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Meds Doctors and Cannabis

Fat Freddy

Well-Known Member
An Open Letter to DEA Chief Chuck Rosenberg: Don’t Resign (Yet)

By David Casarett, M.D.


THEGOODPHOTO VIA GETTY IMAGES


Dear Mr. Rosenberg:

When I heard you say recently that you thought medical marijuana was a “joke,” I didn’t know whether to laugh or cry. But I knew then what I think you’re beginning to figure out now, which is that saying something like that gets you in a whole heap oftrouble.

As I think you’ve realized, those opinions are direct repudiation of the beliefs of all of those people who are using marijuana for medical reasons. (Even the most conservative estimates based on registered users conclude that well over a millionpeople in the U.S. alone are using marijuana medically).

So I’m sorry for what you’ve been through in the past two weeks. Especially those pesky people (about 100,000 of them) who have signed a petition calling for your resignation. That must be bothering you a bit.

But don’t give up. All is not lost, and you could learn to see marijuana differently.

I can say that with confidence because two years ago I thought medical marijuana was a joke too. I figured it offered no real medical benefits, and that it was just a way to get high legally.

My (re)education started in my work as a palliative care physician, when one of my patients asked me whether I thought medical marijuana might help her. The answer I gave her, I’m embarrassed to admit, is pretty much what you told people of United States: Marijuana has no medical benefits. Put simply, I told her that the idea of “medical” marijuana is a joke.

That patient of mine could’ve walked out of my office to look for another, more open-minded doctor. But, luckily for me, she didn’t. Instead she handed me several reprints of randomized controlled trials showing that in fact medical marijuana does offer real medical benefits.

So in that moment I had to admit that my patient knew more than I did about the science of medical marijuana. And I figured if I was that ignorant about marijuana’s benefits, then many of my colleagues probably were too. That’s when I decided to spend two years researching and writing a book about the medical benefits of marijuana.

In the last two years I’ve had to admit that I was wrong. Very wrong. (In much the same way, and for the same reasons, that you’re wrong now.)

The opinions you’re clinging to now are pretty much what I though when I first started writing Stoned: A Doctor’s Case for Medical Marijuana. In fact, I’m pretty sure that if you and I had discussed this back then, we would have shared a good laugh about the grand joke of “medical” marijuana.

I’ve discovered that marijuana does offer benefits. In the past year, I’ve talked with dozens of experts, patients, and activists. I’ve slogged through hundreds of studies of marijuana. Along the way, I’ve graduated from a hard-nosed skepticism to an open-mindedness that I never would have believed possible two years ago. The good news is that you can make the same journey.

So, what have I learned? Does marijuana work?

Well, one thing I’ve learned is that this isn’t the right question to ask.

Does a hammer work? Sure, if you want to pound a nail. But if you want to fix a frozen iPhone, not so much. So whether marijuana “works” depends on what you want it to do.

I can give you one example: Neuropathic pain (pain caused by nerve damage). This is a kind of pain that is difficult to treat, because it doesn’t respond well to opioids like morphine. In fact, many of my patients say that opioids just make them feel sick and sleepy, and that they’d rather deal with the pain.

But I was surprised to learn that marijuana seems to be quite effective in treating that kind of pain. (I’m guessing that this is likely to be surprising to you, too.) In fact, there have been several clinical trials of marijuana for the management of neuropathic pain. I’m thinking of a couple of studies as examples, which have used marijuana and/or its component cannabinoids to treat neuropathic pain in AIDS, multiple sclerosis, and diverse causes.

Those are just a few examples, but you get the picture: Medical marijuana isn’t a joke. Don’t get me wrong: Marijuana isn’t a wonder drug. It doesn’t do many of the things that its most avid proponents claim. (Prevents Alzheimer’s! Cures cancer!) But it probably has more benefits that its most cynical skeptics admit. And it’s not a “joke.”

Please do take a moment to look up the evidence supporting medical marijuana. As a starting place in your education, you might take a look at this meta analysis that appeared in the Journal of the American Medical Association. The criteria they used were very tough, but even that study admitted some benefits.

Or if you want to entertaining bedtime reading, check out my book, Stoned: A Doctor’s Case for Medical Marijuana. Heck, I’ll even send you a free copy.

