Medical Marijuana

There's still no consensus on its effectiveness

February 10, 2017

Karen A. Jamrog,

The numbers are in, and they’re not good: New Hampshire has seen a huge spike in the number of drug overdose deaths, from 177 in 2010 to a projected 488 in 2016. News accounts of overdoses have become all too familiar, with drug addiction shattering lives across ethnic and economic continuums.

Because government data points to opioids — primarily prescription pain relievers and heroin — as the main drivers of overdose deaths, some hope that the state’s recently launched therapeutic cannabis program, through which Granite State patients can legally obtain and use marijuana as medicine, will supplant a significant portion of opioid use and lead to less drug abuse and fewer overdose deaths. But is medical marijuana truly safe and effective? And now that using marijuana for medicinal purposes is legal in the Granite State, is it realistic to expect the opioid epidemic that has plagued our state to wane?

Richard Vincent, a 65-year-old Loudon resident who has multiple sclerosis and serves as the patient advocate on the state’s therapeutic cannabis advisory council, says that using cannabis medicinally has enabled him to stop taking one of the many prescription drugs that he relies on to control his symptoms. He is eager for people who need prescription opioids for medical conditions to use cannabis instead, but says that New Hampshire’s strict qualification rules prohibit many patients from being able to try it. As a result, he says, “people are still suffering.”

New Hampshire residents who want to legally use marijuana for medicinal purposes cannot just go to one of the state’s four authorized dispensaries and buy it. First, a physician must certify that the person qualifies, according to the law, for the use of medical marijuana. Though many people have fervently testified as to the drug’s effective treatment of an array of conditions and symptoms, from chronic pain and arthritis to post-traumatic stress disorder, only individuals who have a state-determined qualifying condition can obtain a registry identification card that permits them to buy and use products from a medical cannabis dispensary.

And while physicians in our state can certify patients for the use of therapeutic cannabis, they do not actually prescribe medical marijuana for any patient, says Douglas Dreffer, MD, a family physician at Concord Hospital Family Health Center-Hillsboro and program director at NH Dartmouth Family Medicine Residency. By certifying a patient, doctors are only verifying that they have known the patient for at least three months and that the patient has a qualifying medical condition. This process concerns some doctors, Dreffer says. “Many doctors feel it’s akin to prescribing,” he says, and feel remiss in not following standard prescription-related protocol, such as following up with the patient to document how the patient’s condition improved or didn’t improve with treatment, the patient’s compliance with the recommended regimen and any side effects the patient experienced.

Legal Issues

Because marijuana — whether used medicinally or not — remains a Schedule I controlled substance on the federal level, it can raise significant problems in medical settings, says Douglas Dreffer, MD, a family physician at Concord Hospital Family Health Center-Hillsboro and program director at NH Dartmouth Family Medicine Residency. “Nurses cannot touch it because they could be arrested for possession,” Dreffer says.

Hospitals are struggling to figure out how to manage situations involving the drug without running afoul of the law, such as when a patient who relies on medical marijuana comes into the hospital. “Each hospital is coming up with their own process,” Dreffer says, “but we can’t dispense it — you can’t get it in our pharmacy — so if you come into the hospital, how do we get you your medicinal marijuana if you bring it from home when we’re not allowed to touch it?” Similarly, Dreffer points out, “if you get your care through the [US Department of Veterans Affairs], you can’t get medical marijuana because they are federal employees, and they cannot legally sign one of these attestations that says you qualify [for the cannabis].”

Finally, to legally obtain medical marijuana, your doctor or advanced practice registered nurse must first certify that you and the doctor or nurse have had a relationship for at least three months, and that you meet the qualifying criteria established by the New Hampshire Department of Health and Human Services. Qualifying conditions can be found here.

Compounding matters, medical marijuana comes in a variety of strains and potencies, but doctors do not specify which type of cannabis patients should use; patients typically rely on trial and error — along with guidance from a worker at the dispensary — to determine the type and dosage that will most effectively help them. Some patients on their first visit to a dispensary will already be knowledgeable regarding which strain is likely to suit their needs, but, Dreffer says, “most of the patients I’ve talked to about this aren’t knowledgeable.” Doctors worry, he says, that someone of unstandardized background or training might decide which strain or potency is best for patients.

There are other risks: Marijuana can impair short-term memory, alter judgment, affect decision-making, influence mood (possibly triggering severe anxiety and psychosis), significantly reduce motor coordination and reaction time, exacerbate respiratory problems, and, on a long-term or possibly permanent basis, could impair cognitive function when used regularly during adolescence. Some users will become addicted. In addition, therapeutic cannabis is more expensive than conventional medicines, Dreffer says, and unlike many pain medications, medical marijuana is not typically covered by insurance.

“It’s a mind-altering drug, just like alcohol,” Dreffer says, and scientifically studying the issues surrounding medical marijuana is difficult because cannabis is still considered a Schedule I controlled substance at the federal level. “Sometimes patients have to be willing to stop all their other medications to try this,” Dreffer says, because doctors can’t predict “what sorts of interactions — safe, benign or otherwise — are going to occur.”

The list of conditions or diagnoses that medical marijuana has been approved for — which does not, Dreffer points out, mean that medical marijuana has been shown or proven to help with these conditions — include cancer, glaucoma, HIV, hepatitis C, Lou Gehrig’s disease, multiple sclerosis, Crohn’s disease, Alzheimer’s disease, spinal cord injuries, traumatic brain injury, epilepsy and Parkinson’s disease.

Despite many people’s insistence that marijuana helps alleviate a range of health problems and symptoms — and there is scientific research that supports the effectiveness of therapeutic marijuana for certain health conditions — cannabis is not proven in a way that satisfies everyone in the medical community regarding its current use. “There seems to be good evidence around [its use for] muscle spasms and multiple sclerosis,” Dreffer says. “There’s some evidence of its use for anorexia from cancer or HIV/AIDS. [But] for most of us, the evidence around use for other conditions is lacking.”

Whether the legalization of medical marijuana will help stem the tide of opioid deaths in the Granite State is anyone’s guess, Dreffer says, because the issue has not been scientifically studied. That doesn’t mean that marijuana does not have that potential, he points out. “It just hasn’t been proven yet.” But, he adds, “I think most people will agree that our chronic pain management processes aren’t effective. We all would like to find something that is effective and reproducible and safe.”

In the meantime, countless patients remain passionate about having medical marijuana as a legal option, touting their personal experiences of its effectiveness. “This is not a Woodstock reunion,” Vincent says. “[Cannabis] is helping people. I know a lot of people are saying they’re not quite sure that it does, but take it from me, it works.”

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