Dr. Stephen Merlin, MD ~ Opinion Editorial

One of the most important precepts in medicine is to “do no harm.” While that may seem self-evident, it is often more complex and nuanced. Take for instance the relief provided to patients through the use of opioid pain killers. Pendulum swings in this treatment approach has landed us in the midst of the deadliest substance use disorder epidemic in our history. I have practiced addiction medicine for almost 32 years with 29 of those years here in South Carolina. I saw the crack cocaine epidemic. I participated in Attorney General Henry McMasters South Carolina Meth Watch Program. Nothing – I repeat NOTHING — has killed like the current pain pill epidemic. Pain pill addiction has birthed the heroin resurgence and its own form of death and destruction. All of this has happened in the context of physicians endeavoring to “do no harm.

To be honest, as of December 2016, I believed in medical marijuana in the way I thought of the tooth fairy. I thought pot is pot and besides, while I felt empathy for those children with rare seizure disorders, I knew nothing about those disorders. This changed completely when I reviewed case studies and received the National Academy of Science-Engineering-Medicine monograph entitled “The Health Effects of Cannabis and Cannabinoids,” which found substantial evidence that cannabis can relieve chronic pain. I am now convinced by medical data, that cannabis can be used to relieve chronic pain as well as these seizure disorders.

Beliefs are hard to change. After all, why let facts get in the way of emotions? So here I sit, an addiction medicine specialist, pondering the consequences of medical cannabis and the precept of “do no harm.

I have come to believe medical cannabis should be allowed because of the clear objective evidence of its efficacy, and because it is so much less dangerous than opioids and many other medications. I support the Compassionate Care Act (S. 212/ H.3531) because these bills have medical safeguards – they stipulate that a legitimate medical doctor with a doctor-patient relationship must issue a recommendation, and thus preventing “pot doctors”. They stipulate conditions for which medical cannabis has been proven to benefit as well. This bill is not a pathway to legalization or a first step towards recreational use. It is a narrowly tailored, state-regulated approach that will ensure safe and legal access for patients with debilitating conditions.

Ideally, there would be no such thing as chronic pain. As a society we are getting older: we survive accidents, cancer, and diabetes longer than ever before. Therefore, we have more people suffering from chronic pain than ever. Continuing the massive overprescribing of opioids will result in a continuance of the current plague. There is conclusive evidence that cannabis is useful in the treatment of chronic pain and evidence from other states concludes that medical marijuana significantly reduces the number of opioid prescriptions. The practice of medicine is full of changes. Providing patients with safer medicine to treat their debilitating pain is the right thing to do. Support science, support patients and support the South Carolina Compassionate Care Act; to do otherwise, is “to do harm.


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