I’m guessing you’re still skeptical, and that’s fair. I’m still skeptical too, because we need more research. But I think we know enough now for even skeptics like you and me to be able to conclude that for some people — though certainly not everyone — medical marijuana might be the best option.

So my advice is to ignore those calls for your resignation, at least for a while. Take some time to learn about the science that’s out there, and about the studies that have been done. Maybe you’ll end up more open-minded, just as I have, and we’ll have a DEA chief who understands what millions of patients are saying about medical marijuana. Then we all win.

Sincerely,
David Casarett, MD


David Casarett, M.D.
Doctor, Author

http://www.huffingtonpost.com/david-casarett-md/an-open-letter-to-dea-chi_b_8622092.html
 

momofthegoons

Vapor Accessory Addict
Staff member
I've renamed this thread to include all conversation regarding doctors and cannabis; from news articles to our own experiences. I came across this article on Facebook and thought it was compelling. This doctor has completely changed his views on cannabis and how patients should be treated. If you follow the link you will see the actual video (which I could not embed) of this transcript.

The thing that struck me was this line, "She handed me those articles and said, "Maybe you should read these before offering an opinion ... doctor." And it has made me think about what I will do in the event that I have to defend my cannabis usage. Currently I don't discuss it with any of my doctors. The doctor who certified me for mmj told me not to; that I would never be prescribed another narcotic again if I did and that I would be looked upon as a drug abuser. That until cannabis is legal federally, no doctors will be on board. While I know there are a few doctors that believe in cannabis therapies, I believe this to be mostly true... and the risk is always there that I might have to take a urine test some day when I visit. If that happened, I would want to be armed with studies and articles like the one below. Because on that day, my doctor and I would be having a serious discussion about cannabis and it's benefits.



A doctor's case for medical marijuana

I would like to tell you about the most embarrassing thing that has ever happened to me in my years of working as a palliative care physician. This happened a couple of years ago. I was asked as a consultant to see a woman in her 70s -- retired English professor who had pancreatic cancer. I was asked to see her because she had pain, nausea, vomiting ... When I went to see her, we talked about those symptoms and in the course of that consultation, she asked me whether I thought that medical marijuana might help her. I thought back to everything that I had learned in medical school about medical marijuana, which didn't take very long because I had learned absolutely nothing. And so I told her that as far as I knew, medical marijuana had no benefits whatsoever. And she smiled and nodded and reached into the handbag next to the bed, and pulled out a stack of about a dozen randomized controlled trials showing that medical marijuana has benefits for symptoms like nausea and pain and anxiety. She handed me those articles and said, "Maybe you should read these before offering an opinion ... doctor."

So I did. That night I read all of those articles and found a bunch more. When I came to see her the next morning, I had to admit that it looks like there is some evidence that marijuana can offer medical benefits and I suggested that if she really was interested, she should try it. You know what she said? This 73-year-old, retired English professor? She said, "I did try it about six months ago. It was amazing. I've been using it every day since. It's the best drug I've discovered. I don't know why it took me 73 years to discover this stuff. It's amazing."

That was the moment at which I realized I needed to learn something about medical marijuana because what I was prepared for in medical school bore no relationship to reality.

So I started reading more articles, I started talking to researchers, I started talking to doctors,and most importantly, I started listening to patients. I ended up writing a book based on those conversations, and that book really revolved around three surprises -- surprises to me, anyway.One I already alluded to -- that there really are some benefits to medical marijuana. Those benefits may not be as huge or as stunning as some of the most avid proponents of medical marijuana would have us believe, but they are real. Surprise number two: medical marijuana does have some risks. Those risks may not be as huge and as scary as some of the opponents of medical marijuana would have us believe, but they are real risks, nonetheless. But it was the third surprise that was most ... surprising. And that is that a lot of the patients I talked withwho've turned to medical marijuana for help, weren't turning to medical marijuana because of its benefits or the balance of risks and benefits, or because they thought it was a wonder drug,but because it gave them control over their illness. It let them manage their health in a way that was productive and efficient and effective and comfortable for them.

