by Rep. Julio Gonzalez, M.D., J.D.

Since speaking of the fantastical nature of medical marijuana, I have been bombarded with commentaries and concerns regarding the legal status of the plant in Florida. Sadly, most of the comments have been hateful, demeaning, and designed only to intimidate.

But hidden amongst the hate speech are some communications that honestly raise questions of a medical role for marijuana and report favorable experiences with its use.

So here’s the bottom line: As a physician, I completely acknowledge the pain and suffering of those afflicted with chronic and debilitating diseases and of the sometimes tragic shortcomings of our pharmacopeia, but the data supporting marijuana as a bona fide medicinal tool is simply lacking… and may always be.

Any honest discussion regarding medical marijuana must begin with the full acknowledgment of the secondary interests motivating it. Many pro-medical-marijuana advocates eagerly cite alleged conspiratorial efforts by pharmaceuticals to stifle its use, but they fail to acknowledge the millions of dollars pumped into the campaign for its legalization by the growing marijuana industry, and the even greater amounts of money some stand to gain from favorable policy decisions.

So, let’s be honest and admit that there are pecuniary interests on both sides of the issue striving to skew the conversation in their favor.

 

Asking the tough questions

With this admission in mind, I begin with one simple question: If marijuana is truly a medicine, then what about its pharmacology makes it so different as to allow it to bypass the scrutiny applied to all others medications? What is medically so different about marijuana that states can implement laws with insufficient study for the sole purpose of bypassing the FDA, and constitutional amendments are passed to allow for its use as a medicine?

The answer, of course, is nothing, which adds to the contention that something much bigger than the use of the plant as a medication — perhaps the quest to legalize its recreational use — is the true driver of the medical marijuana debate. If that be the case, then ransacking the nation’s health care system for the mere promotion of a recreational drug is dishonest, reckless, and dangerous.

Julio Gonzalez for State Representative

Then there’s the pesky issue of the science.

First, marijuana is not one substance, but rather a complex of more than 400 biologically active compounds including, terpenoids, flavonoids, and over 70 cannabinoids. The interactions between these substances and their specific benefits are not understood. What’s more, their specific combinations vary between strains of the plant, growth conditions, the manner in which the plant is prepared for consumption, distribution methods, storage times, and storage conditions.

All this may be totally acceptable for a recreational product, but it is the death knell of a prospective medication.

What’s worse, there is very little data supporting the use of marijuana for many of the claimed indications.

 

What thorough marijuana study reveals

Perhaps the most thorough and objective review on this topic appeared in 2015 in the Journal of the American Medical Association.

Researchers studied 23,754 “hits” on their search engines. They arrived at 79 studies reported in 151 papers from all over the world (encompassing 6,462 participants) that the authors found were of sufficiently low bias and high scientific control to be taken seriously as scientific analyses.The researchers then stratified the collective results of the studies into varying levels of data quality to support a recommendation for the use of marijuana and its derivatives in health care. Neither, the cannabinoids nor marijuana, received a rating of high confidence in the treatment of a single symptom or condition!

Conclusion: the science supporting the use of marijuana or cannabinoids as a medicine is simply not there. In fact, only in the treatment of chronic neuropathic, cancer pain, and spasticity was any data found that rose to a level of moderate scientific quality.

Additionally, when marijuana was used for pain control it did not diminish the demand for opioids, thus eviscerating the contention that by allowing for the use of medical marijuana there would be fewer complications related to opioid use and opioid addiction.

Nausea and vomiting, HIV/AIDs, depression, anxiety disorder, psychosis, sleep disorders, and Tourette syndrome received either low quality support or very low quality support. Studies regarding other conditions such as the actual treatment of cancer, glaucoma, seizure disorders, Crohn’s disease, sickle cell disease, psoriasis, and Parkinson’s disease were so poor that they did not even rise to the level of meriting inclusion in the JAMA study.

 

Risks lacking known rewards

On the flip side, the risks of treatment with marijuana are not inconsequential.

First, dosing of smoked marijuana remains unpredictable. And although much of the medical marijuana debate centers on the effects of single exposures, insufficient information exists regarding the effects of repeated exposures. Approximately 10% of people routinely using marijuana become addicted, with a higher incidence amongst adolescents. Tolerance and down-regulation of receptors have been documented with repeated marijuana use. A marijuana withdrawal syndrome has also been recognized, as has an association with psychosis.

Despite the lack of scientific evidence to support the use of medical marijuana, the states have run the gamut on the list of scientifically unsupported treatments they will allow. For example, last year, Florida approved a constitutional amendment listing cancer, epilepsy, glaucoma, HIV/AIDs, PTSD, ALS, Crohn’s disease, Parkinson’s disease, MS, any medical condition similar to those listed above, and terminal conditions as ones for which marijuana may be used. And in Connecticut, the use of marijuana for the treatment of sickle cell disease and psoriasis is also allowed.

