Medical marijuana
- Using medical cannabis to treat chronic pain is becoming much more common.
- Patients should not be afraid to discuss this issue with their doctor.
- Doctors should maintain a professional approach and inform patients about potential risks and benefits.
Introduction
There are few subjects that evoke stronger emotions among doctors, scientists, researchers, makers, politicians, and the public than medical marijuana.
Is it safe? Will it be legal? Decriminalized? Is its effectiveness truly proven? Under what conditions can it be used? Is it addictive? How do we keep it away from teenagers? Is it really a "miracle drug" as many describe it? Is medical marijuana just a step towards complete cannabis legalization?
These are just some of the many questions about this topic, questions I want to avoid so we can focus on two specific areas: Why do patients find it helpful and how can they discuss this topic with their doctor?
Marijuana is currently legal in 29 states in America and Washington DC. From a federal government perspective, however, it remains illegal. The Obama administration did not prosecute medical marijuana possession. President Donald Trump promised not to intervene with people using medical marijuana, although his administration currently threatens to change this policy.
About 85% of Americans support medical marijuana legalization and it is estimated that several million Americans currently use marijuana.
Marijuana Without Euphoric State
The least controversial extract from cannabis plants is known as CBD (cannabidiol), because this marijuana component has few, if any, psychoactive properties. Marijuana itself has more than 100 active ingredients. THC (tetrahydrocannabinol) is the chemical that induces the euphoric state associated with marijuana consumption. CBD-dominant strains have small amounts or only trace amounts of THC, so patients show no or minimal behavioral changes.
Patients, however, agree on many CBD benefits, from relieving insomnia, anxiety, spasticity, and pain, to treating potentially life-threatening conditions like epilepsy. One form of childhood epilepsy called Dravet syndrome is almost incurable, but dramatically responds to a CBD-dominant marijuana strain called Charlotte's Web.
Medical Marijuana Usage
The most common use of medical cannabis in the United States is pain relief. While marijuana is not strong enough for post-surgical pain or bone fractures, it is quite effective for chronic pain relief. It is also apparently safer than opiates (impossible to overdose and much less addictive) and can replace NSAIDs like Advil or Aleve if a person cannot use them due to kidney problems or ulcers.
Marijuana improves multiple sclerosis and nerve pain generally. This is an area with few other options, and alternatives like Neurontin, Lyrica, or opiates are highly sedative. Patients claim that marijuana allows them to continue their previous activities without feeling completely out of it or exhausted.
Marijuana can also reduce tremors in Parkinson's disease. Quite successful use is also found with fibromyalgia, endometriosis, interstitial cystitis, and most other conditions where chronic pain is a common symptom.
Cannabis can be used to manage nausea and weight loss and to treat glaucoma. A very promising research area is its use for PTSD in veterans returning from combat zones. Many veterans and their therapists report dramatic improvements and have sparked discussions about further studies and easing government restrictions for these studies.
Medical marijuana is also helpful in treating patients suffering from HIV-related pain syndrome, as well as irritable bowel syndrome and Crohn's disease.
None of the above is meant to be an inclusive list, the purpose is to provide a brief overview of pain types for which medical marijuana might provide relief. As with all medications, effectiveness must be critically evaluated and handled with caution.
Talk to Your Doctor
Many patients find themselves in a situation where they want to learn more about medical marijuana but feel awkward discussing it with their doctor. This is partly because the medical community as a whole rejects marijuana as an alternative. Doctors are now holding together and trying to stay ahead of their patients' knowledge. Other patients already use medical marijuana but don't know how to tell their doctor due to fears of being criticized or even blackmailed.
My advice for patients is to be completely open and honest with your doctor. Tell them that you consider this discussion part of your care and that you expect them to be informed and able to at least guide you towards the information you need.
My advice for doctors is that whether you are for, neutral, or against medical marijuana, patients are using it and although we don't have precise studies and a "gold standard" of evidence about medical marijuana's benefits and risks, we must learn more and think openly about it; otherwise, patients will seek other, less reliable information sources; they will continue to use it, simply not tell you, and there will be much less trust and strength in the patient-doctor relationship.
I often hear complaints from other doctors that there is insufficient evidence to support medical marijuana use, but there is even less scientific evidence that allows us to bury our heads in the sand.
Source: article, image: www.blog.ourcrowd.com