With Western medicine’s propensity to view the human body as a schematic grid, marijuana has only been considered “medicine” when the appropriate symptoms are ticked. In California, obtaining a medical marijuana recommendation card has allowed patients access to cannabis as medicine since 1996.
Today, California’s legal recreational market overlaps with the medical model, and we’re seeing how it’s influencing consumers’ relationships with cannabis and their doctors. While anyone over 21 can now purchase cannabis products designed to alleviate conditions like anxiety, insomnia and chronic pain, it’s challenging to define boundaries between cannabis for healing and cannabis for pleasure as well as define how each should be treated from a medical perspective.
But given that over 60% of Americans support marijuana legalization, it seems that these ambiguous definitions don’t bother most of us. But should we all simply self-medicate and move on? Or is there still value in having a doctor oversee the use of marijuana for medical purposes?
As a country with the worst-rated health care among high-income nations and an escalating opioid crisis, the room for improvement is vast. In order to better understand marijuana legalization’s impact from a medical perspective, HelloMD spoke with two leading physicians based in California, Dr. Jeffrey Hergenrather and Dr. Mark Wallace, both of whom treat patients with cannabis.
Both doctors stressed the polarity between a growing adult-use marketplace and a lag in cannabis knowledge due to the federal prohibition on medical research. While it’s widely accepted that cannabis is neither addictive nor life threatening, what risks might be posed by consuming without the guidance of a trusted doctor?
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A pain management specialist at UC San Diego Health, Dr. Wallace started talking to his patients about cannabis shortly after Prop 215 established a medical marijuana model in California. As more research was conducted, cannabis became integral to the practice that Dr. Wallace runs with his colleague, Dr. Michelle Sexton, ND. As an anesthesiologist, Dr. Wallace says they “see all kinds of pain” at their clinic in San Diego.
Dr. Wallace’s new patients are always given a survey asking about their personal history with cannabis. He explains that patients commonly respond, “Yes, I tried it, and I hated it. I don’t want to do it ever again.” When he asks whether disaffected patients were given any medical guidance about dosing and delivery with their 215 recommendation card, most patients respond with a “no.”
“They got ahold of some really potent marijuana in college or tried something from a family member,” adds Dr. Wallace.
While Dr. Wallace agrees that bad experiences with marijuana don’t cause harm, he cautions against recreational marijuana’s power to skew a patient’s perception. “You have to guide them on the appropriate dose, starting with very low doses,” explains Dr. Wallace.
Unpleasant psychological experiences or sleepiness can be attributed to what Dr. Wallace calls the “dichotomy of getting too much.” The paradox of cannabis causing paranoia, when intended to alleviate anxiety is a familiar and frustrating scenario for many. But Dr. Wallace explains that this scenario applies to the pain spectrum as well. He believes that appropriate dosing is critical in order for patients to successfully reduce, rather than increase, their pain.
“The same is true with cannabidiol (CBD),” adds Dr. Wallace. Though using CBD cannabis products is on the rise socially and medically, he warns that while low doses are associated with a stimulating affect, high doses are associated with a sedating effect. Patients who have bad experiences using cannabis might need a significantly different product in the morning than before going to bed.
When a patient presents a condition that might positively respond to cannabis, Dr. Wallace stresses that a “knowledgeable health-care professional” is key for successful treatment. In addition to the complex topic of dosage, Dr. Wallace notes that delivery method is another complicating factor.
“The best way to titrate consumption is with inhalation, but there are many risk factors associated with smoke,” says Dr. Wallace. He cites lab-tested cannabis products, such as tinctures, edibles and vape pens, as the major advantage to the regulated recreational market.
Overall, Dr. Wallace believes that a medical doctor is essential for monitoring what works for a cannabis patient. But he highlights the tax revenue generated from Prop 64 as the greatest benefit to the recreational market—a large percentage of the funds are earmarked for medical research.
However, as long as marijuana remains a Schedule 1 illegal drug at the federal level, medical research on cannabis is severely fettered. In the meantime, the legalization of recreational cannabis will continue to affect the consumer/patient experience, and increasingly, without the oversight of a doctor.
Dr. Jeffrey Hergenrather went to medical school at Brown University before becoming affectionately known as “Doc” at the “The Farm” in Tennessee in 1976. A working eco-village and sustainable education center today, The Farm was once the nation’s largest hippie commune. When his patients at The Farm started reporting how much marijuana was helping them feel better, Dr. Hergenrather says, “I began my education about its utility and began to extensively study the use of cannabis.”
Making his way west following the passage of Prop 215 in 1996, Dr. Hergenrather has treated patients at his practice in Sebastopol, CA ever since, including the plant in his protocols for more than 40 years.
“I have found enlightening and valuable benefits to using cannabis in treating ADHD, autism, genetic disorders and serious childhood diseases such as cystic fibrosis and pediatric cancer,” says Dr. Hergenrather, who is widely known for his work with children and teens.
When treating kids with “a dismal outlook,” Dr. Hergenrather usually encourages them to stay with conventional medicine and then switch over to marijuana therapies if the family chooses to pursue cannabis as a treatment. Dr. Hergenrather reports that he has seen incredibly positive results in controlling, and even reducing, tumor growth.
“Natural cannabinoids have a role in reducing abnormal cells,” explains the Sonoma County doctor. Yet, like his colleague in San Diego, Dr. Hergenrather stresses that we “still don’t fully understand the mechanism,” and that federal prohibition is a huge barrier to much-needed medical research.
Generally favoring a balance of CBD and tetrahydrocannabinol (THC) similar to Dr. Wallace, Dr. Hergenrather emphasizes the need for a medical doctor to dose cannabis appropriately to each patient. “I have a patient who is using 1 mg of CBD per day for anxiety, and it’s changing her life,” the doctor explains. He adds that every treatment plan should be tailored to the needs of each individual.
With the passage of Prop 64, Dr. Hergenrather reports that he’s heard of other medical cannabis providers losing patients; assumedly these patients are now self-medicating in the recreational marketplace. But his practice is even busier in 2018, which Dr. Hergenrather attributes to patients who are uncomfortable “self-administering doses.”
“We have an industry that needs science and laboratories,” concludes Dr. Hergenrather.
Though many doctors are wary of using cannabis in their practice because of the dearth of scientific studies and research, there are physicians out there who are familiar with the plant and have studied the cannabis data that do exist. If you’re thinking of using cannabis as a medical treatment, it might be worth your while to seek out such a medical professional so they can guide you towards the types of cannabis, consumption method and dosing that will give you the effects you’re after. You wouldn’t plan your own medication protocols with traditional pharmaceuticals, so why do it with cannabis?
Photo credit: COM SALUD