Medical Marijuana in the United States 1

Should medical marijuana be prescribed to patients?

Arazeli Dominguez Antunez

Candidate Number

Ronald Wilson Reagan College Preparatory High School

IB Career-related Programme Candidate

Word Count: 2,994

Introduction:
Medical Marijuana in the United States 2

Introduced to the people in Asia during ancient times, marijuana was used as a tea to treat

gout, rheumatism, malaria, and poor memory, but nowadays, medical marijuana is used to treat

several medical conditions such as muscle spascity and neuropathic pain in places such as Asia, the

Middle East, and eastern coast of Africa (Stack & Suddath, 2009), but in the United States, the use of

medical marijuana has been a debatable topic. Cited under the Schedule 1 controlled substances,

marijuana has been legalized in 29 states including Washington DC (Figure 1) that vary from

recreational use to medical purposes. Individual states then impose several qualifications that

patients need to fall under in order to be granted the use of medical marijuana (Lopez, 2018), in

cases such as in Colorado, where adults have to be a Colorado resident, 18 or older, and have a

qualifying medical condition that includes cancer, glaucoma, HIV/AIDS, among others (Colorado

Department of Public Health & Environment 2018). As this issue is prevalent in my career pathway of

health sciences, many patients have considered medical marijuana as a replacement for certain

medicines, but this has also created a conflicting issues that has divided physicians into whether or

not prescribe and encourage medical marijuana as a medicine to patients. Medical marijuana has

been a debatable topic in the United States where high top organizations like the DEA, FDA, and

doctors argue that medical marijuana should not be prescribed to patients due to the lack of evidence

and the harm that it has on the human body, but politicians, patients accounts, and studies conducted

by universities and researchers suggest that medical marijuana should be rightly prescribed by

physicians because there is scientific evidence that shows that medical marijuana helps treats certain

medical conditions that other medications can’t.

Medical Marijuana in the United States 3

Figure 1: Lopez, G. (2018, January 22). Marijuana is legal for medical purposes in 29 states.

Retrieved April 16,

2018, from https://www.vox.com/cards/marijuana-legalization/what-is-medical-marijuana

POV 1:

As major breakthroughs are found in the world of medicine, medical marijuana has revealed

itself of being a prominent medical drug that can enhance the lives of many patients across the

country, prompting many people to agree that medical marijuana should be prescribed to

patients.The debate whether medical marijuana should be prescribed to patients relies on two

marijuana chemicals deriving from cannabinoids: tetrahydrocannabinol (THC) and cannabidiol (CBD).

THC, which is the key ingredient that makes people “high”, has shown to increase appetite, and

decrease pain. Inside the human body, THC connects to the cannabinoid receptors, made naturally

by the body, and sends those signals to activate the receptors, affecting the person's memory,

thinking and coordination. Scientists have been able to extract the THC chemicals from the marijuana

plant and synthesize it (Bradford, 2017), thus creating the FDA-approved medicines: dronabinol and

nabilone, that serve as a medicine to treat nausea from chemotherapy and appetite loss from AIDS

(National Institute on Drug Abuse, 2017). As opposed to THC, CBD acts as a non-psychoactive

chemical that has shown to “actually block the high associated with THC” (Bradford, 2017), and is

more useful than THC as it reduces pain, controls epileptic seizures, and reduces inflammation
Medical Marijuana in the United States 4

(National Drug Institute on Drug Abuse, 2017). Because of these chemicals found inside the plant,

there have been various clinical studies and research that shows that medical marijuana can help

treat patients with certain medical conditions such as neuropathic pain, and PTSD. In a survey

conducted by The New England Journal of Medicine, doctors in 72 countries were given a scenario of

68 year old Marilyn with metastatic breast cancer, where they were asked if they would prescribe

medical marijuana to Marilyn in order to alleviate her pain. According to the survey, 76% of the votes

out of 1,446 were in favor of the use of marijuana for medical purposes. J. Michael Bostwick, M.D.,

professor of psychiatry at Mayo Clinic, proposed the use of marijuana “only when conservative

options have failed for fully informed patients treated in ongoing therapeutic relationships.” Several of

the reasons for why doctors would choose to prescribe medical marijuana is because they feel that it

is their responsibility to ease the suffering of patients as “many pointed out the known dangers of

prescription narcotics, supported patient choice, or described personal experience with patients who

benefited from the use of marijuana” (New England Journal of Medicine, 2013). Most of the public

opinion agrees that medical marijuana should be prescribed to patients, which has prompted several

states to legalize medical marijuana, and as of November 2000, Colorado voters passed the

