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Why the Cleveland Clinic Will Not Recommend Medical Marijuana

The healthcare institute cites a lack of both evidence and FDA approval, but supports medications derived from cannabis.

As medical marijuana dispensaries began ringing up sales for the first time in Ohio on January 16, the Cleveland Clinic — one of the largest hospitals in the country — issued an official statement rejecting cannabis use for patients.

“As a group of more than 3,500 doctors at the Cleveland Clinic, we decided that we are not going to recommend medical marijuana, and it is not part of our policy,” says Paul Terpeluk, DO, the medical director of the Cleveland Clinic’s employee health services. “There are no rigorous studies that we are aware of showing that medical marijuana is safe. For a patient, safety should be the first concern, and that’s why we’re raising a red flag.”

In a statement published on the hospital’s website, Dr. Terpeluk explained that cannabis is not approved by the U.S. Food and Drug Administration (FDA), which has a rigorous process for determining the safety and efficacy of medications. Medications green-lighted by the FDA go through extensive trials to establish accurate dosing and to identify side effects.

On the other hand, the Cleveland Clinic does prescribe FDA-approved medications that are based on specific marijuana compounds called cannabinoids. One such drug, Marinol, contains a cannabinoid called dronabinol. Dronabinol is a man-made form of tetrahydrocannabinol (THC), the main psychoactive ingredient in marijuana. Cancer and AIDs patients may take Marinol to stimulate appetite, reduce nausea, and relieve neuropathic pain.

In June 2018, the FDA for the first time authorized the use of a drug containing a purified extract from marijuana. This treatment for two rare forms of epilepsy, called Epidiolex, contains cannabidiol (CBD), a nonintoxicating cannabinoid extracted from the marijuana plant.

Terpeluk notes that more marijuana-based medications are in development, and the Clinic supports drug research programs that “scientifically evaluate the active ingredients found in marijuana that can lead to important medical therapies.”

In 2017, the National Institutes of Health funded 330 cannabinoid research projects, totaling almost $140 million.

Medical Marijuana on the Rise

While the number of states now selling medical cannabis has climbed to 33 (plus the District of Columbia), state approval of medical marijuana bypasses the type of thorough review process that the FDA enforces, according to Terpeluk.

In these states, healthcare providers must “certify” patient use, and the cannabis can be given only to treat specific health conditions, including AIDS, cancer, epilepsy, multiple sclerosis, severe or intractable pain, and ulcerative colitis.

Diana Martins-Welch, MD, an attending physician in palliative medicine at Northwell Health in Long Island, New York, has certified more than 700 patients to receive medical marijuana.

“When I am certifying a patient, I am stating that I have evaluated him or her, and they meet the criteria under my state’s medical marijuana laws,” she says. “We are not allowed to say that we’re prescribing it, because we can’t ‘prescribe’ a federally illegal medication.”

Dr. Martins-Welch did not start out as an avid proponent of cannabis. “In fact I was probably on the other side of the fence,” she says, “but the more I kept an open mind and saw what medical marijuana was doing for people, I couldn’t ignore it. It was helping people so much in multiple aspects.”

Stage 4 cancer patients often experience a dramatic loss of appetite. When treating these individuals with cannabis oil, Martins-Welch noticed a significant improvement in their quality of life. “Their appetite opens up,” she says. “They’re eating, they’re spending time with family at the dinner table, and they’re really happy because of that.”

She finds that the synthetic FDA-approved medications do not get the same results, causing her patients to become more sedated.

While the Cleveland Clinic warns that vaporizers, edibles, oils, tinctures, and patches lack uniform dosing specificity, Martins-Welch says that she’s able to titrate (measure) the right dose of cannabis oil for her patients.

She agrees that more study is needed to better understand the potential health benefits of marijuana and that patient well-being and treatment results are of the utmost importance.

“Patients deserve to know that whatever they are using to control their symptoms is safe and effective,” stated Terpeluk on the Cleveland Clinic site.

As medical marijuana dispensaries began ringing up sales for the first time in Ohio on January 16, the Cleveland Clinic—one of the largest hospitals in the country—issued an official statement rejecting cannabis use for patients.

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

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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.

Editor’s Note: Cleveland Clinic News Service is available to provide broadcast-quality interviews and B-roll upon request.

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 … <a class="moretag" href="https://newsroom.clevelandclinic.org/2019/01/10/why-cleveland-clinic-wont-recommend-medical-marijuana-for-patients/">Read More</a>