Are you afraid to talk with your doctors about medical marijuana? Perhaps you think they’ll get the wrong idea about why you’re asking. Or maybe you’re worried they won’t have all of the facts. These fears may have some merit. Recent research points to a critical need to improve doctors’ understanding of medical marijuana, especially as laws are changing rapidly across the nation.
“There’s a huge need for patients and doctors to have open conversations about the pros and cons,” says Peter Grinspoon, MD, a primary care doctor and Harvard Medical School instructor who wrote, Seeing Through the Smoke: A Cannabis Specialist Untangles the Truth About Marijuana.
“Medical cannabis is much safer when doctors are updated and educated about it,” he says. “As a doctor, I like to have it as a tool in my toolbox.”
A recent study found that 69% of health professionals felt cannabis had medical uses but only 27% had ever recommended it to a patient. Most doctors reported having limited knowledge about marijuana, and almost 2 out of 3 didn’t know the legal status of cannabis in their state.
Part of the problem is the sheer amount of misinformation. Because it’s a Schedule I controlled substance, the U.S. Drug Enforcement Administration deems it unsafe with a high potential for abuse. More importantly, there is no recognized medical use, and until recently, Grinspoon says, most studies explored only its harms.
That could change, as the DEA this summer accepted almost 43,000 comments, most in favor of a White House proposal to make cannabis Schedule III, meaning it has some medical value. This could open the door to more balanced research. A hearing is scheduled for December.
What Can Be Treated?
Ask 100 doctors, and you might get 100 answers.
Conditions that qualify for medical marijuana are many and vary greatly among states. Some of the more common ones include Alzheimer’s, autism spectrum disorder, cachexia, cancer, chronic pain, Crohn’s disease, epilepsy, glaucoma, HIV and AIDS, multiple sclerosis, nausea, Parkinson’s, and posttraumatic stress disorder.
But don’t run out to your local dispensary just yet. There isn’t a wealth of useful information on effective uses for medical cannabis – mostly because it’s hard to do research on drugs classed Schedule I. Until about 15 years ago, researchers could not receive grants or other funding to study cannabis unless they set out to prove its negative effects, says Grinspoon.
Even less helpful, there are supposed experts on both poles who say it’s either a cure-all or useless.
“The truth lies in the middle as it does with so many things,” says Kevin Boehnke, PhD, an assistant professor of anesthesiology at the University of Michigan and its Chronic Pain and Fatigue Research Center.
Pain is the No. 1 reason people obtain medical marijuana cards, says Boehnke. There is evidence it helps some patients, though more research is needed, he says.
“The fact people might be given an opioid before they’re given the chance to try cannabis for chronic pain, that is potentially harmful,” he says.
Some doctors prescribe it to treat nausea and vomiting, especially if they’re symptoms of chemotherapy. There is also evidence it can help with seizures and multiple sclerosis-related pain and spasticity, Boehnke says. It also may help some people who have chronic pain get sleep.
In addition, says Grinspoon, it’s less habit-forming and has fewer side effects than opioids used for pain, sleeping pills for insomnia, or benzodiazepines for anxiety.
But a knowledgeable doctor is key to using it safely. Why? Well, for one, there can be paradoxical reactions. Some patients who have taken cannabis to lessen anxiety or nausea, for example, report the opposite effect. Another reason: A young patient who used cannabis in college without issue may respond more favorably than an 80-year-old patient on numerous medications who has never consumed it, Grinspoon says.
“Cannabis, like all other medicines, is not harmless,” he says, explaining that teenagers, people with a history of psychosis, and pregnant and breastfeeding women should avoid it.
There can also be side effects and interactions with other medicines, so it’s best to consult your primary care doctor before starting any cannabis treatment plan, he says.
State Law and Your Doctor
Thirty-eight states and the District of Columbia have “comprehensive medical programs,” which means they allow medical use of cannabis products beyond CBD and low-THC level products (as defined by individual state law). Nine permit “limited medical use,” usually in the form of low-THC, high-CBD oils and other products. Only Idaho and Nebraska maintain outright bans, while Kansas allows extremely limited use.
States that ban or heavily limit marijuana are barring a treatment option that shows real promise for some conditions with low risk of addiction, and no risk of lethal overdose, Boehnke says. People who seek out medical cannabis in these states risk not only legal problems, but also – due to the lack of any regulations – the possibility of a contaminated or poor-quality product.
And even where it is legal, there’s a huge need for more education, especially among the medical community.
Lopsided research, misinformation, and a confusing patchwork of regulation leaves many doctors confused over how and when to prescribe it, Grinspoon says.
“There’s a lot we don’t know, and doctors have been some of the main recipients of the misinformation,” he says. “The most important thing is doctors find a way to talk comfortably with their patients about cannabis, even if they’re against it. That’s true with all drugs. We need open, honest, two-way conversations.”