Amendment 20, allowing patients with certain medical conditions to legally use medical marijuana

(Black). As of January 2017, there were a reported 86,840 patients that have a medical marijuana

registration for conditions such as cancer, HIV/AIDS, and seizures, and 958 patients that received a

physician certification for medical marijuana in that month. Severe pain and muscle spasms were two

of the highest conditions reported, as medical marijuana serves as a way to treat these conditions.

On January 2018, the number of reported patients that have an active medical marijuana registration

increased to 93,095, as well as the patients who have received a physician certificate increased to a

staggering 3,422. The effectiveness of medical marijuana has increased in Colorado, as more and

more patients are relying on medical marijuana as their source of medicine (Colorado Department of

Public Health & Environment, 2018), since other prescription drugs have severe negative side effects

that alters a person's well being, like opioids.

Medical Marijuana in the United States 5

Figure 2: Colorado Department of Public Health & Environment. (2018). Medical marijuana statistics

and data. Retrieved April 09, 2018, from https://www.colorado.gov/pacific/cdphe/medical-marijuana-

statistics-and-data

Medical marijuana has shown to be a better medical option instead of opioids in treating neuropathic

pain. Originating from many sources such as diabetes, shingles, and more, neuropathic pain results

from the damage of the nervous system that in the end receives the wrong signals from the affected

nerve fibers. People with this type of pain have trouble sleeping, spontaneous and evoked pain, and

emotional problems (Cleveland Clinic, 1995-2018). Currently, opioids, which includes fentanyl,

codeine, and hydrocodone, is legally prescribed from physicians as a medicine to treat neuropathic

pain, and this type of medicine is well-known for its serious side effects such as physical dependency

on the drug and overdose, but medical marijuana serves as a better treatment for neuropathic pain as

it does not pose any side effects like dependency (Morrow, 2017). According to Margaret Haney, a

professor at Columbia University Medical Center who is currently conducting cannabis research,

"there really is evidence that cannabis and cannabinoids, including synthetic cannabinoids, reduce

pain," expressing that "what's very exciting is there's some suggestion that cannabinoids can be

useful for a type of pain that isn't well-treated by other drugs – neuropathic pain." (Esposito, 2018).

Prescribing medical marijuana will not only help people with neuropathic pain, but also for those who

have PTSD. In the United States, about 8 million of the population suffer from post-traumatic stress

disorder (PTSD), many of them veterans of war (U.S Department of Veterans Affairs, 2016). Along

with PTSD, many also experience suicidal thoughts, due largely in part by a combination of

flashbacks, anxiety, depression, and insomnia ( Wing & Ferner 2017). According to the American
Medical Marijuana in the United States 6

Legion spokesman, Joe Plenzler, they “got young men and women with PTSD and traumatic brain

injuries coming to us and saying that cannabis works.” In 2016, the American Legion submitted a

petition to Congress, asking them to remove marijuana from the list of Schedule 1 controlled

substances, by categorizing it to a lower schedule. Since marijuana is categorized under Schedule 1

controlled substances, many veterans nationwide, including in the legalized states, cannot get

coverage for medical marijuana, making it hard to pay for the medicine that does help them (Ugwu,

2017).