To show you what I mean, let me tell you about another patient. Robin was in her early 40s when I met her. She looked though like she was in her late 60s. She had suffered from rheumatoid arthritis for the last 20 years, her hands were gnarled by arthritis, her spine was crooked, she had to rely on a wheelchair to get around. She looked weak and frail, and I guess physically she probably was, but emotionally, cognitively, psychologically, she was among the toughest people I've ever met. And when I sat down next to her in a medical marijuana dispensary in Northern California to ask her about why she turned to medical marijuana, what it did for her and how it helped her, she started out by telling me things that I had heard from many patients before. It helped with her anxiety; it helped with her pain; when her pain was better, she slept better. And I'd heard all that before. But then she said something that I'd never heard before, and that is that it gave her control over her life and over her health. She could use it when she wanted, in the way that she wanted, at the dose and frequency that worked for her. And if it didn't work for her, then she could make changes. Everything was up to her. The most important thing she said was she didn't need anybody else's permission -- not a clinic appointment, not a doctor's prescription, not a pharmacist's order. It was all up to her. She was in control.

And if that seems like a little thing for somebody with chronic illness, it's not -- not at all. When we face a chronic serious illness, whether it's rheumatoid arthritis or lupus or cancer or diabetes, or cirrhosis, we lose control. And note what I said: "when," not "if." All of us at some point in our lives will face a chronic serious illness that causes us to lose control. We'll see our function decline, some of us will see our cognition decline, we'll be no longer able to care for ourselves, to do the things that we want to do. Our bodies will betray us, and in that process, we'll lose control. And that's scary. Not just scary -- that's frightening, it's terrifying. When I talk to my patients, my palliative care patients, many of whom are facing illnesses that will end their lives, they have a lot of be frightened of -- pain, nausea, vomiting, constipation, fatigue, their impending mortality. But what scares them more than anything else is this possibility that at some point, tomorrow or a month from now, they're going to lose control of their health, of their lives, of their healthcare, and they're going to become dependent on others, and that's terrifying.

So it's no wonder really that patients like Robin, who I just told you about, who I met in that clinic, turn to medical marijuana to try to claw back some semblance of control. How do they do it though? How do these medical marijuana dispensaries -- like the one where I met Robin -- how do they give patients like Robin back the sort of control that they need? And how do they do it in a way that mainstream medical hospitals and clinics, at least for Robin, weren't able to? What's their secret? So I decided to find out.

I went to a seedy clinic in Venice Beach in California and got a recommendation that would allow me to be a medical marijuana patient. I got a letter of recommendation that would let me buy medical marijuana. I got that recommendation illegally, because I'm not a resident of California -- I should note that. I should also note, for the record, that I never used that letter of recommendation to make a purchase, and to all of you DEA agents out there --

love the work that you're doing, keep it up.

Even though it didn't let me make a purchase though, that letter was priceless because it let me be a patient. It let me experience what patients like Robin experience when they go to a medical marijuana dispensary. And what I experienced -- what they experience every day, hundreds of thousands of people like Robin -- was really amazing. I walked into the clinic, and from the moment that I entered many of these clinics and dispensaries, I felt like that dispensary, that clinic, was there for me. There were questions at the outset about who I am, what kind of work I do, what my goals are in looking for a medical marijuana prescription, or product, what my goals are, what my preferences are, what my hopes are, how do I think, how do I hope this might help me, what am I afraid of. These are the sorts of questions that patients like Robin get asked all the time. These are the sorts of questions that make me confident that the person I'm talking with really has my best interests at heart and wants to get to know me.

The second thing I learned in those clinics is the availability of education. Education from the folks behind the counter, but also education from folks in the waiting room. People I met were more than happy, as I was sitting next to them -- people like Robin -- to tell me about who they are, why they use medical marijuana, what helps them, how it helps them, and to give me advice and suggestions. Those waiting rooms really are a hive of interaction, advice and support.

And third, the folks behind the counter. I was amazed at how willing those people were to spend sometimes an hour or more talking me through the nuances of this strain versus that strain, smoking versus vaporizing, edibles versus tinctures -- all, remember, without me making any purchase whatsoever. Think about the last time you went to any hospital or clinic and the last time anybody spent an hour explaining those sorts of things to you. The fact that patients like Robin are going to these clinics, are going to these dispensaries and getting that sort of personalized attention and education and service, really should be a wake-up call to the healthcare system. People like Robin are turning away from mainstream medicine, turning to medical marijuana dispensaries because those dispensaries are giving them what they need.

