Puff The Magic Pot Dragon

By Peter J. McDonnell, MD

As everyone knows, there are just not enough hours in the day to do everything that needs to be done and, most especially, to read all of the various medical journals and textbooks that accumulate on our desks. Requirements for CME credits, learning to use new electronic medical record systems, and the various time-intensive requirements being placed upon physicians in order to renew their board certifications add to the perception of many doctors that they are on a treadmill that never slows down. 

Like all ophthalmologists, I budget copious time to read each and every issue of Ophthalmology Times from cover-to-cover.  But lately, I find that reading a daily newspaper is sometimes too much of a luxury, and typically I simply look at the headlines, skim the first few sentences, and move on the next article.  Five minutes max to read the entire newspaper each morning, then out the door to get to my office.

More in this issue: How to have healthy awareness and educate yourself regarding ACOs

A recent publication in the Baltimore Sun, however, arrested my attention and demanded that I spend the time to read it carefully.  Entitled, “Doctors Need Marijuana Training,” the article responds to recent legislation passed in my state enabling physicians to prescribe marijuana for medical purposes.

The ever-so-promising title of this article, penned by the president and interim executive director of the Pharmacists’ Education and Advocacy Council of Maryland, gave me the wrong idea.  Logically, I assumed the article was advocating for requiring physicians to attending workshops conducted by tie-dyed instructors in which giggling attendees listen to Bob Marley CDs while passing around reefers (with big bowls of Cheetos, instead of bagels, at the tables during the breaks in the course). This might be one CME course worth closing down the office!        

Sadly, this is not the case.

Rather, the article criticizes insufficient education of our medical students about marijuana (perhaps because they are studying all the time and not partying?)  The author proposes that “one solution to improve patient outcomes and minimize diversion is to require that all physicians receive appropriate medical education before . . . prescribing medical marijuana.  It seems little to ask that physicians complete training in addiction and marijuana effects before prescribing it to the citizens of Maryland.” The correspondent is calling for standard courses in which sober physicians in dark rooms are bombarded with PowerPoint presentations, with brief breaks in the atrium to consume weak coffee and tasteless Danish.

The cost-benefit of these newly-required courses would be poor for ophthalmologists, as to my eye the data supporting the value of marijuana in the management of eye disease are suspect at best.  The California Medical Association, however, lists glaucoma as #7 amongst 12 “serious medical conditions” meriting a medical cannabis card (arthritis is #3, migraine is #8).  While that state notes “physicians will have to keep abreast of emerging literature on the subject of medical cannabis,” I do not see it mandating courses as proposed above for Maryland doctors. 

No doubt some ill patients benefit from this treatment.  A recent study published in JAMA Internal Medicine reported that the yearly rate of opioid painkiller overdose deaths in states with medical marijuana laws was about 25% lower, on average, than the rate in states without these laws.      

There is an important lesson here for busy ophthalmologists:  before rushing to sign up for a course entitled “Marijuana Training,” read the fine print in the course description.

California Medical Association.  Physician Recommendation of Medical Cannabis.  Guidelines of the Council on Scientific Affairs Subcommittee on Medical Marijuana Practice Advisory. 

Bachhuber MA, et al.  Medical Cannabis Laws and Opioid Analgesic Overdose Mortality in the United States, 1999-2010.  JAMA Intern Med Published online August 25, 2014