December 23rd, 2018
By Natan Schleider, M.D.
Mr. J.B., a 24 year old male up and coming advertising executive for a NYC start-up looks great on paper. He has a Masters Degree from a reputable Ivy League school. His rowing strength, skills, and discipline landed him an undergraduate scholarship, at least until he injured his back and was prescribed Percocet. He is from an affluent family, the kind that consider yachting a sport.
Issue is, he may be getting drug screened as part of his promotion at work. The recreational once monthly use of oxycodone that started a few years ago has ‘blossomed’ into daily use of what is supposedly heroin–he suspects it is ‘some garbage laced with fentanyl, different high you see’ which he snorts every few hours so he doesn’t ‘get sick.’
Appropriately concerned that his habit may be life threatening, I find him sitting in my office, nose running, pale and fatigued, yawning, and rubbing the goose bumps on his restless legs.
JB is clearly in opiod withdrawal and in New York State medical marijuana is recently approved to prescribe for Opiod Use Disorder.
Why? Because studies show that marijuana reduces the dose of opiods needed by at least 1/3rd and relieves pain.
As my predecessor physicians did during prohibition which began 100 years ago in 1919 when one of the few legal means of obtaining medicinal alcohol was by prescription, so now can New York State doctors prescribe marijuana for various medical ailments from cancer to post traumatic stess disorder to Opiod Use Disorder.
Given that New York like the rest of the USA is in the midst of an opiod epidemic causing countless deaths, any tool we can use to save lives from naloxone to buprenorphine to methadone to medical marijuana should be easily at doctor’s disposable.
This begs several questions:
- Why do doctors need a special DEA number and special training to prescribe buprenorphine, a medicine FDA approved for treating opiod withdrawal and dependence which it is virtually impossible to overdose on.
- Why do doctors need special training to prescribe medical marijuana as patients drop like flies from illegal pain killer and opiod use?
- Why don’t doctors need a special DEA number to write for powerful prescription opiods that are highly addictive and cause respiratory depression and death at high doses.
These complicated questions are based on history dating back to prohibition, reflect lobbying power of ‘big pharma,’ and ignorance that leaves marijuana a Schedule 1 medicine meaning the following according to the DEA:
Schedule I drugs, substances, or chemicals are defined as drugs with no currently accepted medical use and a high potential for abuse. Some examples of Schedule I drugs are:heroin, lysergic acid diethylamide (LSD), marijuana (cannabis), 3,4-methylenedioxymethamphetamine (ecstasy), methaqualone, and peyote. [See https://www.dea.gov/drug-scheduling].
Should marijuana become legalized for recreational use as Govenor Cuomo intends next year, perhaps medical marijuana prescribing will become a relic like the 100 year old prescription for medical alcohol?
For the interim New York doctors can and should, where medically indicated, offer patients medical marijuana instead of opiods.
Thanks for reading!
Natan Schleider, M.D.
BOARD CERTIFIED ADDICTION MEDICINE DOCTOR