If that's a wake-up call to the medical establishment, it's a wake-up call that many of my colleagues are either not hearing or not wanting to hear. When I talk to my colleagues, physicians in particular, about medical marijuana, they say, "Oh, we need more evidence. We need more research into benefits, we need more evidence about risks." And you know what? They're right. They're absolutely right. We do need much more evidence about the benefits of medical marijuana. We also need to ask the federal government to reschedule marijuana to Schedule II, or to deschedule it entirely to make that research possible. We also need more research into medical marijuana's risks. Medical marijuana's risks -- we know a lot about the risks of recreational use, we know next to nothing about the risks of medical marijuana. So we absolutely do need research, but to say that we need research and not that we need to make any changes now is to miss the point entirely. People like Robin aren't seeking out medical marijuana because they think it's a wonder drug, or because they think it's entirely risk-free. They seek it out because the context in which it's delivered and administered and used, gives them the sort of control they need over their lives. And that's a wake-up call we really need to pay attention to.

The good news though is that there are lessons we can learn today from those medical marijuana dispensaries. And those are lessons we really should learn. These are often small, mom-and-pop operations run by people with no medical training. And while it's embarrassing to think that many of these clinics and dispensaries are providing services and support and meeting patients' needs in ways that billion-dollar healthcare systems aren't -- we should be embarrassed by that -- but we can also learn from that. And there are probably three lessons at least that we can learn from those small dispensaries.

One: we need to find ways to give patients more control in small but important ways. How to interact with healthcare providers, when to interact with healthcare providers, how to use medications in ways that work for them. In my own practice, I've gotten much more creative and flexible in supporting my patients in using drugs safely to manage their symptoms -- with the emphasis on safely. Many of the drugs I prescribe are drugs like opioids or benzodiazepines which can be dangerous if overused. But here's the point. They can be dangerous if they're overused, but they can also be ineffective if they're not used in a way that's consistent with what patients want and need. So that flexibility, if it's delivered safely, can be extraordinarily valuable for patients and their families. That's number one.

Number two: education. Huge opportunities to learn from some of the tricks of those medical marijuana dispensaries to provide more education that doesn't require a lot of physician time necessarily, or any physician time, but opportunities to learn about what medications we're using and why, prognoses, trajectories of illness, and most importantly, opportunities for patients to learn from each other. How can we replicate what goes on in those clinic and medical dispensary waiting rooms? How patients learn from each other, how people share with each other.

And last but not least, putting patients first the way those medical marijuana dispensaries do, making patients feel legitimately like what they want, what they need, is why, as healthcare providers, we're here. Asking patients about their hopes, their fears, their goals and preferences. As a palliative care provider, I ask all my patients what they're hoping for and what they're afraid of. But here's the thing. Patients shouldn't have to wait until they're chronically seriously ill, often near the end of life, they shouldn't have to wait until they're seeing a physician like me before somebody asks them, "What are you hoping for?" "What are you afraid of?" That should be baked into the way that healthcare is delivered.

We can do this -- we really can. Medical marijuana dispensaries and clinics all across the country are figuring this out. They're figuring this out in ways that larger, more mainstream health systems are years behind. But we can learn from them, and we have to learn from them. All we have to do is swallow our pride -- put aside the thought for a minute that because we have lots of letters after our name, because we're experts, because we're chief medical officers of a large healthcare system, we know all there is to know about how to meet patients' needs.

We need to swallow our pride. We need to go visit a few medical marijuana dispensaries. We need to figure out what they're doing. We need to figure out why so many patients like Robin are leaving our mainstream medical clinics and going to these medical marijuana dispensaries instead. We need to figure out what their tricks are, what their tools are, and we need to learn from them. If we do, and I think we can, and I absolutely think we have to, we can guarantee all of our patients will have a much better experience.

Thank you.
 

Vicki

Herbal Alchemist
My holistic doctor is all for MMJ, and totally approves. I’ve been waiting a long time to find a good doctor that understands cannabis can help. These were her exact words to me when I told her I was going to get a recommendation: “CBD may or may not help you, but marijuana definitely will!”
 

