CMDA's The Point

Unmasking Medical Marijuana

May 23, 2019
Unmasking Medical Marijuana May 23, 2019

by Amy Givler, MD

At age 60, I can pretty much say I will never recommend marijuana to any of my patients. I have far too clear memories of my teenage years, when I knew many friends and family who smoked pot, to their detriment. In high school it wasn’t hard to tell who was using regularly because it interfered with their learning. They seemed slightly disoriented and less aware of what was going on around them.

And the years since then have only reconfirmed my reluctance to embrace marijuana. For 31 years as a family physician I have actively discouraged my patients from using this drug.

“How’s it different from alcohol?” they might ask.

“I don’t want you to drink alcohol either,” I say, “at least not to the point of getting drunk. And what is the purpose of marijuana except getting high? With alcohol it is possible to drink a small enough amount that it doesn’t impair you.”

But for the first 27 years of my career, I didn’t have this conversation often. Unless people were in substance-use recovery—and wanting me to know this part of their medical history so I could support them—I seldom knew. With most patients, if I asked about drug use as part of their medical history, they denied it. Only if they had tested positive on a drug screen in the emergency room did they reluctantly admit to using “sometimes.” And if they protested they had just been around a smoker, not smoking themselves, my standard response was they would have to sit in an unventilated room with a smoker for an hour before they would get enough THC in their system to test positive.

All that changed one day in June 2015. It was the day after the Louisiana legislature passed a law allowing medical marijuana, and my very first patient asked me for a prescription for it.

“No way!” I said.

“But it’s legal!” he said.

“So I guess you have been using marijuana for a while?”

“Oh, yes,” he said, “and it really helps my anxiety.” Since he is one of my most anxious patients, I wonder about that. I suspect it is actually making his anxiety worse.

I wondered if that encounter was a harbinger for the future, and indeed it has turned out to be so. Even though Louisiana has dragged its feet on actually getting medical marijuana to market (Thank you, O my sluggish southern state), hardly a week goes by without someone asking me whether medical marijuana would help them. I think you know by now how I respond.

And when I ask new patients about marijuana use, they never hesitate any longer before telling me if they do. Clearly they consider the legality of medical marijuana to be permission granted by the medical profession to use all forms of marijuana. But of course, recreational marijuana is still illegal here. And the federal government considers marijuana to be a Schedule I drug, and thus illegal even in states which allow it to be used in any form.

The public perception is that marijuana is safe, though the facts prove quite otherwise. In the short-term, marijuana impairs memory, motor coordination and judgment. With long-term use, marijuana can cause addiction, chronic bronchitis, diminished lifetime achievement, cognitive impairment, depression, anxiety, apathy and progression to other drugs. For those who use it during adolescence, there is a greater risk of dropping out of school, abnormal brain development and developing a chronic psychosis disorder. The number of motor vehicle crashes caused by driver impairment due to marijuana is skyrocketing.

Recreational marijuana has been available in Colorado since 2013. Every year the state studies the impact with a report. The 2018 report states:

  • Yearly traffic deaths involving marijuana increased 151 percent since 2013.
  • The percentage of traffic deaths related to marijuana increased from 11 to 21 percent.
  • Within three years after legalization, the percentage of people who “had used marijuana in the past month” increased 45 percent.
  • Since 2013, marijuana-related ER visits increased 52 percent, while hospitalizations increased 148 percent.
  • The average THC content has risen steadily from 16.4 percent in 2014 to 19.6 percent in 2017. THC is the psychoactive component of marijuana.

(Note: THC percentages are rising everywhere. In the 1970s, THC in marijuana plants averaged 1 to 2 percent. Nationwide, it now averages 13 percent.)

  • The average potency of concentrated extracts increased from 56.6 percent in 2014 to 68.6 percent in 2017.
  • Highway seizures of black-market marijuana have increased 39 percent, and U.S. mail seizures have increased 1,042 percent.
  • Marijuana tax revenue is less than one percent of Colorado’s budget.
  • Violent crime has increased 18.6 percent, and property crime increased 8.3 percent.
  • The price of all forms of marijuana has dropped in half since 2014.
  • As of June 2017, there are 491 retail marijuana stores, compared to 392 Starbucks and 208 McDonald’s.