POV 2:

As in any other ethical dilemma, the other half of society believes that medical marijuana

should not be prescribed/recommended from physicians to patients as it is argued that there has not

been enough evidence linking medical marijuana treating certain conditions, that medical marijuana

can end up in the hands of the wrong people, and its negative effects that it can have on the human

body. Many health professionals argue that medical marijuana should not be prescribed to patients

because, according to Barry Dworkin, MD, “there is a safer drug alternative for some patients that

mimics THC’s effects” (Dworkin, 2003) such as the FDA-approved Marinol drug. This specific drug

has been proven to effectively treat nausea and vomiting in association with chemotherapy, and

anorexia associated with AIDS (Orrange, 2015), and if medical marijuana is prescribed to patients

with these medical conditions, then it will have “the potential over years to cause more known harm

and health complications in addition to the patient’s original health” (Dworkin, 2003). Alongside

Dworkin, the Drug Free America Foundation also argues that there is already a synthetic version of a

medical marijuana-component available to patients and that there is no need to prescribe medical

marijuana to patients. THC, a chemical compound found in marijuana, is already proven to be

effective in prescription form as a synthetic medication, which leads to no need to legalize the plant.

Since medical marijuana is legal in states such as California, there is great fear that even though

medical marijuana is intended to be used by patients with specific medical conditions, there is a

loophole in the system where medical marijuana is “falling into the hands of people for whom it was
Medical Marijuana in the United States 7

not intended”, where medical marijuana is being prescribed to those who actually need it, but people

can find a way to resell the drug to those who don’t need it and use it as a recreational drug. In

California, for example, the patient registration system is deemed as problematic, having an open

opportunity for the resale of medical marijuana to non-patients to occur (Medical Marijuana, 2016). In

order for the resale of medical marijuana to not occur as often, the public encourages for physicians

to not prescribe medical marijuana in the first place, but it’s also not only because of resale, but also

because of the several side effects that medical marijuana poses. Medical marijuana contains many

side effects that affects the individual in a medical, psychological and cognitive way (Ammerman,

2014). The brain's functions and structures are altered through the use of marijuana as one of its

chemicals, THC, “gets into the brain rapidly and attaches to cannabinoid receptors” (Scholastic Inc,

2011), affecting the several brain structures of the brain. For example, the hippocampus, the area

where memory is regulated, can experience sudden side effects from THC such as impairment of the

memory, and the cerebellum, which regulates motor coordination, can be obstructed, resulting in the

impairment of an individual's coordination (Scholastic Inc, 2011), such that because of its

detementrial side effects, many physicians oppose prescribing, or even recommending medical

marijuana as recommending medical marijuana can “prove to be more harmful than helpful” (Drug

Free America Foundation, Inc. , 2016).

Medical Marijuana in the United States 8

Figure 3: Scholastic Inc. (2011). The Science of Marijuana: How THC Affects the Brain.

Retrieved May 9, 2018, from http://headsup.scholastic.com/students/the-science-of-marijuana

Medical marijuana not only affects the structures of the brain, but it also affects the respiratory system

that over time can lead to a life-threatening condition. Containing over one hundred harmful

chemicals similar to tobacco smoke, it has been shown that medical marijuana’s effects are similar to

the effects from smoking tobacco (Drake & Slatore, 2017). There have been studies that showed that

the effects of smoking marijuana was linked to the same effects as tobacco smoke, such as chronic

cough and respiratory illnesses (Medical Marijuana, 2016), including asthma, COPD, bronchitis, and

lung cancer (Drake & Slatore, 2017). When marijuana is smoked, the cell linings of the large airways

of the lungs are injured by the several chemicals that marijuana imposes, which can lead to chronic

cough, wheezing, acute bronchitis, and phlegm production. Not only are the cell linings injured, but

when smoking marijuana, air pockets can be created between both of the lungs and the chest wall

(American Lung Association, 2015), which can lead to a “collapsed lung; a potentially life-threatening

condition also called a pneumothorax” (Drake & Slatore, 2017), and in other cases, marijuana can

increase the risk of developing lung cancer as the smoke contains various unique chemicals like

carcinogens. Prescribing marijuana can lead to addiction “who contend that marijuana's negative

physical side effects outweigh any medical benefits the drug may offer” (Medical Marijuana, 2018).

According to the Drug Free America Foundation, medical marijuana should not be prescribed to

patients because it can “create a public health danger for seriously ill patients” due to the harmful

chemicals that medical marijuana has.

