Marijuana continues to be the absolute most highly abused drug in America. The arguments for and from the legalization of marijuana continue to escalate. This piece is not intended 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 is still forbidden by Federal law and patients who self-medicate or abuse marijuana should not be prescribed controlled substances.
Unfortunately, many physicians are often up against the dilemma of if 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 is still an illegal Schedule I controlled substance without accepted medical use in the U.S. The fact remains that all state laws have Federal oversight, as previously mentioned in the Supremacy Clause of the Constitution. “The Supremacy Clause is really 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, which can be based on the Supremacy Clause, federal law preempts state law, even once the laws conflict.”(1)
Whenever a physician becomes aware that a patient is using marijuana, alternate ways of therapy must certanly be implemented other than prescribing controlled substances. Physicians must also take steps to refer the individual for treatment and cessation if any illegal drug use is revealed, including marijuana. How does 750mg CBD Gummies compare against 250mg, 500mg and 750mg CBD gummy bears? Physicians must also remember that the marijuana produced today is significantly more potent than the past and using high potency marijuana together with controlled substances is not safe for patients.
Can there be anything as FDA approved medical marijuana? You can find two FDA approved drugs in the U.S. containing a manufactured analogue of THC (tetrahydrocannabinol), which can be the principal chemical (cannabinoid) accountable for marijuana’s psychoactive effects. An artificial version of THC is contained in the FDA approved drugs Marinol (Schedule III) and Cesamet (Schedule II) which are prescribed to deal with nausea for cancer patients undergoing chemotherapy. Marinol can be prescribed to stimulate the appetite of cancer and anorexia patients (2). The FDA happens to be 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 retain the psychoactive properties of traditional marijuana and doesn’t make a high. If this drug receives FDA approval, it would make history being the initial approved drug containing CBD in the U.S.
Additionally, DEA has issued a particular 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 as of 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 keep yourself updated that they’re breaking Federal law and could be prosecuted under Federal statutes. Furthermore, physicians must certanly be testing for marijuana use and if detected, they will not prescribe controlled substances, regardless of their diagnosis and the patient’s symptoms, as per current Federal statutes.