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Pharmacists Assess Risks And Benefits Of Medical Marijuana


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The landscape is rapidly evolving for medical marijuana laws, and the role of pharmacists in serving patients who use it is complex and changing.

Two experts spoke on what pharmacists should know to help their patients during a session at the American Society of Health-System Pharmacists Midyear Clinical Meeting in Orlando, Florida.


Since California first allowed use of medical marijuana in 1996, 19 other states and the District of Columbia have passed laws to allow it. Connecticut's legislature has gone a step further and reclassified marijuana from a schedule I drug, suggesting no medical benefit, to a schedule II drug.


However, because federal law considers marijuana a schedule I drug, doctors are prevented from prescribing it and pharmacies are prevented from dispensing it.


Pharmacists are left to decipher how they can help their patients legally and effectively. They also have to consider that marijuana can have adverse effects when taken in combination with other drugs, said Laura Borgelt, PharmD, associate professor in clinical pharmacy and family medicine at the University of Colorado in Denver.


"Anytime you're using a CNS depressant, there can be additive depressant effects, so alcohol, benzodiazepines, antihistamines, and narcotics can cause varied interactions."

Medical marijuana can also adversely affect patients with immunosuppression, psychiatric disturbances, and cardiac and respiratory diseases.


In addition, the adverse effects of medical marijuana in young people, whose brains continue to grow into their 20s, must be considered, said Lawrence Cohen, PharmD, associate dean at the University of North Texas College of Pharmacy in Fort Worth. "By using this at an earlier age, you really could interfere with normal brain development," he said.


Positive interactions can include greater pain relief when used in conjunction with opioids, which could lead to a reduction in use. Patients should be made aware of this, he said.

Large clinical trials are needed to explore the benefits and harms of interactions, both doctors said.


Three Ways to Use It

Dr. Borgelt explained that there are 3 ways marijuana can be used. It can be smoked or the vapor can be inhaled, it can be ingested with food or drink, and it can be absorbed through a topical cream or tincture.


Deciding which form is best has fallen to the patients, she said.

"It's kind of following a self-titration model," she said. Whether that's good or bad is being debated across the country.


She noted that if patients are choosing to inhale it, she prefers that they vaporize it instead of smoke it because of the harmful effects of smoking. Eating it can be problematic because it takes longer to feel the effects — possibly several hours — and patients who don't think it's working could ingest another dose, she explained.


Having a pharmacist who can help patients understand the choices and explain that marijuana has grown much more potent over the decades and comes in many different forms is very important, she said.


Pharmacists need to ask the right questions to have those conversations.


"People may be using it as an add-on therapy for things they're already getting, and we need to know," Dr. Cohen said. "You want to make it clear to patients that you want to know about everything they use, not just prescription drugs, but nonprescription drugs and even herbal supplements. There may be interactions that can be clinically significant."



Edited by bobandtorey
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Once simple dispensing mistakes start turning into criminal charges watch how quickly pharmacists start opting out of being cannabis distributors .


I have already talked to a longtime pharmacist in a facebook thread regarding his feelings on this new model he says talk among the other people In the profession they are frightened at the thought of losing their careers if such a mistake occurs and most want nothing to do with the program saying they feel forced into something  by politicians  that they either don't agree with or feel comfortable being part of .

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pharmacists and pharmacies make many errors, including narcotic drug errors, on a daily basis.


theres no way they would deal with a substance, that when convicted of a crime, would rob them permanently of their medical license here in michigan.

Edited by t-pain
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 the reason marijuana hasn't been rescheduled is because no product of whole, raw marijuana has a "currently accepted medical use" in the U.S., which is part of the legal definition of Schedule I defined by the Controlled Substances Act.

By contrast, Schedule II substances have a currently accepted medical use in the U.S. or a currently accepted medical use with severe restrictions (and, like Schedule I drugs, a high potential for abuse).

 regardless of the schedule, any substance may be prescribed by physicians and dispensed by pharmacists only when incorporated into specific FDA-approved products. That is why Schedule II opioid products can be obtained in pharmacies by prescription, but raw opium, despite being in Schedule II, cannot be prescribed.


 The Controlled Substances Act provides a process for rescheduling controlled substances by petitioning the Drug Enforcement Administration. The Act is a federal mandate not state controlled. Two federal agencies, the Drug Enforcement Administration and the Food and Drug Administration, determine which substances are added to or removed from the various schedules.


 there have not been scientific studies, of adequate size and duration, showing that a product comprised of raw, whole marijuana (smoked or vaporized or otherwise ingested) has medicinal value. FDA has never approved crude plant materials as a prescription medicine, partly because there is no way to administer it in defined doses and without any toxic by-products. However, there have been studies showing that components or constituents within marijuana have medical value. This is where many people get confused. That is why both statements "marijuana has no medical value" and "marijuana is a medicine" are both untrue.


OK then why does it say ?  thanks

to a schedule II drug.

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Well, here we go. We are going into the weeds (excuse the pun) over marijuana. They get all worked up over small details and lose sight of the big picture. There has never been one death or seriously adverse side affect associated with marijuana, yet what are the medical professions concerns when it comes to cannabis? Why the possibility that someone will be harmed by marijuana.


Let's end this needless hand wringing and solve all problems in one fell swoop. Make it legal for adults to grow and use marijuana as they see fit. Why do we need the government involved in this at all?

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