Guest Blog by Ethicist David Campbell, PhD
Medical marijuana is a controversial topic which will only become more controversial as recreational marijuana becomes legal later this year.
The biggest ethical controversies concerning medical marijuana are based upon two competing viewpoints: whether medical marijuana is truly a safe, effective medication which doctors should be recommending, or whether medical marijuana is indeed an effective legitimate medication which should be offered to more patients but is not because of the prejudice and stigma against marijuana.
The irony over the central controversy surrounding medical marijuana, namely whether it is harmful or the bias against it is more harmful, is that because of the bias against medical marijuana, we simply do not have enough concrete evidence to support one side of the argument over the other.
Due to discomfort around conducting clinical trials over the value of medical marijuana, we don’t have enough data to confirm that medical marijuana is truly a safe and effective method of alleviating certain symptoms and ailments such as chronic pain, anxiety, sleeplessness, and lack of appetite. Currently we are uncertain what the ideal amount which should be prescribed is, or what the possible long-term side effects could be. For now we have to rely on limited studies and testimony of patients who report that medical marijuana not only helps alleviate these ailments, in some cases they are the only treatment which truly alleviates them.
The problem with only or mostly relying on patient testimony is the placebo effect. Some patients report that all manner of non-evidence based treatments, everything which fits under the umbrella of naturopathy to prayer and faith based spiritual healing, can alleviate or cure symptoms or illnesses. However, these claims are simply not verified through objective clinical trials. Until the bias against medical marijuana decreases and we are able to have more studies on the benefits and harms of medical marijuana, we won’t be certain if it should become a standard medication or remain as an experimental and controversial treatment on the fringes of mainstream medicine.
That being said, there does seem to be evidence that medical marijuana can be effective means of treating certain symptoms, and when it comes to cancer patients who have unmanageable pain, and considering that many pain medications, such as opioids, have considerable side effects and can lead to addictions, medical marijuana might be the less harmful option. Considering how many people become addicted to prescription medications every year, the fear of the odd patient becoming addicted to medical marijuana seems exaggerated and overstated.
The fear that some patients might be seeking medical marijuana just to “get high” is also exaggerated, as these individuals could simply seek out recreational marijuana, which is much more potent, cheaper, and easier to access than medical marijuana.
While the ethical issues of medical marijuana and recreational marijuana are and should be separated, there is an important question which the legalization of recreational marijuana has on medical marijuana. Namely, once recreational marijuana is legalized, will medical marijuana become subsidized and covered by OHIP like most other medications? And if not, on what grounds other than ongoing bias against medical marijuana and those who use medical marijuana? On the basis of fairness and equity, medical marijuana should be covered by OHIP as soon as we are absolutely certain that it works and that its benefits outweigh its risks, just like any other medication.
For now it seems as if the potential benefits of medical marijuana outweigh the potential harms and risks. However, we shouldn’t over-exaggerate the risks or benefits of medical marijuana. It is hardly a benign wonder drug and does have risks and side effects, but for some patients it seems to work. What we need is less bias and more science, as science is ultimately the best antidote to cure any bias.
David Campbell, PhD, is an Ethicist at Kingston Health Sciences Centre.
Categories: June 2018 edition