Symposium to Examine Issues Related to Marijuana Use

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Andrea Barthwell, MD

Policy issues regarding medical and recreational marijuana laws continue to stir debate among the general public, the media, and physicians, and many of these issues will be addressed during Symposium 11, “Marijuana: Addiction Physicians and the American Public 2014.”

The symposium, presented from 8 to 10 am Sunday in Orange Ballroom D, Lower Level, will examine circumstances leading to the current situation of medical marijuana use, explore scientific issues, develop recommendations to assist physicians, formulate policy recommendations, and use the uniquely qualified perspective of addiction medicine physicians to lead the debate. One of the organizers of the session is Andrea Barthwell, MD, FASAM, ABAM Diplomate, and Co-Chair of the ASAM Task Force on Medical Marijuana.

“I have found there are three points of view among physicians in the medical marijuana debate,” Dr. Barthwell said. “One group is the activist physicians who object to current drug policy and see participation in the so-called ‘medical marijuana’ activities as a way to object, or to protect from prosecution the people who are using marijuana. Second are those physicians who have patients who report feeling better with the use of marijuana and who do not feel a need to challenge that report for a host of reasons, including that they want their patients to feel better. The third group is those who are motivated by the financial gain.”

At the heart of the debate is determining whether the healing properties of the cannabinoid system can be achieved while minimizing the psychotropic effects of the drug, she said. Endocannabinoids are crucial to bioregulation. With scientific evidence suggesting they may help reduce inflammation, insulin sensitivity, and fat and energy metabolism, endocannabinoids could be a tool in reducing the prevalence of metabolic syndrome. Additionally, modulation of the endocannabinoid system may be a cure for more chronic neurologic and immune conditions. While many questions remain, further research promises to shed insight into the mechanisms of health and disease, and provide new therapeutic options.

“Unimpeachable preclinical research indicates that there are many ways in which the endocannabinoid system of the body can be manipulated to produce either cannabinoid agonist or antagonist actions,” Dr. Barthwell said.

Still, the hazards of medical marijuana use exist, including the harmful effects of smoked marijuana, the potential for abuse, the potential for recreational users seeking the “high,” and the lack of standardization with regard to contamination, she said.

A portion of the symposium will be devoted to ASAM’s official position on medical marijuana. ASAM has outlined a number of recommendations on the matter, two of which include the need for federal regulatory standards for drug approval and distribution, and rejecting a process where state and local ballot initiatives approve medicines. These ballot initiatives could be decided by individuals not qualified to make such decisions, Dr. Barthwell said.

“Ultimately, ASAM believes physicians should not issue a recommendation for medical marijuana use unless the physician has adequate information regarding the composition and dose of the cannabis product, and has adequate training in identifying substance abuse and addiction,” she said.