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The medical marijuana debate intensifies

In early July, the Drug Enforcement Administration finally answered a nine-year-old petition from medical marijuana advocates asking the government to reclassify marijuana from a Schedule 1 controlled substance.

The DEA denied the petition, saying the drug should retain its classification because it has a high potential for abuse, has no accepted medical use in the United States and lacks an acceptable level of safety for use even under medical supervision.

Even though 16 states and the District of Columbia have legalized or decriminalized medical marijuana and recent polls have found Americans are increasingly in favor of legalization, the federal government considers it a substance on par with heroin or PCP, more harmful than cocaine and methadone.

Given the continued resistance from the government, physicians trying to decide if they should recommend (as a Schedule 1 controlled substance it can't be prescribed) medical marijuana – or become "pot doctors" – have a lot to consider.

Numerous studies have shown marijuana to have some therapeutic value – for instance, stimulating appetite, reducing nausea, easing muscle spasms and numbing pain. Those concerned about the use of marijuana, however, say more studies need to be done and also point to concerns about car accidents and deaths that may happen when drivers are "pot impaired."

Medical associations like the American Nurses Association and the American College of Physicians have publicly recognized the value of medical marijuana. The ACP has declined further comment beyond its 2008 position paper supporting research into the use of therapeutic marijuana.

One of the bigger concerns physicians have about recommending medical marijuana is a fear of losing their license to prescribe.

"Unfortunately, there are a lot of misperceptions out there due in large part to the fact that marijuana is still illegal under federal law," said Kris Hermes, media specialist at Americans for Safe Access, a national member-based organization advocating for safe and legal access to medical marijuana. Doctors often erroneously believe they will lose their license to prescribe if they recommend medical marijuana to their patients, Hermes said, but they are protected under the First Amendment.

"Doctors have little or nothing to fear," said David Bearman, MD, a pain management specialist and co-founder of the American Academy of Cannabinoid Medicine. "(We have) Conant vs. Walters, which says there's something called the First Amendment to the Constitution, which gives us free speech, which means we can give patients whatever advice we want," he said. "We have not given up our right to free speech merely because we're physicians."

Bearman suggests that doctors who are thinking about recommending medical marijuana educate themselves, especially about the science of the endocannabinoid system.

"Grounding yourself in the science is important," he said. "The second thing that's important is to recognize that you really don't have to do anything different than you would for any other medication."

In other words, he said, practice good medicine.