There are few topics that can stir stronger emotions among doctors, scientists, researchers, policymakers and the public than medical marijuana. Is it safe? Should this be legal? Decriminalized? Is its effectiveness proven? Under what conditions is it useful? Is it addictive? How can we prevent this from falling into the hands of teenagers? Is it really the “wonder drug” people claim it to be? Is medical marijuana just a ploy to legalize marijuana in general?
They are only one some of the great questions around this subject, questions that I will carefully avoid in order to focus on two specific areas: why do patients find it useful, and how can they discuss it with their doctor?
Marijuana is currently legal at the state level, in 29 states and Washington, DC. It’s still illegal from the federal government’s perspective. The Obama administration has not made prosecuting medical marijuana even a minor priority. President Donald Trump has promised not to interfere with people using medical marijuana, although his administration is currently threatening to reverse that policy. About 85% of Americans support legalizing marijuana for medical purposes, and it is estimated that at least several million Americans currently use it.
Marijuana without effect
The least controversial is the extract of the hemp plant known as CBD (meaning cannabidiol) because this component of marijuana has little or no intoxicating properties. Marijuana itself contains over 100 active components. THC (which stands for tetrahydrocannabinol) is the chemical that causes the “high” that comes with marijuana use. CBD-dominant strains contain little or no THC, so patients report very little, if any, altered consciousness.
However, patients report many benefits of CBD, from relieving insomnia, anxiety, spasticity, and pain to treating life-threatening conditions such as epilepsy. A particular form of childhood epilepsy called Dravet syndrome is almost impossible to control, but it responds dramatically to a CBD-dominant marijuana strain called Charlotte’s Web. The videos of this are dramatic.
Uses of Medical Marijuana
The most common use for medical marijuana in the United States, it is for pain control. Although marijuana is not strong enough to relieve severe pain (e.g., post-surgical pain or broken bones), it is very effective for chronic pain that affects millions of Americans, especially as they age. are getting older. Part of its appeal is that it is clearly safer than opiates (it is impossible to overdose and much less addictive) and it can replace NSAIDs such as Advil or Aleve, if people do not cannot take them because of problems with their kidneys or ulcers or GERD.
In particular, marijuana appears to relieve pain related to multiple sclerosis and nerve pain in general. This is an area where few other options exist, and those that do exist, such as Neurontin, Lyrica, or opiates, are highly sedative. Patients report that marijuana allows them to return to previous activities without feeling completely low on energy and disengaged.
Along the same lines, marijuana is considered a fantastic muscle relaxant, and people swear by its ability to reduce tremors. Parkinson’s disease. I have also heard of its successful use for fibromyalgia, endometriosis, interstitial cystitisand most other conditions for which the final common pathway is chronic pain.
Marijuana is also used to manage nausea and weight loss and can be used to treat glaucoma. A very promising area of research is its use for PTSD in veterans returning from combat zones. Many veterans and their therapists report drastic improvement and are calling for more study and a loosening of government restrictions on such study. Medical marijuana is also said to help patients suffering from pain and wasting syndrome associated with HIV, as well as irritable bowel syndrome and Crohn’s disease.
This is not an exhaustive list, but rather a brief overview of the types of conditions for which medical marijuana can provide relief. As with all remedies, claims of effectiveness should be evaluated critically and treated with caution.
Talk with your doctor
Many patients find themselves in the situation where they want to learn more about medical marijuana, but feel embarrassed to discuss it with their doctor. Part of the reason is that the medical community, as a whole, has been too dismissive of this issue. Doctors are now catching up and trying to stay ahead of their patients’ knowledge on this issue. Other patients already use medical marijuana but don’t know how to tell their doctor for fear of being reprimanded or criticized.
My advice to patients is to be completely open and honest with your doctors and have high expectations of them. Tell them that you consider this part of your care and that you expect them to know about it and at least be able to direct you to the information you need.
My advice to doctors is that whether you are for, neutral or against medical marijuana, patients are embracing it, and while we don’t have rigorous studies or “gold standard” evidence of the benefits and of the risks of medical marijuana, we need to educate ourselves, be open-minded and above all, be non-judgmental. Otherwise, our patients will seek other, less reliable sources of information; they will continue to use it, they just won’t tell us, and there will be that much less trust and strength in our doctor-patient relationship. I often hear complaints from other doctors that there is not enough evidence to recommend medical marijuana, but there is even less scientific evidence to bury one’s head in the sand.
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