 

The endocannabinoid ruse

There are those, particular amongst the more vitriolic advocates, who misguidedly cite the endocannabinoid system as evidence for the benignity of marijuana use, suggesting that we should allow for marijuana’s medicinal use because cannabinoids are already existing inside our bodies. In fact, the existence of such a system should result in further caution against the proliferation of marijuana use.

The human body does produce cannabis-like substances, but they naturally exist in very small quantities, are precisely released, and linger for very brief periods of time. These endocannabinoids affect nerve growth and maturation, and guide intercellular connections during pruning (the process by which nerve cells find and refine their connections).

Exocannabinoids, on the other hand, those that are ingested or inhaled like marijuana, are long lasting, exist in higher quantities, and are relatively indiscriminate in their distribution.

The consequences of taking these substances from an external source are not only unknown, but potentially very disruptive to human development — an even more disturbing consideration since brain development continues until the age of 25 years. Such indiscriminate and physiologically disruptive effects may explain the negative behavioral and emotional changes associated with adolescents who are repeatedly exposed to marijuana.

 

Study and FDA approval needed

Yes, as a legislator, I am aware that in Florida, 71% of the electorate voted for the medical marijuana constitutional amendment. But such an outcome, promoted by monied interests, does not negate the fact that marijuana is not a medicine.

Like any other physiologically acting collection of substances, marijuana is a potentially dangerous, incompletely understood, and improperly controlled combination of chemicals whose benefits have not been found to sufficiently outweigh its risk.

I continue to call for the FDA and the federal government to devote resources to the study of this plant and its effects. With adequate support for well-controlled, scientific research, there may come a day when sufficient, meritorious information will be available to allow the FDA to provide health care providers with reliable prescribing information and for manufactures to create products known to be beneficial to patients.

But until such time, physicians need to shy away from the indiscriminate, and still illegal, use of marijuana in their patients, and states need to be leery of policies enacted in contradiction to federal law.

As for the advocates, if their goal is to legalize marijuana for recreational use, then let’s have that discussion and not use our nation’s health care system as a ruse for the promotion of marijuana’s greater acceptance as a recreational drug.

In the meantime, and despite the accusations, bully tactics, and vitriol, I will continue to evaluate the medical literature regarding marijuana with a scrupulous eye and a mind open to the strengths of both sides of the argument.

Dr. Julio Gonzalez is an orthopaedic surgeon and lawyer living in Venice, Florida. He is the author of “The Federalist Pages” and serves in the Florida House of Representatives. He can be reached through www.thefederalistpages.com to arrange a lecture or book signing.

The Illusion of Marijuana As Medicine

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18 thoughts on “The Illusion of Marijuana As Medicine

  • June 1, 2017 at 12:29 pm
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    Funny I know about 20 people who didn’t use Cannabis for their debilitating diseases or opioid problems and now they are all gone, in heaven. All the people I know that chose to try Medical Cannabis, along with cutting out all the garbage in our lives, well they are still alive. For example: In Florida Cathy Jordan lives and grows her own medical Cannabis. She was diagnosed with ALS 30 years ago. Doctors say and we all know, ALS patients only have a five year life span after being diagnosed. She has used Cannabis this whole time and is still alive. She even outlived the doctors that diagnosed her from the very beginning saying she only had five years.
    From what Rep. Julio Gonzalez, M.D., J.D. said above, I don’t want people like this running our state or being able to carry a medical license. Extremely uneducated and very biased toward the Cannabis plant in general. Unreal how 71% speaks and the words of one person can have 10 times more weight. Let’s get this going, we’re talking creating 20,000 possible jobs in a year and possibly saving double that amount of people.
    I pray everyday for all of us. Blessings to all

    Reply
  • June 1, 2017 at 12:39 pm
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    Cannabis alleviates suffering. It is observable to anyone that is capable of compassion. Everyone deserves access to relief. Florida voters have spoken…. you are our Representative, please make it happen.

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  • June 1, 2017 at 1:18 pm
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    I happen to have broken my back in 2008 in a car accident. Pharmaceuticals are all well and good but let’s not kid ourselves here to start Big Pharma will always control the market & prices secondly the gov. Is proactively trying to make life a living hell for anyone in cronic long term pain, now they are threatening to take Drs licenss away just for refilling the medication I have been talking for 10 yrs. It’s a nightmare & if you move to find another pain specialist to take you on… Where is our help?

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  • June 1, 2017 at 3:00 pm
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    An intelligent discussion about “medical marijuana” is hard to find, Julio did his best to bring light to the subject not heat. I wish we had more legislators like him.

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    • August 10, 2017 at 4:26 pm
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      We have too many legislators like him and that’s the problem. They are whores that are beholden to archaic dogmas and the mighty green dollar. He does not serve his constituents or the people of Florida’s greater interests. Precisely why we need to remove all of them!