Baron23

Well-Known Member
Great article, @momofthegoons . I think that "taking control of your health care" applies to most of us who try to get away or minimize the heavy pharma our doctors want to give us in favor of self-admin of MMJ.

"we know a lot about the risks of recreational use"

We do??
 

momofthegoons

Vapor Accessory Addict
Staff member
"we know a lot about the risks of recreational use"

We do??
Glad you enjoyed the article. I found it refreshing considering how many doctors seem to be against it.

However this statement made me wonder as well. I'd love to know what medicinal risks he is referring to. The munchies? Perhaps he is being more general and referring to those folk who'll pop an oxy, have a beer and smoke a joint in the name of having a good time? :idon'tknow:
 

Baron23

Well-Known Member

Killick

Well-Known Member
In Canada there is no need to go into a clinic. A statement of diagnosis from your doc is required. The clinic, who you work with online/phone, will ensure your paperwork is complete, then they set up a Skype-like appointment time. If your paperwork is ready on Monday you might get an appointment on Tuesday, and make your first order on Wednesday. A 'prescription' isn't required. It's an authorization, which can be obtained from pharmacists, physicians assistants, LPNs, and a few other modalities which escape me at present. It's pretty easy to get for anyone with a little motivation.
 

Fat Freddy

Well-Known Member
In Canada there is no need to go into a clinic. A statement of diagnosis from your doc is required. The clinic, who you work with online/phone, will ensure your paperwork is complete, then they set up a Skype-like appointment time. If your paperwork is ready on Monday you might get an appointment on Tuesday, and make your first order on Wednesday. A 'prescription' isn't required. It's an authorization, which can be obtained from pharmacists, physicians assistants, LPNs, and a few other modalities which escape me at present. It's pretty easy to get for anyone with a little motivation.

That's great! Unfortunately, here in Ohio, after it all shakes out some time this decade perhaps, a recommendation is probably going to cost us patients a few well-timed blow jobs and maybe one or two good ass reamings! And that's every 90 days!
Geez...can hardly wait! :aaaaa:

.
 

Killick

Well-Known Member
Fortunately Canada made it legal at the Federal level. With the forthcoming 'recreational legal' there will be more clusterfuckage at the provincial and municipal levels. And, oddly enough, at the Federal level with all the new laws and rules coming out.
Currently there are over 200,000 medical patients in Canada, and with the new 'legalization ' every single medical patient will be treated like a recreational user, subject to the whims of the new laws. This includes when and how they medicate, as well as driving.

Some towns are enacting 'no cannabis use in public' bylaws, which mean that any Federal building is now a safe place to consume medications - post offices, agriculture inspection buildings, and even the local RCMP detachment building are all exempt from any cannabis-related bylaw fuckery. I'm thinking it's time to drop by the local RCMP office and see what they think about it...
 

momofthegoons

Vapor Accessory Addict
Staff member
The number of people over age 65 using marijuana is increasing faster than any other age group, but they think doctors need to catch up

5cf252ac4cf2701a9f2338d4-1536-1152.jpg


  • More and more older people are using cannabis to soothe the pains, diseases, and mental health problems that come with aging.
  • A new study suggests that even though people over age 65 are the fastest-growing population using marijuana, they come up against many barriers when trying to access it.
  • A lack of research, unclear communication with doctors, and a reluctance to be honest about its use due to stigma, are all stopping older people getting the products they need.
  • Respondents that had trouble getting a medical cannabis license from their doctors believe it is because the doctors not up to date with the latest research.
  • "From a physician's standpoint this study shows the need to talk to patients in a non-judgmental way about cannabis," said Hillary Lum, coauthor of the study. "Doctors should also educate themselves about the risks and benefits of cannabis and be able to communicate that effectively to patients."


More and more older people are turning to cannabis for their ailments, because it can soothe the symptoms of problems like arthritis, Parkinson's, and chronic pain. A new study suggests that the number of people using marijuana is increasing faster for those aged over 65 than for any other age group, but they come up against many barriers when trying to access it.

"Older Americans are using cannabis for a lot of different reasons," said Hillary Lum, an assistant professor of medicine at the University of Colorado School of Medicine and coauthor of the study. "Some use it to manage pain while others use it for depression or anxiety."

