The MJ Scam

Here is a very interesting guest commentary by Gregory W. Rutecki MD in a recent Consultant magazine:

 

Fibromyalgia, or for that matter many chronic pain syndromes, are not uncommon in primary care. In the case of fibromyalgia, there is no ideal treatment. Patients with the diagnosis therefore may choose to seek pain relief from non-medical sources. One drug sought after is marijuana. A recent study looked at red flags generated by marijuana use in this particular cohort.1

DISTURBING ASSOCIATIONS WITH CANNABIS USE

Four hundred and fifty-seven patients with fibromyalgia were asked to report self-medication with marijuana, and 13% said they were using it. This figure is consistent with a previous study that verified use by urine drug screens.

American College of Rheumatology criteria were applied to document the diagnosis of fibromyalgia. A psychologist evaluated all patients. Opioid-seeking behavior was identified according to validated criteria. A number of disturbing associations were demonstrated with cannabis use that might inform primary care practitioners about potentially serious problems.

•The cannabis group had a significantly higher incidence of unstable mental illness. There are data to suggest that cannabis use may exacerbate or precipitate psychiatric disease.

•Opioid drug-seeking behavior was more common in the group using cannabis.

•The unemployment rate of 77% in the cannabis cohort suggests either the absence of any favorable effects of cannabis on the disease or more serious functional impairments in the users.

•The risks associated with the combination of cannabis and other pharmacological treatments are unknown and may be serious.

•The diagnosis of fibromyalgia was incorrect in one-third of the patients in this study group.

•Since one-third of the entrants did not have fibro-myalgia at all, some persons may be using the diagnosis dishonestly to justify marijuana use or to request 
narcotics.

IMPLICATIONS FOR PRIMARY CARE PRACTICE

Although the authors themselves identify limitations to their study (it was of small size and was conducted in a tertiary referral center, and the cannabis use was self-reported), the results will change my practice. I will be stricter with my diagnoses of fibromyalgia. I will consider marijuana use as a potential risk factor for other psychi-atric problems. I will also be more wary regarding requests for narcotics in this particular group and will consider urine testing for marijuana metabolites.

 

Isn’t this interesting?  Using a questionable diagnosis like fibromyalgia to obtain questionable treatment like medical marijuana may not be appropriate.  Who would have thunk it?

Douglas Farrago MD

Douglas Farrago MD is a full-time practicing family doc in Forest, Va. He started Forest Direct Primary Care where he takes no insurance and bills patients a monthly fee. He is board certified in the specialty of Family Practice. He is the inventor of a product called the Knee Saver which is currently in the Baseball Hall of Fame. The Knee Saver and its knock-offs are worn by many major league baseball catchers. He is also the inventor of the CryoHelmet used by athletes for head injuries as well as migraine sufferers. Dr. Farrago is the author of four books, two of which are the top two most popular DPC books. From 2001 – 2011, Dr. Farrago was the editor and creator of the Placebo Journal which ran for 10 full years. Described as the Mad Magazine for doctors, he and the Placebo Journal were featured in the Washington Post, US News and World Report, the AP, and the NY Times. Dr. Farrago is also the editor of the blog Authentic Medicine which was born out of concern about where the direction of healthcare is heading and the belief that the wrong people are in charge. This blog has been going daily for more than 15 years Article about Dr. Farrago in Doximity Email Dr. Farrago – [email protected]

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4 Responses

  1. Princess of Problem Patients says:

    *sigh* I really wish more physicians would realize there’s science behind fibromyalgia being a CNS disorder. http://fmaware.org/PageServer06af.html?pagename=fibromyalgia_causes

    I have fibro (and Sjogren’s, endometriosis, familial hypertension, and am a TNBC survivor), and narcotics make me nauseous. I tried pot once and just got sleepy – I had better pain management with a nice Long Island Iced Tea. Please don’t lump everyone with fibro into the same category. We’re not all narc-seekers or potheads. It’s difficult enough to find meds that work at a dosage that’s tolerable, and I know several with fibro who stockpile opioids if/when possible *because of* narc-seekers and being lumped into the same category of “not really needing it” by doctors.

    That said, “Responsible Opioid Prescribing: A Clinician’s Guide” is a good resource for physicians. http://www.fsmb.org/pain-overview.html

  2. M. Craig Pinsker, M.D., Ph.D says:

    On the other hand:
    How do we know that the diagnosis of fibromyalgia was incorrect? What exactly are the diagnostic criteria that we can all agree upon? There is no lab test. There is no known pathogen to isolate. Can anyone prove that much of what we see are not somatic representations of a psychiatric disease?
    I had one patient who said that he no longer needed gabapentin, or opiates because he started smoking up to 4 joints a day. Should I have insisted on his taking my prescribed meds?

  3. Kurt says:

    Just say no. The benefits are dubious, they dont’ have a quantitative test to bust those driving under the influence and every
    doper will be clogging one’s office faking “legitimate” illnesses to
    get the pot. I’m sorry, I could see very limited use for compassionate situations in the past but now they are trying to justify its use to treat pimples and I’m not buying it. I never saw whopping doses of Marinol do anybody any good anyway.

  4. W. Rabbit says:

    Addiction is always a tough thing to tackle. On the one hand you want to prevent people abusing prescription drugs, on the other, what if someone who does abuse drugs really have the disease and need the drug? And then again, how can you tell one from the other if the disease cannot be definitively diagnosed.

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