      Reply
  • June 1, 2017 at 3:17 pm
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    Read this response you detailed the information on legal marijuana.
    I totally agree-I see this as a monitary maker not a medicinal life saver for the ailing. As you have written such.
    Like all Drugs it is addictive (America
    already has a substance abuse problem) legalizing marijuana will
    ADD more problems.

    Reply
  • Pingback: The Illusion of Marijuana As Medicine – Dr. Rich Swier

  • June 1, 2017 at 6:56 pm
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    This is literally one of the most made up, b/s things i have ever read.

    You are okay with opiods, but dislike Cannabis…

    Wow

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  • June 1, 2017 at 10:59 pm
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    Julio, you’re about to box yourself into a corner with this one. Are you sure you want to attempt a fact-based argument about marijuana? You’re absolutely right about one thing – this is about more than medicine. Also, please don’t dismiss me as a hater. I most certainly do not hate you.

    I want you to think hard about the advice Hippocrates gave your profession centuries ago, and consider the following:

    What causes more harm to the individual – the worst possible excesses of marijuana addiction, or prison? Why don’t you tell the reader, and your constituents, what the scientific research says about that?

    Let’s say your above argument is correct, and that within the narrow confines of traditional pharmacology the evidence of widespread marijuana treatment efficacy is lacking. Fair enough. Now take off the physician hat and put on the state representative hat. You have constituents who’s lives have been ruined not by addiction or any other negative effect of marijuana itself, but because they’ve been arrested and prosecuted for using it.

    Is this really the best you can do? Is making a narrow argument against medical marijuana and avoiding the bigger issue really your best effort? I could take your above argument seriously if you would address the larger problem of marijuana criminalization and the myriad of well-defined social ills it’s led to. But you haven’t. So you know as well as I do it’s a cop-out. A way of hiding behind safe, conservative political ideology. This isn’t what healers do.

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  • June 2, 2017 at 9:23 am
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    Simply stunning that a physician such as yourself isn’t looking to research. Look to Israel for your studies. In the US the only studies that can be conducted is to prove HARM, so of course you won’t find US studies.
    Then of course we have Irvin Rosenfeld, the longest surviving Federal marijuana patient. 30 year resident of Florida, stockbroker, and productive member of society who wouldn’t be alive today without it.
    The sky hasn’t fallen, he hasn’t been swallowed by a sinkhole, and he’s utilized cannabis DAILY for over 35 years now with no ill effects. Zero opioid consumption.
    Please, take off your blinders. Your patients need you to, and the citizens of Florida deserve to stop suffering.

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    • June 3, 2017 at 9:33 am
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      There are many studies in the US on cannabis. One need only to do a search on Google to find peer-reviewed journals and websites that cite those journals which show the efficacy of cannabis for a myriad of diseases.

      Check out ’68 Studies on The Efficiency of Marijuana Against Cancer’ at http://naturalrevolution.org/68-studies-efficiency-marijuana-cancer/ and anyone can see how effective cannabis is, and this is just one disease of many that can benefit from the use of cannabis.

      Reply
  • June 2, 2017 at 10:17 am
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    A typical medical doctor, and on top of it, a politician who hasn’t looked at all the published studies of the efficacy of cannabis, but rather in this article, uses one study to base his opinions on. It’s irresponsible at best, and dangerous at most to espouse such biased language because he can’t seem to grasp the multi-medicinal modalities of cannabis.

    I could argue each point he brings up, but it would seem rather futile in my attempt to shed light upon someone who’s vilified cannabis, and clearly, he hasn’t done his research, nor has met any one of the thousands of cannabis patients that this medicine has eased their pain and suffering.

    Yes, he “acknowledges the pain and suffering of those afflicted with chronic and debilitating diseases…”, but in that statement, it’s very clear, just like the doctor and politician he is, while he ‘acknowledges’, he doesn’t ‘sympathize’ with those who are suffering. And that’s a big problem. When there is no compassion, no understanding of the harsh realities patients are facing every single day with pain and diseases, he can write an op-ed piece and voice his skewed and less than informed viewpoints, but that doesn’t justify his stance in asserting that cannabis is “potentially dangerous”, especially when zero deaths have occurred from its use in the course of recorded history spanning thousands of years.

    And then, to suggest that the FDA should scrutinize cannabis as if their stamp of approval is an indicator of health and safety, is a farce, especially considering that the FDA admits to murdering over 100,000 people each and every year from the products that they approve and certify as Generally Recognized as Safe (GRAS).

    Until Mr. Gonzales realizes that there are lives at stake with the ill-informed decisions that he makes as a representative in FL, affecting hundreds of thousands of patients in FL, people will continue to suffer and die at the hands of people like himself who have not done due diligence to look through ALL of the data and see all the benefits that cannabis can offer.

