Ob/gyns voice their thoughts on medical marijuana

Cannabis has no place in the pharmacopoeia 

I totally agree with Dr Lockwood. [“Medical marijuana: An oxymoron and a risk to fetuses,” March 2017 Contemporary OB/GYN] 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 United States. 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!

Via the web

Cannabis useful in oncology 

I am professionally offended and incensed by your bias against medical cannabinoid use, as discussed in the March issue of Contemporary OB/GYN. As just one example of your flagrant bias, you state “[the] Birth Defects Prevention Study [...] observed that periconceptional cannabis use was modestly associated with anencephaly (adj. OR 1.7; 95% CI:0.9–3.4),” when anyone with the least knowledge of statistics sees that the confidence interval includes 1 and hence does not meet the already questionable threshold of significance that is accepted by our scientific community.

As an oncologist, I have seen firsthand and repeatedly the testimonial experience and advantage of this natural substance in the management of cancer patients, when other measures have failed. I draw your attention to the articles in JAMA, in particular “Opioids Out, Cannabis In: Negotiating the Unknowns in Patient Care for Chronic Pain”, (Vol 316, No 17, Page 1763, November 1, 2016), in which opportunities to address the nations opioid crisis with cannabis are discussed.

Moreover, there is substantial anecdotal evidence of cancer remissions induced by cannabis, and seizure control by cannabidiols.

Loosening of the illegality of this substance will propel better research.

I do not disagree with your recommendations to avoid cannabis and all other pharmacologic substances, caffeine included, during pregnancy and even in the prenatal period. Ginger notwithstanding for nausea. Just please do not intrude on the usefulness in oncology of this substance.

B Stephens Dudley, MD

Nashville, Tennessee

Leave politics out of the cannabis debate 

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!

Via the web

Dr Lockwood responds

I thank the readers for their comments. My main points are:  1. the medicinal value of marijuana appears minimal even in the relatively rare setting of nausea control during chemotherapy; and 2. we cannot rule-out a teratogen signal from its use by pregnant women. Thus, the drug should not be used by women who may become or are pregnant. 

I am fascinated by the passion evoked by this topic-not many subjects can unite aging hippies, agribusiness and big pharma on one side and evidence-based medicine adherents, neurodevelopmental experts and the religious right on the other!

Charles J Lockwood, MD, MHCM