Published in JAMA (Journal of the American Medical Association), Dec. 13, 2016
To the Editor:
The Viewpoint on medical board expectations for physicians recommending marijuana1 summarized model guidelines proposed by the Federation of State Medical Boards (FSMB) for its members.2
We have two principal concerns. Regarding conflicts of interest, Dr Chaudhry and colleagues stated, “the physician should not be associated in any way with a dispensary or cultivation center.” This wording is more restrictive than the actual policy ratified by the FSMB. It would impede physicians who wish to collaborate with dispensaries and cultivators in studying which specific cannabinoid/terpenoid ratios patients find effective. Such data collection, in the absence of desperately needed clinical trials, can help unravel the diverse efficacy of various cannabinoids. Such an association for research purposes should not exclude physicians who recommend medicinal cannabis.
Also worrisome is the recommendation by Chaudhry and colleagues that “state medical and osteopathic boards advise their licensees to abstain from the use of marijuana for medical or recreational purposes while actively engaged in the practice of medicine.” This provision does not appear in the model guidelines developed by the FSMB Workgroup, adopted as policy by the FSMB House of Delegates in April 2016.
Although most physicians enter rehabilitation programs because of dependence on alcohol, opioids, or both, the Federation does not recommend that users of recreational alcohol or prescribed opiates suspend their practice. Using medicinal cannabis is not prima facie evidence of impairment or abuse. Requiring those physicians to suspend practice would be an unwarranted intrusion into a private physician-patient relationship and a stigmatization of clinicians making a rational treatment decision, in consultation with their physicians, about a substance with a lower addiction potential than either alcohol or opiates. The proposed policy to disallow such usage is scientifically unsupportable.
Jeffrey Hergenrather, MD
Society of Cannabis Clinicians
Stephen S. Robinson, MD, MPH
Compassionate Health Options
San Francisco, California
Fred Gardner, BA
O’Shaughnessy’s: The Journal of Cannabis in Clinical Practice