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    Medical marijuana: An oxymoron and a risk to fetuses


    Dr Lockwood, editor in chief, is Senior Vice President, USF Health, and Dean, Morsani College of Medicine, University of South Florida, Tampa. He can be reached at [email protected].


    In a time marked by a conservative lurch of the American electorate, and mounting state and federal legislative efforts to restrict access to family planning, voting, and union collective bargaining, there has been a paradoxical nationwide loosening of laws proscribing marijuana use. Twenty-eight states and the District of Columbia have now decriminalized personal marijuana possession. Moreover, the percent of US adults who perceive great risk from marijuana usage has declined from 51.7% in 2003 to 33.3% in 2014.1 Interestingly, Americans have not only become increasingly inured to potential risks, they have also enthusiastically embraced putative “medical” uses of cannabis.

    Indeed, without substantive scientific evidence for their action, 29 states and the District of Columbia have now legalized medical marijuana.2 My own state of Florida—which voted for Donald Trump, returned a large GOP majority to the state legislature, and has a Republican Governor—enthusiastically passed a medical marijuana referendum this past November (6.5 million votes in favor vs 4.6 million against). Ironically, the biggest supporters of the pro-cannabis referendum were reliably conservative farmers, tobacco interests, and land developers, all of whom stood to gain financially from the plant’s cultivation. While aging hippies and libertarians may be heartened by this trend, obstetricians should be concerned.

    Efficacy of medical marijuana

    There is de minimus evidence supporting the pharmacological value of cannabis. Whiting and associates recently conducted a systematic review and meta-analysis of studies examining the risks and benefits of cannabinoid therapies.3 Of 79 trials identified, only 4 were judged to be at low risk of bias. Compared with placebo, marijuana resulted in a greater complete nausea and vomiting response among those undergoing chemotherapy with an odds ratio (OR) of 3.82 (95% CI: 1.55–9.42; 3 trials). Among chronic pain patients, the average number of patients reporting a ≥ 30% reduction in pain was slightly greater with cannabinoids than with placebo (OR, 1.41; 95% CI: 0.99–2.00; 8 trials). However, common side effects included dizziness, dry mouth, fatigue, somnolence, euphoria, disorientation, drowsiness, confusion, loss of balance, hallucination and, interestingly enough, nausea and vomiting. Given the excellent new antiemetics on the market and the myriad of analgesics, these “benefits” are hardly notable. Moreover, cannabis did not reduce rates of depression or improve intraocular pressure among glaucoma patients. At best these studies suggest that additional trials may be warranted in highly select populations but they certainly do not support the sale of this drug for any legitimate pharmaceutical purpose.


    NEXT: Marijuana use in pregnancy >>

    Charles J Lockwood, MD, MHCM
    Dr Lockwood, Editor-in-Chief, is Dean of the Morsani College of Medicine and Senior Vice President of USF Health, University of South ...


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    • UBM User
      Any enabling attitude or tax money or government advocacy for marijuana is very foolish. why would anyone think that smoking in any form is good? why should we subsidize alcohol? why should we subsidize Meth, cocaine, etc? But we do. I think that meets the definition of STUPID in Websters. Wm. Bart Pate, MD
    • Anonymous
      I agree with the medical aspects of this article, but am surprised at the bias of the political diatribe preceding the information. Colorado, the first state to allow medical marijuana, has been a "Blue" state with a Democrat Governor for many years. In fact the enactment of the laws and the associated federal ambivalence toward the State legislation occurred during the prior president's term. Let's leave the politics out of the medical literature!!!!
    • UBM User
      I totally agree with Dr. Lockwood. At the present time and until we have good quality RCTs , cannabis has no place in the pharmacopoeia. One point is worth making. Marijuana is a Schedule I drug yet it can be studied on human subjects in the US. The FDA/NIH maintains a "farm" in Mississippi that grows one species. There are many. The species available, I am told is of diminished potency compared to what is available to the street consumer. Therefore studies that used this particular variety may not be representative of effects reported by users of the "street" varieties. Overall, the societal impact of a substance that can do fetal harm yet is promoted by stalwarts of euphoria or purveyors of self-serving economic interests are totally misguided and the irreparable harm to society is noteworthy. Count me out!


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