An Open Letter to DEA Chief Chuck Rosenberg: Don't Resign (Yet)

Two years ago I thought medical marijuana was a joke too. I figured it offered no real medical benefits, and that it was just a way to get high legally. My (re)education started in my work as a palliative care physician.
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medical marijuana and a doctor's prescription
medical marijuana and a doctor's prescription

Dear Mr. Rosenberg:

When I heard you say recently that you thought medical marijuana was a "joke," I didn't know whether to laugh or cry. But I knew then what I think you're beginning to figure out now, which is that saying something like that gets you in a whole heap of trouble.

As I think you've realized, those opinions are direct repudiation of the beliefs of all of those people who are using marijuana for medical reasons. (Even the most conservative estimates based on registered users conclude that well over a million people in the U.S. alone are using marijuana medically).

So I'm sorry for what you've been through in the past two weeks. Especially those pesky people (about 100,000 of them) who have signed a petition calling for your resignation. That must be bothering you a bit.

But don't give up. All is not lost, and you could learn to see marijuana differently.

I can say that with confidence because two years ago I thought medical marijuana was a joke too. I figured it offered no real medical benefits, and that it was just a way to get high legally.

My (re)education started in my work as a palliative care physician, when one of my patients asked me whether I thought medical marijuana might help her. The answer I gave her, I'm embarrassed to admit, is pretty much what you told people of United States: Marijuana has no medical benefits. Put simply, I told her that the idea of "medical" marijuana is a joke.

That patient of mine could've walked out of my office to look for another, more open-minded doctor. But, luckily for me, she didn't. Instead she handed me several reprints of randomized controlled trials showing that in fact medical marijuana does offer real medical benefits.

So in that moment I had to admit that my patient knew more than I did about the science of medical marijuana. And I figured if I was that ignorant about marijuana's benefits, then many of my colleagues probably were too. That's when I decided to spend two years researching and writing a book about the medical benefits of marijuana.

In the last two years I've had to admit that I was wrong. Very wrong. (In much the same way, and for the same reasons, that you're wrong now.)

The opinions you're clinging to now are pretty much what I though when I first started writing Stoned: A Doctor's Case for Medical Marijuana. In fact, I'm pretty sure that if you and I had discussed this back then, we would have shared a good laugh about the grand joke of "medical" marijuana.

I've discovered that marijuana does offer benefits. In the past year, I've talked with dozens of experts, patients, and activists. I've slogged through hundreds of studies of marijuana. Along the way, I've graduated from a hard-nosed skepticism to an open-mindedness that I never would have believed possible two years ago. The good news is that you can make the same journey.

So, what have I learned? Does marijuana work?

Well, one thing I've learned is that this isn't the right question to ask.

Does a hammer work? Sure, if you want to pound a nail. But if you want to fix a frozen iPhone, not so much. So whether marijuana "works" depends on what you want it to do.

I can give you one example: Neuropathic pain (pain caused by nerve damage). This is a kind of pain that is difficult to treat, because it doesn't respond well to opioids like morphine. In fact, many of my patients say that opioids just make them feel sick and sleepy, and that they'd rather deal with the pain.

But I was surprised to learn that marijuana seems to be quite effective in treating that kind of pain. (I'm guessing that this is likely to be surprising to you, too.) In fact, there have been several clinical trials of marijuana for the management of neuropathic pain. I'm thinking of a couple of studies as examples, which have used marijuana and/or its component cannabinoids to treat neuropathic pain in AIDS, multiple sclerosis, and diverse causes.

Those are just a few examples, but you get the picture: Medical marijuana isn't a joke. Don't get me wrong: Marijuana isn't a wonder drug. It doesn't do many of the things that its most avid proponents claim. (Prevents Alzheimer's! Cures cancer!) But it probably has more benefits that its most cynical skeptics admit. And it's not a "joke."

Please do take a moment to look up the evidence supporting medical marijuana. As a starting place in your education, you might take a look at this meta analysis that appeared in the Journal of the American Medical Association. The criteria they used were very tough, but even that study admitted some benefits.

Or if you want to entertaining bedtime reading, check out my book, Stoned: A Doctor's Case for Medical Marijuana. Heck, I'll even send you a free copy.

I'm guessing you're still skeptical, and that's fair. I'm still skeptical too, because we need more research. But I think we know enough now for even skeptics like you and me to be able to conclude that for some people -- though certainly not everyone -- medical marijuana might be the best option.

So my advice is to ignore those calls for your resignation, at least for a while. Take some time to learn about the science that's out there, and about the studies that have been done. Maybe you'll end up more open-minded, just as I have, and we'll have a DEA chief who understands what millions of patients are saying about medical marijuana. Then we all win.

David Casarett, MD

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