Regarding that last point, the dispensaries, it is a crying shame to tell you they are clustered in disadvantaged neighborhoods. Whereas 65 percent of local jurisdictions in Colorado have banned marijuana businesses, the poor don’t have the same resources to protect their communities. Ben Cort is a substance abuse treatment consultant and a Colorado resident who has written a rollicking book on the impact of marijuana on his state, Weed, Inc. In his “Social Justice” chapter, he writes, “If there is money to be made selling a vice substance most of it will be made in poor neighborhoods.” In one neighborhood in Denver (which is 70 to 90 percent minority), there is one marijuana shop for every 47 people. This sounds like exploitation of vulnerable people.

Why do I care about Colorado when I live in Louisiana? Because medical marijuana is now legal here, at least technically, and medical marijuana legalization is associated with increased illicit marijuana use as well as increased ER visits for marijuana-intoxicated children. Most importantly, it has proved to be the stepping-stone to legalization of recreational marijuana. Nine states have legalized recreational marijuana.

There are 14 conditions named in Louisiana’s law as potentially treatable with medical marijuana. How many on this list have evidence-based support? Exactly four, although how they are worded in the law is much too broad. One condition is “cancer,” but marijuana has only been shown to help chemotherapy-induced nausea and vomiting. It does nothing for the cancer itself. In fact, marijuana does not cure anything. It is used purely for symptoms.

The three other conditions that have some scientific support (though frankly, it is weak) for treating with marijuana are:

  1. Neuropathic pain
    Note: This is not the same thing as musculoskeletal pain, such as arthritis or fibromyalgia. And even when some pain is reduced in neuropathic pain, people report no change in physical functioning, emotional functioning or quality of life.
  2. Spasticity and bladder spasms in multiple sclerosis
  3. Epilepsy

Note: It is the CBD component, and not THC, which provides some benefit. CBD is not psychoactive.

For none of these conditions would marijuana be a first-line treatment. Since there is no scientific support to use marijuana for the other 10 conditions listed, how did they get on the list? Lobbyists? Just because a medical condition causes emotional or physical suffering, such as autism, HIV/AIDS or Parkinson’s Disease, that is not a good reason to treat it, without any evidence, with a psychoactive substance that has significant potential harms. Shouldn’t the medical profession test medications to make sure they are beneficial and safe before they are released for use? I think we are going about this process backwards.

Chances are good that your state is among the 34 that have approved medical marijuana. Seeing what “treatable conditions” are on your state’s list may surprise you. Sickle cell disease? PTSD? Alzheimer’s? ALS? Autism? Come on, people. There isn’t a shred of evidence that marijuana helps any of these.

I admit I am just sticking my pinky toe into a subject that has massive financial implications. There is a lot of money to be made in the marijuana industry. And unfortunately, the public perception—that marijuana is benign—is at odds with the mounting evidence that it is anything but. What grips my heart is that the poor and disadvantaged will be disproportionately harmed. But those of us who care about justice can speak out, remembering this proverb, “The good-hearted understand what it’s like to be poor; the hardhearted haven’t the faintest idea” (Proverbs 29:7, MSG).

Amy Givler, MD

About Amy Givler, MD

Amy Givler is a family physician in Monroe, Louisiana. She and her husband Don met in 1980 at a CMDA student event her first year of medical school, and they have both been active members of CMDA ever since. Amy graduated from Wellesley College and Georgetown University School of Medicine, and she then completed her family medicine residency at the same indigent-care hospital where she now works part time. She also works at an urgent-care clinic and is the medical director for a Shots for Tots clinic. Amy loves to write and has written many articles and one book, Hope in the Face of Cancer: A Survival Guide for the Journey You Did Not Choose. She and Don have a heart for missions, and hope to do more short-term trips now that their three children have launched from the nest.


