Gilbert Fanciullo, MD, MS, director of the Pain Management Center and professor of Anesthesiology at the Geisel School of Medicine in Dartmouth, NH, acknowledged that “physicians and the general public are in agreement that marijuana shows promise in combating diverse medical problems.”

However, “little about cannabis is straightforward,” he added. Challenges include that medical and recreational use of marijuana are not two discrete elements: patrons of medical marijuana clinics are three-quarters male and “recreationally familiar” with marijuana. In addition, “doctors and nurses become both healers and scofflaws,” and no evidence-based guidelines exist for marijuana’s risks, benefits, risk stratification, dosage, use at work, use when driving, use in pregnancy, or for monitoring.

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RELATED: Most Clinicians Support Use of Medicinal Marijuana

Marijuana is known to have neurological, affective, and cardiovascular effects, and some studies have linked its use to lung cancer and head and neck squamous cell cancer; however, long-term effects remain unknown.5

Dr. Fanciullo urged prescribers of marijuana to “use prudence, shared decision making, and caution.”

Three states have legislation pending and two, Colorado and Washington, have legalized the use of recreational marijuana (see Table).2

Table. Status of Medical and Recreational Marijuana in the United States2

Legalized Medical Marijuana Legislation/Ballot Measures Pending to Legalize Medical Marijuana Legalized Recreational Use of Marijuana
Alaska Florida Colorado
Arizona Pennsylvania Washington
California Ohio
District of Columbia
New Hampshire
New Jersey
New Mexico
New York
Rhode Island


  1. Joy JE, Watson SJ Jr, Benson JA Jr. eds. Marijuana and Medicine: Assessing the Science Base. Washington, DC: Division of Neuroscience and Behavioral Health, Institute of Medicine, National Academy Press; 1999.
  2. 23 legal medical marijuana states and DC: laws, fees, and possession limits. Available at: Last Updated: September 31, 2014. Accessed: October 14, 2014.
  3. Doblin RE, Kleiman MA. Marijuana as antiemetic medicine: a survey of oncologists’ experiences and attitudes. J Clin Oncol. 1991; 9(7):1314-1319.
  4. American Cancer Society. Marijuana. Available at: herbsvitaminsandminerals/marijuana. Updated: August 26, 2014. Accessed October 14, 2014.
  5. National Cancer Institute: PDQ® Cannabis and Cannabinoids. Bethesda, MD: National Cancer
    Institute. Date last modified May 13, 2014. Available at: Accessed October 15, 2014.