But the study, published this month in the journal Drugs & Aging, found that a lack of research, unclear communication with doctors, and a reluctance to be honest about its use due to stigma, are all stopping older people getting the products they need.

Researchers interviewed 136 people over the age of 60 in 17 focus groups across 13 counties in Colorado, and found that older people don't always feel comfortable asking for a medical marijuana license from their doctors. This pushes them towards buying from the black market instead.

"I think [doctors can] be a lot more open to learning about it and discussing it with their patients," said one respondent. "Because at this point I have told my primary care I was using it on my shoulder. And that was the end of the conversation. He didn't want to know why, he didn't want to know about effects, didn't want to know about side effects, didn't want to know anything."

Other respondents said their doctors refused provide them with the certificate required for obtaining medical marijuana, and they suspected it was because they weren't educated on the latest research.

Cannabis products can be an important alternative treatment for many older people, who are often taking many different types of medications that can have unpleasant and harmful side effects.

"From a physician's standpoint this study shows the need to talk to patients in a non-judgmental way about cannabis," said Lum. "Doctors should also educate themselves about the risks and benefits of cannabis and be able to communicate that effectively to patients."

Barbara Buck, a realtor in her 50s, started growing cannabis when it became legal for medical use in her state. She told INSIDER she's an "avid gardener," so thought she might as well give it a try.

Buck said she used cannabis herself to help with sleep and menopause symptoms, but has also converted many people in their 60s and 70s towards cannabis for pain, depression, and anxiety.

"The main reason I grew Cannabis [is] to help people like it has always helped me," she said. "The only reason I stopped was due to moving to a house that wasn't as suitable for growing. My goal is to move to the country in a couple of years and start again!"

She said she's noticed the taboo surrounding cannabis has shifted immensely in the last decade, but she still is hesitant to be open with everyone about the fact that she uses it herself. Nevertheless, she thinks marijuana should be legal worldwide, because you can't overdose on it like opioids or alcohol — addictions that millions of Americans suffer with.

This was mirrored in the results of the new study. Participants thought more negatively towards recreational cannabis than medical cannabis, but they also felt more favorably towards it than alcohol.

One concern Buck has, though, is about over-regulation from the government.

"I believe it will go federally legal very soon in the US in part due to the last Farm Bill that was passed," she said. "Now that the government sees how much money there is to be made they will do whatever it takes to get a piece of the pie."
 

Shredder

Dogs like me
I'm still leary of the whole medical situation. I never really trusted doctors before or now. Being honest with them leads to negative consequences, even in a legal state.

Even the pot doctors are just there for the $. Some because they can't get a job in the real world.

I'm a firm believer that I am my own best doctor.
 

momofthegoons

Vapor Accessory Addict
Staff member
JAMA: Most Doctors Know Nothing About Cannabis

Most American physicians are woefully ignorant and “unprepared” for the reality of cannabis consumption among patients despite it being approved for medical use in 34 states and legal for all adults in 10 of those states.

That’s the diagnosis of Nathaniel Morris of the Stanford University School of Medicine, who wrote about the shameful state of clinician knowledge in an op-ed published in the influential Journal of the American Medical Association (JAMA) earlier today.

Morris attended medical school in California, where medical marijuana has been legal for nearly 23 years. Despite that fact, the psychiatric specialist revealed that he’s had to turn to his patients, rather than his medical education, to gain knowledge about cannabis.

“Marijuana has become an inescapable part of my medical training,” he wrote, “and most of my learning has come from patients.”

Doctors Unprepared to Talk MMJ
This comes as no surprise to America’s millions of medical marijuana patients and adult cannabis consumers, who have long been frustrated by the medical profession’s refusal to take cannabis seriously as anything other than a drug of addiction.

As Leafly has written about and documented, many desperate patients often turn to specialty cannabis clinics after being shamed by their own family physicians when inquiring about medical cannabis. Others have simply sought out adult-use cannabis on their own, and begun self-medicating, after finding that their doctor knew less about cannabis than the patient did.

As Leafly writer Bruce Kennedy documented in a story published earlier today, researchers in Colorado found that more seniors in that legal state are using cannabis both medically and recreationally—though fewer are speaking to their doctors about it for fear of being shamed or running into stark ignorance on the part of the physician.