Writers point of view:

The usefulness of medical marijuana is up for grabs, some propose that doctors should

recommend it, while others refute that it is not logical that physicians consider medical marijuana as a

medical option for patients, but after extensive research on this issue, I strongly believe that medical

marijuana should be prescribed/recommended to patients that actually do need it and who meet all
Medical Marijuana in the United States 9

criterias. It is true that there are not many scientific data that backs up medical marijuana, but

because marijuana is cited under the Schedule 1 controlled substances, scientists can not make

sufficient progress that will show the effectiveness of medical marijuana, but there are personal

accounts of those who have taken medical marijuana to treat their medical condition, like epilepsy,

that has shown tremendous change and progress in their everyday lives. For most of her life, 12 year

old Alexis Bortelli has lived with epilepsy, all of her prescribed epilepsy medications did not work in

minimizing her seizures, but when one doctor suggested that medical marijuana could work, her

family decided to move from Texas to Colorado, where since November 2000, it is legal to have

access to medical marijuana. Ever since Bortelli has taken medical marijuana, the number of seizures

that she’s had reduced tremendously, stating that “ever since I've been on this cannabis, I've actually

been seizure-free for – today it's 974 days, so we're coming up on 1,000. So I think that's pretty good”

(CBS News, 2017). The positive impact that medical marijuana has had on Alexis Bortelli’s health

highlights one of the several outcomes that comes from prescribing medical marijuana to people with

certain medical conditions, where other medical options have worn out. As the opioid crisis in the

United States is rising everyday, it is difficult for patients to use other drugs as there is a high chance

that they will become addicted to them, but recent studies have shown that medical marijuana has

“put a dent in the opioid abuse epidemic”, which steers patients away from using “more dangerous

addictive drugs”. W. David Bradford, a professor at the University of Georgia, and his three

colleagues conducted a study using data from Medicaid, found that there has been a 14% reduction

in opioid prescriptions when patients have legal access to medical marijuana. Another similar study

was conducted by Hefei Wen from the University of Kentucky College of Public Health, along with

Jason Hockenberry at Emory University, reaches to similar conclusions as Bradford, citing that

medical marijuana has “ the potential to reduce opioid prescribing for Medicaid enrollees, a segment

of population with disproportionately high risk for chronic pain, opioid use disorder and opioid

overdose” (Harris, 2018), which for me, this further on supports my point of view on the issue of

doctors prescribing medical marijuana because medical marijuana has shown that it works in treating
Medical Marijuana in the United States 10

pain and can then reduce the opioid crisis by 14%, but people do not accept the idea that it can work

because of what it is cited under, but if as individuals, we are more open to the idea of prescribing

medical marijuana, then there can be a decrease in the number of people that will use opioids to treat

conditions such as pain.

Conclusion:

Medical marijuana has been in the center of it all. Does it have health benefits? Is it dangerous

for already ill patients? Can it be trusted? These are the kind of questions that people ask themselves

in terms of whether doctors should prescribe medical marijuana to its patients. As in every debatable

topic, there are always the pros and the cons, and in the dilemma of medical marijuana, it all applies,

for example, marijuana can help ease with epilepsy, as seen in the case of Alexis Bortelli, but

allowing patients to have access to medical marijuana is a pathway for it to be resold to those who do

not need it. Those who agree with prescribing medical marijuana cite that there have been studies

that suggest that medical marijuana can help alleviate neuropathic pain, replacing the use of opioids

in this case. As the opioid crisis is surging, studies conducted by W. David Bradford and Hefei Wen

have shown that there has been a reduction of 14% in opioid prescriptions when using marijuana, as

a great number of veterans with PTSD are prescribed medications that has negative side effects,

many veterans have expressed that when using medical marijuana, they have felt much better than

when they were on antidepressants. But those who are against prescribing medical marijuana to

patients have pointed out that here have been other findings that suggest that medical marijuana is

harmful to the lungs as it can cause chronic cough and lead to a collapsed lung. Medical marijuana

can also have several medical, psychological and cognitive effects as the functions of certain parts of

the brain such as the hippocampus and the cerebellum are impaired. As more people weigh their

opinion on this ethical dilemma, the scientific world always makes new findings day to day that can

change the course of the medical history in regards of whether medical marijuana should or should

not be prescribed to patients.

Medical Marijuana in the United States 11

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