Another seriously false misconception is that smoking marijuana is less dangerous than smoking tobacco. Physiologically, there is no reason to believe that inhaling the hot smoke from any dried plant should be more or less prone to cause lung disease. One long-term study, published in JAMA in 2012, purported that smoking marijuana was less likely to cause COPD than smoking tobacco and actually compared marijuana smokers with tobacco smokers who smoked more than 40 times as many cigarettes per day. When marijuana smokers were compared with tobacco smokers who smoked roughly similar numbers of cigarettes per day, there was no significant safety benefit for persons who smoked either substance.
Physicians can obtain guidance on how to minimize the medical and legal risks of prescribing opioids for treating pain from pain experts and from an excellent free publication by the California Medical Board titled “Guidelines for Prescribing Controlled Substances for Pain” (bit.ly/MBC-pain-guidelines).
David Louis Keller, MD, FACP
Separating ‘errors’ from opinions regarding medical marijuana use
Thanks to Dr. Keller for voicing his opinion in regards to my article, “5 reasons physicians should choose marijuana over opioids” (bit.ly/Kaplan-marijuana). While productive discourse is always welcome, stating there are “serious errors” in my article is disingenuous. My citations, to name just a few, include the National Cancer Institutes and JAMA. I gladly and confidently stand behind their credentials.
Certainly anyone can find articles and sources to contradict another author’s argument. It’s ultimately up to the reader to weigh the preponderance of evidence in each argument. I will admit that Keller is well versed in stating his opinion, as he has done so in 226 other “letters to the editor” to various publications (I checked Google). I do not deny his passion, nor his research. But his opinion, based on his research, is still just that: an opinion.
As for the issue of state legalization vs. federal legalization, there is no argument here. Federal law still rules marijuana as illegal. However, as to my point, consumers are using marijuana for medical and recreational purposes in those states where it is allowed. And while U.S. Attorney General Jeff Sessions once said, “Good people don’t smoke marijuana,” it’s unclear if he will move to enforce federal law on this issue.
Ultimately, there is more than anecdotal evidence that marijuana has helped many patients with their pain associated with surgery or during cancer treatment. And I welcome their adamant defense of this alternative to opioids in subsequent letters to the editor or in the comments section of the blog.
Jonathan Kaplan MD, MPH
San Francisco, California