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  • June 2, 2017 at 6:05 pm
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    Julio, you can cherry-pick the facts as much as you’d like to justify carrying water for Mel Sembler and Sheldon Adelson. Kudos, though, for a good attempt at trying to clarify what you believe are the “murky waters” here. You are a lone voice in a chorus that has voted for the LEGAL RIGHT to use cannabis for its medicinal properties. What you think is of NO CONSEQUENCE, as the law is on our side, and your opinion is only for the consumption of your “champions”, above. We, the citizens of Florida, will have what we need in spite of your mean-spirited efforts to deny us such. Speaking for 71% of the Florida electorate, we respectfully ask that you crawl back underneath the rock you came out of and leave opinions on this matter to the bloggers and journalists, who at least look at their heart when they pen a story, and not their wallet…

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  • June 4, 2017 at 10:43 am
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    IMHO there R some valid comments to this article. But always remember when one ascribes motives, especially negative ones to a writer, they R starting to lose their own argument. I know Dr. Gonzalez, and I can assure U there is not an evil or negative bone in his body. There R some problems with this article and one is, as well written as it is, the general public is not interested in medical hypotheses. And he kinda notes this in his conclusion where he states: “As for the advocates, if their goal is to legalize marijuana for recreational use, then let’s have that discussion and not use our nation’s health care system as a ruse for the promotion of marijuana’s greater acceptance as a recreational drug.”

    U C, Dr. Julio Gonzales is thinking like a Dr. in this article, but leaves the door open for the legalization of marijuana argument. And admittedly this would have been a more moral argument. U C, if marijuana was legal then the above article would be moot. U C many a hospice Doctors have said to their patients caretakers, if he will feel better with some wine or booze then let him have it. But this cannot be said for marijuana in states where it is not legal. I will close with the make it legal argument, which is old and obvious. Prohibition did not work and marijuana prohibition does not work either. Its prohibition is and will always be a FAILED GOVERNMENT PROGRAM with the UNINTENDED CONSEQUENCE of enriching criminals, incarcerating good people needlessly, and punishing taxpayers. THE ANSWER IS TO LEGALIZE IT AND TAX THE HELL OUT OF IT. We have then changed a huge government useless counter productive waste, into a governmental Profitable Program. No matter how high government made the tax on well made joints by corporations, it would be far cheaper than what users R paying now…..MY disclaimer as I close is I do not smoke anything neither cigarettes nor grass.
    Julio U R a good man and I am proud that U represent us.

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  • August 10, 2017 at 1:52 pm
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    Another MD so stuck in his own ego that he fears venturing out into actual science that proves him wrong. I suggest you educate yourself of the body’s endocannabinoid system and learn something instead of breezing thru your CEUs to maintain your license, so you can have your admirers call you Doctor. You and your kind dont cure anything you just pump pills into poor trusting patients and when they find something that puts your kind out of the pill business you are gonna daemonize it because you dont actually want to heal anyone you dont get your fancy cars and expensive things by curing. Its cured my mothers COPD reduced fluid around her heart and reversed her CHF kept her off of opioids that were killing her and reduced her 17 rxs to only 4. You sir are a charlatan.

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  • August 10, 2017 at 1:52 pm
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    As someone who suffered from daily chronic and debilitating migraines….who ended up on 20 different pharmaceuticals…who continued to have migraines while also almost killing themself in the process from those same pharmaceuticals. I now only use cannabis and surprisingly I have not had a migraine in the four years I’ve been using it. I also am now capable of staying awake and holding a coherent conversation. This may be anecdotal but it has saved my life. I even used cannabis after 4 surgeries and didn’t even use aspirin. You really need to get educated. It could save one of your patients life. I know my 72 year old father is thankful for it. Bone cancer is painful….thankfully Cannabis isn’t addictive so at least he has some quality of life.
    Btw…I am a former cop.

    Reply
  • August 10, 2017 at 2:29 pm
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    I wish we could have an honest discussion on these matters. The citations brought are not even a portion of the studies that have or are going on currently around the world. Right now numbering in the thousands. Yet we feed our children Adderall or Ritalin when the studies number in the 100’s. I can respect an opinion, but not when it is so lacking empirical evidence to its substance. Medically applying cannabis to a chronic intractable 6 year state of hemiplegic migraines has ended the chronic and intractable nature of the migraines in my life. It has caused my niece to be a 29 year survivor of neuroblastoma stage 4, it changed the course of my mother’s end stage disease to be able to do what she most wanted to do: go see her grandchild graduate for her masters degree before she passed. It has stopped my sister’s migraines and I have so many more real life stories.

    When one reads data from a skewed view of decidedly against, no amount of data can open the mind. Only experience can open a closed mind. May your mind open to this, sir, because experience is a cruel teacher, one that visits us all.

    Reply

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