has issued a unique 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 is not federally approved as an accepted medical treatment in the U.S. Patients who smoke or ingest marijuana need to be aware that they’re breaking Federal law and might be prosecuted under Federal statutes. Furthermore, physicians should 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.