EDITORIAL: The medical marijuana dilemma

Chief Medical Officer, Dr. Kenneth George, recently disclosed while addressing the opening of the International Association for Hospice & Palliative Care workshop, that the Ministry of Health was gathering evidence with regard to marijuana used in well-defined clinical situations. Section 12 (3) (a) of the Drug Abuse (Prevention and Control) Act Cap 131 states that “it is not unlawful … for a practitioner, acting in his capacity as such, to prescribe, administer, manufacture, compound or supply a controlled drug…” Despite the Act giving medical practitioners the autonomy to prescribe the drug, there is still a stigma attached to it and the general public is oftentimes reluctant to accept its viability as a prescribed drug. 

 

The medical marijuana debate is an interesting one because of the diversity of opposing views.  There are those who believe that it is a harmful drug and rightly classified amongst its counterparts as a severely harmful Schedule 1 drug. On the other hand, they are those who believe that although it may have its dangers, that it possesses great value as a medicinal herb for treating various conditions. Still, others believe the drug is completely harmless and persons should have the right to consume if they desire. With regard to the drug being one that is highly abused, we must take note that theoretically it is possible to abuse anything including alcohol and prescription drugs. The great philosopher Aristotle postulates in his Golden Mean theory that there is a desirable middle or that a balance must be met between two extremes, one of excess and the other of deficiency. Everything must be done in moderation. This is the view that one needs to adopt with medical marijuana usage. It must be done in moderation. Granted, although there are side effects to its usage such as dry mouth, dizziness, fatigue, confusion and hallucination, careful consideration must be given to its usage ensuring that the cons not outweigh the pros.

 

Medical research done in the US has shown that there is some evidence base for use of marijuana for medicinal purposes. A recent systematic review “Cannaboids for Medical Use a Systematic review and Meta Analysis”, published in the Journal of the American Medical Association, looked at randomised controlled trials of cannabis or cannaboids to treat medical conditions. In patients experiencing nausea and vomiting due to chemotherapy improvements, complete resolution in 47 per cent was recorded versus 20 per cent of controls. It also increased the number of people who had resolution of pain to 37 per cent up from 31 per cent. It was further shown to reduce pain ratings by about half a point on a 10-point scale, and to reduce spasticity in multiple sclerosis or paraplegia in a similar manner. Additionally, in the abstract “The effectiveness of cannaboids in the management of chronic non-malignant neuropathic pain: a systematic review”, it was concluded that “cannabis-based medicinal extracts used in different populations of chronic non-malignant neuropathic pain patients may provide analgesia in conditions that are refractory to other treatments”. Based on similar medical research in the US, there are currently some 25 states that utilise marijuana medicinally. Additionally, recently in Canada the Access to Cannabis for Medicinal Purposes Regulations came into effect. The regulations allow “for reasonable access to cannabis for medical purposes for Canadians who have been authorised to use cannabis medicinally by their health-care practitioner”.

 

I welcome the fact that the Ministry of Health of Barbados is forward thinking enough to consider alternatives to conventional ways of treating patients. The overwhelming research shows that there is some medicinal benefit to the drug, especially as relates to analgesic properties and therefore serious consideration should be given to its usage in palliative care treatment. If it is possible to improve the life of a patient battling a chronic or terminal illness, we owe it to humanity to do whatever we can to help – today it may be our neighbour … tomorrow it may be us.