THC Gummies, CBD Capsules: What They?
Morris, a young physician just entering the profession, notes that “when I review medications at the bedside, some patients and families hold out THC gummies or cannabidiol capsules, explaining dosages or ratios of ingredients used to treat symptoms, including pain, insomnia, nausea, or poor appetite.” What he doesn’t know is that for every patient who offers that information, many others take the same medications but keep it hidden from him.

He wrote:

“On inpatient units, there are patients who ask to use marijuana products for various conditions like they do at home. I have seen patients who have smuggled marijuana into the hospital and smoked in their rooms. Patients tell my coworkers and me about recent marijuana trends, such as using ‘wax’ or shatter,’ concentrated extracts that are highly potent and poorly understood. Heavy marijuana users who abruptly stop using when they enter the hospital sometimes experience withdrawal symptoms including sleep disturbances and restlessness.”

These “recent marijuana trends” have, of course, been around for years. Full information about these various forms of cannabis are available at Leafly and plenty of other sites, if physicians would only care to look.

Only Saying What Others Know
It took courage for Morris to write about this subject in a forum as high-profile as JAMA. At the same time, he exhibits many of the same assumptions that discourage patients from talking about their cannabis use openly. It should come as no surprise that “heavy marijuana users” sometimes experience withdrawal symptoms in hospitals. Most hospitals won’t allow them to medicate with cannabis. If you take away any patient’s regular medications, they’re likely to suffer negative reactions.

And that “heavy marijuana user” might be a military veteran who’s managing their PTSD with medical cannabis. Or a twentysomething regulating their anxiety. Or a chronic pain patient who’s gone off opioids thanks to medical cannabis—but now they’re forced to endure the pain or return to opioids because they’re stuck in a hospital bed. So yeah, they’re going to report a little “discomfort.”

91% of Med Schools Won’t Touch It
The statistics on this problem are outrageous. Morris quotes a 2016 survey that found only 9% of medical schools had any curricular content on medical cannabis. The same survey found that 85% of medical residents reported receiving no education—zero—about medical marijuana in medical school or during their residency.

Imagine that an entire class of drugs like statins came on the market, were prescribed in the millions—but doctors didn’t know the first thing about them. They weren’t mentioned in medical school or during a doctor’s residency. That’s where we are with cannabis.

No Studies? Hardly.
“Part of the reason physicians may feel poorly trained is that many of marijuana’s health effects are not known,” Morris writes. This is untrue. Though it has been extremely difficult to conduct federally-approved cannabis research in the United States, thousands of studies have been published on the medical effects of cannabis. Entire issues of The Lancet and other leading journals have been devoted to the subject. It’s not that hard to find. The first step is to use a little tool commonly known as The Google.

Morris ends his article by noting that “most of my medical training around marijuana has been realizing how much I still have to learn.”

Welcome to Leafly, Dr. Morris. Make yourself comfortable. We have everything you want to know about cannabis but were afraid to ask.

 

momofthegoons

Vapor Accessory Addict
Staff member
Cannabis toothpaste invented by dentist who wants to end drug stigma

A DENTIST has developed a toothpaste made with cannabis – and hopes to revolutionise dental treatment.

Doctor Veronica Stahl, a dentist from Mortsel in Belgium, says cannabis is antibacterial and fights dental plaque.

And the painkilling effect of the toothpaste – called Cannabite Lifelong – could alleviate toothache and even treat pain from root canal surgery.

There is evidence cannabis extracts can safely treat chronic pain in adults, although research is ongoing in the UK and worldwide.


Dr Stahl, who is from Israel and is licensed to practice in the UK, says products that exploit the healing properties of cannabinoids could help millions of patients maintain their own natural teeth despite gum disease, cavities and other soft tissue diseases.
 

momofthegoons

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Why won’t your doctor prescribe you cannabis?

Almost 60% of US healthcare providers feel negatively about medical cannabis, while less than 12% view it positively. These results, the product of a surveyreported in the forthcoming March 2020 issue of Preventative Medicine, provide a startling insight into the relationship between medical cannabis and those who can prescribe it.

