Why are doctors generally reluctant to prescribe Marinol yet more than willing to prescribe opioids or benzos?

Question

Marinol is a physically non-toxic Schedule III (CIII) drug that can be prescribed for virtually anything a doctor feels that it might be appropriate for, yet most doctors seem reluctant to prescribe it until all other treatment options have failed (if at all).

These other treatment options are almost in all cases more physically toxic than is either Marinol or cannabis itself, so it can't be because they're afraid of bodily harm.

Opioid drugs, benzodiazepines, and many other drugs are severely physically addictive (whereas Marinol is not) and they're prescribed routinely, so it can't be because they're afraid of addiction.

What gives with modern medicine? Why are we ignoring such a seemingly useful, yet benign substance?

Answer 1

Marinol (dronabinol) has caused dependence in those given high doses over a prolonged period. Although it is relatively nontoxic, people have experienced side effects severe enough to halt use. The real problem stems from fear of abuse or misuse by the patient, including use by people other than the patient. This is rare, but it happens. Most physicians have little experience in fully understanding addiction and even less experience with the use of Marinol as a legitimate therapy. Bottom line - fear and ignorance.

In 31 years, I've had only two patients prescribed this drug. Go figure. Prejudice about the use of any cannabis-related drug stems back to the 1930s and the first U.S. federal "drug czar" - Harry Anslinger. Anslinger was instrumental in the now cult film "Reefer Madness." Much of the misinformation about marijuana stems from his tireless work. Unfortunately, our federal government (especially law inforcement and the judiciary) is not ready for another legal intoxicant, regardless of its potential benefit. They want people to suffer.

Rick the Pharmacist

Answer 2

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Answer 3

Doctors vary widely in their prescribing practices. My primary physician actually became slightly angry when I suggested Vicodin for coccygeal pain - saying he only prescribed it for broken bones etc., and that my tailbone was not broken. Another physician gave me a quantity of 50 7.5-500s of Vicodin with 0 refills for the same chief complaint, but this physician would never prescribe a benzo, while the first doctor I mentioned has had me on Xanax and Klonopin simultaneously.
Switching gears....
I had very bad vomiting when I was a senior in high school. Doctors diagnosed me with Cyclic Vomiting- which is an exclusionary diagnosis really. At any rate, back then they tried Reglan, Phenergan, Compazine, Zofran, etc. and nothing worked. Eventually I was given Marinol, and I found it's anti-emetic effects to be only slightly better than the others mentioned. I simply had to wait out the vomiting episodes while on an I.V. At any rate, I ALWAYS found the anti-emetic effects of smoked weed much more efficacious than Marinol. My doctors never prescribed me marijuana (I live in Texas, what do you expect?) But one gastroenterologist did give me "under the table" advice about weed....It worked for me.
Marinol did not. Just giving an anecdote here.

Answer 4

Few reasons.. 1) DEA -- Drug Enforcement Agency audits and pressures doctors prescribing habits,.. Which has often lead to doctors being suspended, or losing their ability to practice medicine at times. (This is a scary proposition for anyone). 2) Media -- Television , Newspapers, Magazines, Internet, etc has demonized and spread only the worst case scenarios with these types of medications.. you never hear of how they are helping people in major pain, or helping a person who formerly was making D's and F's making A's and B's and get through college and be successful, etc. 3) General Stigma -- Along with the media, people like to talk about these medications as 'evil' and doctors are not immune to this. They get it in their head as well that only serious cases need these medications.. etc. While they are prescribing psychoactive SSRI/SNRI's left and right which is potentially more dangerous. 4) Addiction potential -- These drugs/medications have the ability to produce euphoria, or some 'benefit'. Even if it isn't a euphoria often people are relieved of PAIN (which makes it a strong attraction) -- or they are incredibly , suicidally anxious and a benzodiazpeine changes their lives.. so immediate attraction..) -- And so on. Most of the world could tell you , accurately, the real difference in dependence and addiction. 5) Along with that last statement, LACK of education .. PROPER education of these types of 'demonized' stereotyped medications to the doctors, and general public. To educate on how to safely take them , what to look for to stay OUT of trouble, and to LESSEN the imbalanced negative perspective that has been placed upon them. The list goes on and on really.. but the fact is, anything that gives someone a 'beneficial' effect is just unnacceptable in mainstream society. God forbid someone feels a little euphoria or relief. I don't see it changing,.. unless the "War on Drugs" starts to leave Doctors and regular LEGAL prescription medications alone! If the War on Drugs focused on Illegal drugs.. not only would more benefit be derived (vastly) -- but doctors would be better able to treat patients without the FEAR of their licensed being revoked. When you think about it, officers, media, government officials, and so on are *practicing medicine* indirectly through these tactics. They do so because they are dictating what a doctor can and cannot do with their only arsenal/tools -- which are medications. Usually the most effective of these 'tools', are the ones you mention. It is a tough one, and again, if the DEA backed off and the Media had a campaign to raise equal and fair/balanced awareness about these medications and the real people behind them the western world would not stereotype and demonize them (the medicine and people) so. Good question,

Answer 5

It takes over one hour for Marinol to reach full effect, compared to minutes for smoked or vaporized cannabis. Some patients accustomed to inhaling just enough cannabis smoke to manage symptoms have complained of too-intense intoxication via Marinol's predetermined dosages. This powerful psychoactive effect, however, has led to recreational use of Marinol. Marinol produces a more acute psychedelic effect than cannabis and that`s why it`s not advised

Answer 6

Because you wont become addicted to Marinol or overdose on it. Opioids and Benzo's are highly addictive and keep you coming back for more. Much like tobacco companies, pharmaceutical companies are murderers with tight fist's arround the Doctors throat and smile at the thought of small chidren accidently injesting large amounts of their highly addictive and deadly drugs. They consider themselves above the cartel using doctors as legal drug dealers to sell their products.

Answer 7

Marinol is an anti-nausea drug, but it is not a first line drug. There are many good first line drugs.

Doctors don't just treat you. They treat many patients and develop a feel for what works and what doesn't.

May be this link will help you.

http://www.nccn.org/patients/patient_gls/_english/_nausea_and_vomiting/4_treatment.asp

Answer 8

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