Why Cleveland Clinic Won’t Recommend ‘Medical Marijuana’ for Patients

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Terri Zupancic, 216.312.4021  

By Paul Terpeluk, D.O.
Medical Director of Cleveland Clinic’s Employee Health Services

On Sept. 8, Ohio law began permitting state-licensed dispensaries to sell marijuana to treat a specific set of health conditions, with a doctor’s recommendation. We at Cleveland Clinic, however, will not be recommending “medical marijuana” for our patients.

At Cleveland Clinic, we believe there are better alternatives.

In the world of healthcare, a medication is a drug that has endured extensive clinical trials, public hearings and approval by the U.S. Food & Drug Administration (FDA). Medications are tested for safety and efficacy. They are closely regulated, from production to distribution. They are accurately dosed, down to the milligram.

Medical marijuana is none of those things.

The Ohio law allows marijuana to be dispensed for 21 specific health conditions, including AIDS, cancer, epilepsy, MS, severe or intractable pain, and ulcerative colitis, to name a few.

Rather than relying on marijuana, we – governments, regulators, medical researchers and pharmaceutical companies – need to focus on research that isolates specific compounds found in marijuana, produces a dose-specific medication, and submits it to testing and regulatory processes.

Such FDA-approved products are already available – most recently for epilepsy – and more are in various stages of research and development.

In June, the FDA approved Epidiolex for treatment of seizures in two rare forms of severe childhood-onset epilepsy. It is the first FDA-approved drug to contain a purified compound – cannabidiol (CBD) – derived from marijuana. Previously, the FDA had approved dronabinol and nabilone, both of which contain synthetic versions of tetrahydrocannabinol (THC) to treat chemotherapy-related nausea and to increase appetite in patients with AIDS.

To be clear, there is a difference between medications and “medical marijuana” in the popular sense of the term.  In 2017, the NIH supported 330 projects totaling almost $140 million on cannabinoid research.

These are the types of marijuana-derived medicines Cleveland Clinic supports and prescribes. Unfortunately, that’s not what will be sold through dispensaries.  Products such as vaporizers, edibles, oils, tinctures and patches all lack uniform dosing specificity. The levels of THC or CBD can differ greatly from one dispensary to another or one batch to another. By contrast, an FDA-approved medication offers uniformity; a medication bought in Cleveland today will be the same medication bought in Cincinnati or Denver or San Francisco a year from now.

The federal and Ohio governments should support drug development programs that scientifically evaluate the active ingredients found in marijuana that can lead to important medical therapies.

Patients deserve to know that whatever they are using to control their symptoms is safe and effective. And clinicians need to have confidence that a treatment will work as intended. As a healthcare provider our goal is to help patients, to treat their conditions, to improve their quality of life and to ease their suffering – within the bounds of scientific evidence.

About Cleveland Clinic
Cleveland Clinic is a nonprofit multispecialty academic medical center that integrates clinical and hospital care with research and education. Located in Cleveland, Ohio, it was founded in 1921 by four renowned physicians with a vision of providing outstanding patient care based upon the principles of cooperation, compassion and innovation. Cleveland Clinic has pioneered many medical breakthroughs, including coronary artery bypass surgery and the first face transplant in the United States. U.S. News & World Report consistently names Cleveland Clinic as one of the nation’s best hospitals in its annual “America’s Best Hospitals” survey. Among Cleveland Clinic’s 52,000 employees are more than 3,600 full-time salaried physicians and researchers and 14,000 nurses, representing 140 medical specialties and subspecialties. Cleveland Clinic’s health system includes a 165-acre main campus near downtown Cleveland, 11 regional hospitals, more than 150 northern Ohio outpatient locations – including 18 full-service family health centers and three health and wellness centers – and locations in Weston, Fla.; Las Vegas, Nev.; Toronto, Canada; Abu Dhabi, UAE; and London, England. In 2017, there were 7.6 million outpatient visits, 229,000 hospital admissions and 207,000 surgical cases throughout Cleveland Clinic’s health system. Patients came for treatment from every state and 185 countries. Visit us at clevelandclinic.org. Follow us at twitter.com/ClevelandClinic. News and resources available at newsroom.clevelandclinic.org.

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