ASAM says doctors should not be gatekeepers of medical marijuana programs

A strongly worded white paper from the American Society of Addiction Medicine (ASAM) urges physicians not to recommend use of smoked marijuana as medicine to their patients, and takes the additional step of recommending a halt to medical marijuana programs in the 15 states that have authorized them.
“‘Medical marijuana,’ currently distributed pursuant to state legislation, does not accord with critically important aspects of the modern scientific model,” states the ASAM white paper, which is based on an analysis of existing literature and which underwent a field review. “It lacks quality control and standardization; can be contaminated with pesticides and microbes; and does not assure patients a reliable and reproducible dose.”
The ASAM document suggests instead that all cannabinoid medications be subject to the Food and Drug Administration’s (FDA’s) standard regulatory process. The white paper points to ongoing research into chemical entities in the endocannabinoid system—research that is designed to systematically examine one particular chemical and its promise for treating one specific disease state.
“Doing regulation on a state basis is a non-starter for ASAM,” says Andrea G. Barthwell, MD, a former ASAM president who was a coordinator of a committee that ASAM formed to study the medical marijuana issue.
Release of the white paper in the weeks prior to next month’s ASAM Medical-Scientific conference in Washington, D.C. actually culminates two years of activity from the committee, whose recommendations were adopted by ASAM’s governing board a year ago. Barthwell, a former deputy director for demand reduction at the federal Office of National Drug Control Policy (ONDCP), says ASAM physicians already are taking the document to legislators in states presently considering authorizing medical uses of marijuana (such as Illinois), as well as states now considering repeal of existing medical marijuana measures (such as Montana).
“We have three goals: to educate our [physician] membership about the untenable position they’ve been put in, to go to other medical societies, and to change the conversation about marijuana,” says Barthwell, who directs the Two Dreams Outer Banks Comprehensive Wellness Center for the Treatment of Alcoholism and Addictions.
Media reports in many states in recent years have described a largely unregulated atmosphere around distribution of marijuana to medical patients. ASAM argues that some of the potential risks associated with the systems that have evolved include adverse events, possible dependence in some patients, and diversion of the drug to adolescent users.
“Both the American Medical Association (AMA) and the American College of Physicians (ACP) have rejected the use of state legislative enactments to determine whether a medication should be made available to patients,” the ASAM white paper states. The paper says the Institute of Medicine (IOM) has called for additional research into non-smoked delivery systems for cannabinoid medications.
Barthwell says the ASAM’s position in no way amounts to a denial of the potential for cannabinoid compounds in treating illness. “We all agree there is some potential—otherwise we wouldn’t be working with the endocannabinoid system,” she says.
Barthwell estimates that the field is less than a decade away from at least identifying promising tools in the endocannabinoid system, based on the research that is currently taking place.
She will discuss the white paper as part of an April 16 symposium presentation at the ASAM conference, to be held April 14-17 in Washington, D.C. The conference also features another presentation on the topic of cannabis as medicine, on April 17. Visit www.asam.org for more information.