  1. Avatar Bishop Reuben Keya Lubanga on May 23, 2019 at 1:25 pm

    I Have had the humble privilege of hosting Amy and Don as a couple on a medical mission in my home in Kenya Africa. Her love for people and generosity towards the needy and sick is quite disarming. The period we have stayed with Amy will remain unforgettable in our hearts and minds.

  2. Avatar Jeffrey Vrielink, M.D. on June 3, 2019 at 2:05 pm

    I have long known that Marijuana does something for Bipolar symptoms, as many of my patients have used it to self-medicate their symptoms (racing thoughts, irritability, and insomnia). I still tell them that I don’t recommend it. The long term negative effects by far outweigh any perceived benefits.

    Last year Michigan residents voted to legalize Marijuana in our state…and unfortunately it passed. I wish people would use their brain more than their emotions to guide their decisions and votes. Just because something in now legal doesn’t make it right. In our pluralistic society with its shifting values we will see a lot of things become acceptable and popular, that years ago would make us cringe.

    In years past it was alcohol, then abortion, now marijuana. When I was in high school in the early 80’s parents still had rights. Now minors can get contraceptives, condoms, HIV testing, and treatment of STD’s etc. without parental consent. It seems that now anything goes. Where will this nonsense stop? Sex reassignment surgery for minors? Physician Assisted Suicide? We are on a slippery slope. I no longer say God bless America, but “God have MERCY on America.”

  3. Avatar Frank Bryant MD on June 3, 2019 at 5:30 pm

    Amy, Hope you are well. I agree with your thoughts on medical marijuana. I get asked about it on a regular basis. I tell my patients I do not prescribe it. Regards to don.

    Frank Bryant MD

    • Avatar Frank Bryant on June 3, 2019 at 5:31 pm

      Don. Ooops.


  4. Avatar Jon on June 5, 2019 at 8:21 pm

    Thank God that states are finally legalizing marijuana and I’m so glad my Dr. Is not as narrow minded as this article. Marijuana has shown to be of no aid in PTSD and since when is helping cancer symptoms such as nauseau and appetite not a medical use? I could go on but i’m pretty you have already made up your mind. One last thing though, let’s not confuse the fact that because some people will abuse any and everything including marijuana, that doesn’t prove that their are no valid uses for those that aren’t interested in abusing the drug.

    • Avatar C T Harris on August 23, 2020 at 7:45 pm

      Amen Jon.
      I bet these Dr.s that are anti-cannabis probably have written Rx for Opiods, Benzos, etc. which EACH kill more people and ruin more lives than all the cannabis in the world. Yet since the Dr.s and big Pharma don’t make $$$ on cannabis, but do make money on Big Pharma’s poison, they seem to be able to ignore the fatalities and harm caused by them.
      I do agree that Recreational Cannabis is getting very far from ‘natural’ in its THC content, but traditional cannabis (2-7% THC) and its sister hemp (<0.3% THC) have helped many people, not only over time going back to before Christ appeared the first time, but yet still today.
      Thank God for President Trump and the Congress's Christmas miracle in 2018 in the form of the Agriculture Improvement Act of 2018 which takes politicized and unhumbled Dr's like AMy Givler out of the equation when purchasing Hemp NATION WIDE and for those state representatives who have or are trying to legalize recreational cannabis so the Dr.s are out of that also.
      A good Dr knows they are a tool of God held by his hand, not the very hand of God themselves. There are too few good Dr's getting their voices heard as they are too busy helping people to write articles and blog posts.

  5. Avatar Laura Chandler on November 25, 2019 at 7:24 am

    I as a psychotherapist disagree and substance abuse counselor. Actually marijuana is helpful in treating PTSD and anxiety. Dr. Dorfman (psychiatrist) prescribed it to patients for this reason. It actually safer to take than many of the psychiatric drugs on the market. However, I don’t advocate street marijuana since it has a lot of pesticides and higher THC. I also believe that your medical opinion is extremely biased due to your religious beliefs.

  6. Avatar CBD for sleep on January 20, 2020 at 9:37 am

    With a national stigma surrounding the potential harms and implication of cannabis use as a gateway drug to other substances transitioning from a vilified substance to one with therapeutic merits has been controversial.

