#35 Marijuana

Healthcare has a complex and convoluted relationship with marijuana. Marijuana is a “schedule 1” substance, meaning it has a high potential for abuse and no accepted medical use, yet a synthetic version of it is FDA approved as an appetite stimulant. Dr. Thomas, hospitalist, discusses the relevant historical and political context of the drug, as well as its pharmacology, cannabinoid hyperemesis syndrome, and some communication techniques for discussing drug use with patients.

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Why are there very limited studies about marijuana?

In the U.S., the Drug Enforcement Administration (DEA) has classified marijuana as a “Schedule 1” drug meaning that it’s deemed to have no medical use and a high potential for abuse.

U.S. researchers can only study the effects of cannabis using plant material grown by the University of Mississippi under contract with the National Institute on Drug Abuse (NIDA) (Erickson, 2020)

Why is Dronabinol FDA approved?

Even though cannabis is “Schedule I” in the U.S., the synthetic form of the plant’s psychoactive compound tetrahydrocannabinol (THC), is “Schedule III”.

Dronabinal is an FDA approved medication made with synthetic THC that is prescribed as an appetite stimulant for patients with AIDS or on chemotherapy.

Cannabinoid hyperemesis syndrome (CHS)

CHS is condition experience by long-term cannabis users who have recurrent episodes of severe nausea, vomiting and abdominal pain. It’s etiology is unknown.

While the only known cure for CHS is to stop cannabis use, treatment includes supportive measures such as

  • IV fluids
  • Antiemetics: Ondansetron (Zofran), Metoclopramide (Reglan), Promethazine (Phenergan), Lorazepam (Ativan)
  • Analgesics. Use narcotics with caution.