The survey, which investigated the opinions of 1,439 licensed clinicians anonymously from 2011 through to 2017, hints at some of the hurdles cannabis needs to clear for doctors to warm to it. The survey’s authors found that provider advice tended to discourage cannabis use, while the most positive clinician views toward cannabis were for palliative use.

Notably, the findings also reported that the proportion of positive sentiment toward cannabis did increase over time. With the survey wrapping up in 2017, one could hope that contemporary clinicians are better-versed in the therapeutic applications of cannabis.

For those familiar with the current lay of the medical landscape, however, that’s not the case. Leafly turned to Joe Dolce to help unpack this clinician reticence toward cannabis. Dolce is author of Brave New Weed and co-founder of MedicalCannabisMentor.com, an online learning platform that provides evidence-based, research-grounded courses for healthcare providers, dispensary personnel, and in the not-too-distant future, patients. He works alongside Dr. Junella Chin, an expert cannabinoid-prescribing physician who has treated more than 10,000 patients.

For Dolce, the obstacles hindering physicians from getting behind cannabis are clear and need to be urgently addressed. While healthcare providers may be digging their heels in, patients are leveling up with their knowledge of cannabis.

“The problem for patients is that they are often ahead of their providers when it comes to cannabinoid meds, and they often have no one they can turn to for trusted advice on dosing and how to use them for optimal efficacy,” said Dolce.

The origin of the problem: omission in education
One glaring omission that disadvantages doctors can be traced back to med school. “The endocannabinoid system (ECS) is not taught in most medical schools, so healthcare providers have no knowledge of what it does, nor that it is the master regulator of all the other receptor systems,” said Dolce. “Because neither the ECS nor cannabinoid medicine are taught in med school, healthcare providers are largely uneducated about it and quite naturally don’t trust it.”

The ECS isn’t new knowledge, though. Scientists have known about the existence of the endocannabinoid system for more than 25 years. More recently, researchers hypothesized that this internal signaling system started evolving over 600 million years ago, dating back to prehistoric forms of life no more complex than sponges.
https://www.leafly.ca/news/science-tech/what-is-the-endocannabinoid-system
Today, studies have demonstrated that cannabinoid receptors are present in skin, immune cells, bones, fatty tissue, pancreas, the liver, the heart, blood vessels, and the gastro-intestinal tract. We also know that the endocannabinoid system participates in multiple processes such as pain, memory, mood, appetite, sleep, stress, immune function, metabolism, and reproductive function.

You could justifiably argue—and some experts have—that the endocannabinoid system is one of the most critical physiologic systems implicated in the establishment and maintenance of human health, operating as a bridge between the body and mind.

But among the least educated are those who need to be the most informed. Many healthcare providers are still unfamiliar with the ECS—at last count, in 2013, only 13% of med schools taught the ECS in any capacity. A recent Leafly reportsuggests that very little has changed.

Cannabis is botanical medicine, not pharmaceutical medicine
According to Dolce, there are additional barriers that impact clinician sentiment toward cannabis. “Physicians are used to single-action targeted pharmaceutical meds. Cannabis is a botanical medicine composed of over 165 active compounds that work synergistically,” he said. “Botanical meds require more patient education and often, hand-holding. The way most clinics work doesn’t allow enough time for this.”

Dolce also points out that it can be challenging for healthcare providers to allow time to familiarize themselves with something new. “Being a doctor is a stressful and high-pressured job,” said Dolce. “They work a lot, and there is always more to learn and read. Convincing a doctor to spend more time learning about a medicine that is still federally illegal is not the easiest task.”
https://www.leafly.ca/news/health/how-to-find-a-medical-marijuana-doctor
Prescribing medical cannabis also requires patience and time. Dolce, and many cannabis medicine experts, emphasize that it can take some patients weeks, or even months, to reach their optimal cannabis dose. Learning to dose medicine incrementally to find the sweet spot can be empowering for a patient but can absorb more time in consultation.

“All this being said, teaching patients to self-administer meds is not unfamiliar to clinicians. They do it with diabetic patients using insulin or patients in pain who must self-titrate Gabapentin (Neurontin). And don’t forget those SSRIs,” he said.


Finally, the risk of liability represents a further deterrent. “No insurance company will cover healthcare providers for prescribing cannabinoid meds, so there are structural and systemic reasons docs stay away from it,” said Dolce.
 

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