  7. Avatar Jessica on May 16, 2020 at 11:57 pm

    I am saddened to see how the Flexner Report of 1910 has seemingly influenced medicine to this day. As Christians, the promise we have of food and healing is found in a plant. This particular plant works in relationship to the Endocannabinoid System, a master regulatory system providing homeostasis for the body and brain. So why is it more conceivable to believe in a shot program- one that has from the beginning relied on aborted fetal tissue (the first polio & chickenpox vaccines were created using tissue from the scapula of a 3 month old fetus; the cell line used in the mumps vaccine used 83 elective aborted fetuses). We were sold on the belief that chemical and synthetic medications are superior to what was found in nature, with the help of Rockefeller Medicine. Are medical schools even teaching about the Endocannabinoid system? There are thousands of studies on Pub Med showing that cannabis is beneficial for conditions related to oxidative stress, which is just about every condition. So why as a healer would you deny your patients healing from a plant & only give them patented pharmaceuticals?

  8. Avatar on June 24, 2020 at 6:14 am

    As more states continue to vote for recreational marijuana laws and laws in current states go into effect, the requirements of sellers will continue to change. There for the need for ID Cards increases!

  9. Avatar kryptolights on October 1, 2020 at 1:07 pm

    Germicidal actinic ray is acknowledged as a good suggests that of deactivating bacterium and bound viruses. It is, however, probably harmful to humans. The spectral vary of 200-280 nanometers, conjointly referred to as UV-C, was till recently believed to be unworkable as a steriliser once folks actively occupied a space. because of studies completed by Dr. David Brenner and his team at Columbia University, additional analysis is proving that the ranges of 207nm to 230 nm, or “Far-UV” isn’t harmful to humans.

  10. Avatar Angela Evans on November 29, 2020 at 5:57 pm

    A different view: As a Christian, I was against Marijuana because I thought it was wrong and having tried it in teenager years, it never appealed to me
    However status post, multiple traumas, Diagnosed with PTSD, Anxiety and Depression, I have changed my thoughts. Since using Medical Marijuana, I feel the best I have in 40 years. The couch was my resting place the past 5 years. It now has an obvious concave to it. I never got off it Other than to eat and visit my grandchildren once a week. Then bring on Covid-19 and I am crying and wanting to be dead. Prayed but could not connect. Against my better(?)judgment and out of desperation I applied and was given the opportunity to use MM as therapy. Now I am energetic, happy and have been able to connect with the creator of the universe.
    “I haven’t the time for the pain.” now because I am busy reading, studying and creating. So think again and prescribe it cautiously.

  11. Avatar Ernest on May 9, 2021 at 3:43 pm

    I don’t smoke or use it but when your offerd hard core meds for pain that can affect your liver then you can say how you really feel people are to quick to point out all the negatives but if your lying on your back in chronic pain you can get out because it’s debilitating then answer me this will you feel the same way I’ve been in the er 6 times countless doctors different diagnosis I’m pretty much always in pain one pain med is very addictive the other one don’t work so answer me this is pain is all your feeling or concentrating on do you really care about all the other things you mentioned I’m a former law enforcement professional that was totally against marijuana but not anymore I’m not going to watch someone I love suffer because of what people think and God knows our hearts

  12. Avatar on June 15, 2021 at 3:59 pm

    A lot of people hate work. Not just the effort it requires, but the whole concept. I used to count myself among them. Work was something to be minimized, and eventually eliminated through the attainment of wealth. But now that I’m older and I’ve been through a lot more, and I’ve had the opportunity to get the perspectives of others, my view of work has changed. I’m now convinced that work is a gift from God.

  13. Avatar on June 15, 2021 at 4:00 pm

    That may seem counter-intuitive. But that’s something else I’ve learned – that God’s way generally is counter-intuitive. We often say “God works in mysterious ways”, and I suspect that this counter-intuitiveness is part of that. Whatever we think to be correct, God has another plan. And so it is with work.

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