Marijuana sensibilities changing fast: Are you ready for patients’ questions?

April 19, 2023
Public support for marijuana legalization has never been higher in the U.S., but evidence of its clinical utility in glaucoma care remains clouded at best.
Cannabis Bottle and Script

Two-thirds of U.S. adults now express support for marijuana legalization, a complete about-face from 20 years ago, as proponents overwhelmingly cite medical benefits based more on perception than evidence in some cases.

Per survey data published by the Pew Research Center, U.S. public opinion for marijuana legalization is at its highest point ever with 67% favoring legalization as compared to two decades earlier when 63% favored keeping marijuana illegal. Moreover, nearly nine in 10 Americans today believe marijuana should be legalized for medicinal or recreational use with 86% of those in favor of legalization citing perceived medical use.

That public opinion has helped turn laws nationwide with 21 states and Washington, D.C., now legalizing small amounts of marijuana for recreational use and three dozen states legalizing marijuana for medical purposes. Such is the case, nearly three-quarters of the U.S. population live in a locality with medical marijuana allowances. Despite such advances in state legislation, evidence suggests Americans still receive contradictory information regarding medical marijuana’s utility.

Perceptions vs. reality

Unsurprisingly, patient misperceptions about marijuana’s therapeutic value regarding glaucoma care remain a concern. In a study from Ophthalmology Glaucoma, researchers found half of responding dispensaries in Colorado claimed marijuana use was recommended as a glaucoma therapy while the other half deferred or demurred recommendations. This, despite the fact that only 7% of surveyed American Glaucoma Society (AGS) members recommend marijuana as a therapy and only about 3% of surveyed glaucoma patients used the drug therapeutically.

“Few glaucoma specialists have recommended marijuana as a treatment for glaucoma and an even smaller percentage of patients report its use as a treatment for glaucoma,” the authors concluded. “In contrast, many dispensary employees endorse its use. As legal access and public acceptance of marijuana escalates, physicians should be aware of these perceptions when educating patients.”

As doctors of optometry, it’s crucial to be informed about the latest treatments for glaucoma and to help guide patients through their options. It’s essential to approach the topic of marijuana use for glaucoma with sensitivity, as patients may have heard of benefits and be curious about it. However, it’s important to educate patients about the potential risks associated with marijuana use.

The AOA’s position statement pans on marijuana as an effective glaucoma treatment option, concluding:

The use of marijuana (in any form) as a medication to reduce eye pressure in glaucoma is not safe or practical. Marijuana is also not a medication that would reduce the risk of developing glaucoma. There are many medications that are FDA-approved to treat eye pressure that have very few side effects and need only be used once or twice daily in the form of an eye drop or pill. Additionally, there are some laser and surgical procedures that can help reduce eye pressure. These procedures may eliminate or reduce the number of other medications used to treat eye pressure. Glaucoma can be a difficult disease to diagnose and treat. It requires frequent testing of eye pressure, monitoring of visual field loss and optic nerve evaluations.

Ultimately, marijuana as a glaucoma therapy comes down to the fact that its side effects outweigh the medical benefit, says Dan Bintz, O.D., of Oklahoma. The marginal intraocular pressure (IOP) reduction over such a relatively short period of time, combined with the intoxicating effect, ends the story there, he says: “The patient would have to be intoxicated 24 hours per day to get even a marginal decrease in intraocular pressure.”

Dr. Bintz adds: “There has been enough research to know it really isn’t effective. That could change if new research emerges using formulas that could eliminate the undesirable side effects and increase the pressure-lowering ability. But again, there are already many of these medications available with some now available as generics.”

When discussing glaucoma treatment options with patients, it’s important to emphasize adhering to clinically proven treatment options. By being knowledgeable about the risks and benefits of marijuana use for glaucoma, doctors of optometry can educate their patients and guide them toward safe and effective treatment.

Read more about the marijuana and glaucoma discourse in the AOA Focus article, The Cannabis Conundrum.

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