With a rising number of patients seeking a prescription for marijuana, clinicians are increasingly faced with the dilemma of prescribing a treatment that lacks support or recommending patients not use a medicine that could benefit them in the long-run.

Most, out of caution, end up choosing the second option.

"It's understandable that physicians might be reluctant to prescribe cannabis, because there is not a great deal of evidence about its effectiveness for many of the conditions we'd like to use it for, or about its safety," says Dr. David Juurlink, who heads the division of clinical pharmacology and toxicology at Sunnybrooke Health Sciences Centre, a University of Toronto teaching hospital.

"It's understandable that physicians might be reluctant"

But deciding not to prescribe marijuana may not be erring on the side of caution, he says.

Indeed, despite a lack of evidence for cannabis, there also isn't much evidence against it. At least compared to the variety of potent pharmaceuticals commonly prescribed for pain.

"We consider them evidence-based therapies, but they really haven't been studied and documented for many patients in a way that shows that their benefits offset their risks," notes Dr. Juurlink.

"All drugs have toxicities, whether they are plant based or come from pharmacies. It's the case that the direct toxicities of drugs for pain — like Oxycontin or Fentanyl or anti-inflammatory drugs — are simply much greater than the toxicities of cannabis."

Patients who suffer from severe pain are often treated with opioid-based medicines and non-steroidal anti-inflammatory drugs (NSAIDs). But the dangers of these drugs have become increasingly apparent and experts are urging for an end to their loose prescribing.

Recent data ranks Canada as the second highest per-capita consumer of prescription opioids, second only to the U.S. In Ontario, the rate of opioid-related deaths doubled between 1992 and 2010, now totaling about 550 deaths a year.

"You can make a case to prescribe cannabis"

NSAIDs, while less acutely fatal, are known to cause intestinal bleeding and kidney problems when taken too regularly.

But can medical marijuana be safely prescribed as an alternative to painkillers? Dr. Juurlink seems to think so.

"I think the point that physicians, and perhaps patients, can take away is that you can make a case to prescribe cannabis to select patients. Especially when the patient tells you that it works for them and when prescribing it allows the patient to reduce their use of other noxious drugs."

Source: LeafScience