Doctor Debates Medicinal Marijuana

Dr. Luther Quarles.
Dr. Luther Quarles.

By Gianna Volpe

Long Island became home to two of New York’s first legal medical marijuana dispensaries this January, with Columbia Care opening in Riverhead offering its services under state law to those facing cancer, epilepsy, inflammatory bowel disease, HIV/AIDS, amyotrophic lateral sclerosis (ALS), Parkinson’s disease, neuropathy and Huntington’s disease. Under the law, patients must have a prescription and can only gain access to liquid, vapor or pill forms of the drug – smokable marijuana is not legal under current New York law. Dr. Luther Quarles, a resident at Southampton Hospital, weighed in on the subject.

What has your experience been with medical marijuana?

I’ve met more people who have obtained it illegitimately, but they’ve used it for nausea or other [medicinal] purposes such as pain. I’ve heard arguments of people using it for seizures, but I personally haven’t seen that or seen the data behind that.

We use a version of it here [at Southampton Hospital] called Dronabinol or Marinol for patients who are older, need to eat and have good gastro-intestinal systems, but aren’t eating because they’re not hungry. Using what the gut — or the body — has is much better than using an IV or tube feeds, so we give them the Marinol to get the appetite going. That seems to promote wound healing and nutritional status overall, so they’ll generally do better and heal better. That’s been my limited experience with it.

What are the pros and cons to its user?

It has good appetite stimulation and anti-nausea/vomiting benefits for people going through chemo, but is really hard to regulate because different states have different levels of regulation. So there are logistical issues, but it’s also not controlled because there are so many different types — or strains — which is more what [a clinician] would worry about. When you take an aspirin, well, an aspirin is an aspirin is an aspirin; but the marijuana you get from “place A” and “place B” can be different. If it were a national FDA-regulated substance then I think we could say sure, but we don’t have that yet.

It hasn’t been properly vetted and carries a social stigma, as well as the fact that it’s still considered illegal. That’s where the problem lies — in having the ability to do that type of research in a legitimate setting without the legal ramifications.

Where do you stand on the subject?

In my opinion, if [medicinal marijuana] could be properly vetted, studied and regulated so you know you’re getting what you’re paying for, then I think there might be some benefit to it, but I don’t know enough about the data overall to say, ‘Yeah I’m 100% for or 100% against it.’ Right now I’m kind of caught in the middle because there’s so many different sources of data I’m trying to vet through that it’s hard to even have this discussion. It’s not like something I can pull up and say, ‘Lipitor is a good drug that lowers your cholesterol or cardiac risk.’ I can’t do that with marijuana because every strain is different and gives a different effect.

What does a dispensary opening in Riverhead say to you as a clinician?

I think it says there’s been some progressiveness in the thought of using marijuana as medicine, though you always worry about people misusing it the way people misuse Percocet or oxycodone.

Is medical marijuana a better option for treating pain considering the addiction risks inherent to using opiates?

We [doctors] need to use our best clinical judgment to do what’s best for the patient, so I would most likely go with the oxycodone because as a clinician I have a better understanding of it and the data behind it. When it comes to a medical marijuana dispensary, I don’t really know the strains of marijuana there, who is supplying them, etc. You use what you’re familiar with and what you know works and most of the data says there really hasn’t been a benefit to using [Percocet or oxycodone] outside of two to four weeks—it’s good for that acute ‘get you over the hump’ pain or ‘you just had surgery’ pain. So the person with a broken arm may just need the Percocet to get through those first few day, though some people—like cancer patients with bone metastasis—may need it on a longer term basis. Treating pain does get difficult though because pain is so subjective, so we just need to use our best clinical judgment when it comes to do what’s best for a patient.