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Medical Marijuana: Considering the Needs of Individual Patients and the Larger Community

By Sanjiv Mehta

Note: Guest blogger Sanjiv Mehta is a fourth-year medical student at the University of Pennsylvania’s Perelman School of Medicine. He will serve as PAMED’s second health policy intern during October.

The most exciting aspect of medical school has been learning to empathize and connect with a diverse range of individuals. Understanding a patient’s experience and sharing in their challenges has driven my desire to study medicine and the variety of therapies and medications that can bring patients solace.

Learning about the debate regarding medical marijuana legalization in Pennsylvania, I was filled with a similarly strong feeling of empathy for many of the individuals advocating for access to the drug when every medical treatment had failed them. I could feel nothing but compassion and sorrow when reading stories of parents fighting for their children to gain access to medical marijuana to treat disabling diseases including intractable epilepsy.

After connecting with their apparent desperation, I was both surprised and frustrated at the fact that many medical societies, including PAMED are opposed to the bill. Considering the foundation of medicine involves relieving suffering whenever possible, I couldn’t understand why physician leaders would be against giving needy patients access to medical marijuana through a systematic and safe distribution system.

However, after my first week on my policy internship with PAMED, I have begun to appreciate the underlying complexity that drives debate on such public health and policy issues. Delving into the research and concerns behind PAMED’s and other physician society’s stance against legalization, I have gained a better appreciation for the challenging fact that what might be an obvious choice for a single patient or group may not be in the best interest of the larger community.

Reviewing the literature, it’s clear that much of the hesitation around legalizing medical marijuana relates to the lack of knowledge and understanding of the effects of cannabinoids as a drug. While there is evolving research about dosing and possible side effects, most of the long-term effects on an individual’s brain are not fully understood. This is particularly true for the use of marijuana in the pediatric population.

We still have a limited understanding of what cannabinoids can do to a young brain that undergoes extensive development from birth into early adulthood. More importantly, there is some concerning early evidence that it can increase rates of psychiatric disease in predisposed individuals or lead to potentially permanent memory deficits in the future.

With this uncertainty and more importantly with the potential for long-term harm, physician leaders have every right to express some hesitancy in supporting the use of medical marijuana. They will hold the responsibility and burden of prescribing medical marijuana and managing any unintended consequences that come with it. I doubt many would argue that there are some children and some adults who would have immediate benefit from this drug. However, the possibility for additional, unknown adverse effects or long-term damage to a child’s developing brain must have just as serious weight in ongoing debate.

Physicians have a duty to both care for suffering patients but also consider how their recommendations can affect the society as a whole. While I may not fully agree with the position, I can understand why PAMED can empathize with many supporters but still choose to oppose SB3. PAMED and physician leaders have a responsibility to present their interpretation of the evidence and what they believe is in the best long-term interest of Pennsylvania patients.

In this context, their recommendations for changing marijuana’s drug classification and supporting rigorously monitored clinical trials of cannabinoids in children demonstrate another nuanced path to help as many individuals as possible in a safe and validated manner.

As I learn more about both sides of this debate, I still empathize with supporters of this bill. At the same time, I am excited to attend the PAMED House of Delegates and appreciate the attitudes of the larger physician community on this issue.

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