Medical Marijuana - Breaking the Stigma
Updated: Sep 7, 2022
Where my passion started
In 2019 I was walking my Bassett hound in Key West, FL when a woman comes running after my family and asked us to wait while she brought out her Basset hound. The woman was a retired emergency physician who was in Key West working as a marijuana physician. Being an emergency doc myself, I was intrigued but knew nothing about medical marijuana. I, like most of my physician colleagues, looked at medical marijuana users as a stoners ticket to legalized pot.
Well, a year later COVID hit. I was no longer employed, so I began to recall my conversation with the doctor in Key West. By August of 2020, I had my Pennsylvania medical marijuana physician certification and started working for a large company. When I started, I thought stoners would be most of my patients and had prepared myself to deny them certifications. My first day I was shocked at how many legitimate people I saw that were struggling with anxiety and pain; and, more so, by the number of patients who had truly been helped by medical marijuana. After a few weeks, I felt my patients needed more. They needed a truly educated doctor and continuity of care. I began to read more about medical marijuana and began the process to open my own practice. Here is a little summary of what I learned.
Marijuana, Cannabis, CBD, Hemp-What is the difference?
When I started this journey, I had no idea what all the different terminology meant so let me break it down for you. Cannabis is the genus of the plant species that encompasses what we think of as marijuana and hemp. THC and CBD are the most well known and predominant cannabinoids in cannabis. The THC compound is the one known most famously for the high sensation you get from cannabis, a psychoactive response. And in many states and on a federal level, it is still illegal. CBD, alternatively, is considered a “non-psychoactive” compound, meaning that you do not get the high that we associate with THC. CBD is present in both marijuana and hemp, however, hemp must contain only trace amounts of THC no more than 0.3%, which is not enough to result in a psychoactive response. This is what you see at convenient marts, online, and vape shops. These products are from hemp. According to US Law, the term marijuana refers to the dried flowers and leaves of the cannabis plant. So, both hemp and marijuana are cannabis.
Cannabis IS Medicinal
Cannabis can help patients suffering with numerous conditions. For a long time, reports of the medicinal benefits of cannabis were anecdotal, but research is growing and so is the evidence that cannabis is an effective, safe treatment option. Cannabis works because both CBD and THC are chemically similar to your body’s endocannabinoids. This allows them to interact with your cannabinoid receptors, CB1 and CB2. These receptors are in areas of the nervous system that affect movement, coordination, responses to stress, and responses to inflammation and pain. As well, they are widely distributed throughout the peripheral organs and the immune system. Through its interactions with the endocannabinoid receptors, cannabis is thought to help alleviate anxiety, reduce inflammation, relieve pain, control nausea, relax muscle spasm in multiple sclerosis, and stimulate appetite in patients with cancer and AIDS. Some studies even show that marijuana improved inflammatory bowel symptoms including abdominal pain, nausea, and decreased appetite.
Repeatedly, I hear from my patients that their lives have been changed since starting medical marijuana. Anxiety patients that they felt blunted, like a zombie lacking emotion. While the anxiety was better, they did not feel like themselves. Many would rather suffer debilitating anxiety rather than have no emotion. Many worry about the addictive and potentially deadly side effects of benzodiazepines. After starting medical marijuana they no longer feel medicated. Rather, they feel themselves without fear, panic, and often physical manifestations. And many are able to come off of benzos and other psychiatric medications.
Pain patients who come into the program taking opiate medications multiple times a day slowly wean to using maybe once a day, and many stop using opiates all together. Patients who hadn’t slept in years because of pain report they are finally able to sleep and how “life changing” that has been for them. Patients who had addictions to opiates who may be in a methadone or suboxone program are able to not only remain sober but also come off the methadone or suboxone.
It is not just pain and anxiety. I had a mother cry because her teenage autistic son began to speak after starting medicinal marijuana. Crohn’s patients that could eat again and live life without constant pain and nausea. And cancer patients who could treat the pain and nausea of treatments and calm the overwhelming anxiety that comes with a cancer diagnosis.
These patients are not the exception but rather the majority of my practice.
Living in Shame
Because of the stigma placed upon medical marijuana, most patients do not speak of their use. They feel stigmatized as a stoner looking for a legal high even though many patients don’t even get high to get the effects of medicinal marijuana. One does not need to be high to feel the medicinal effects of marijuana. Many patients do not even like the feeling of being high, but they like being able to live again. Repeatedly, I hear that they don't want to tell their doctor or that they don’t feel comfortable talking about medical marijuana with friends/colleagues because they will be judged.
Breaking the Stigma
Marijuana is medicinal. Marijuana does change lives. I believe that is up to the medical marijuana community to work together to break the stigma. The department of health needs to regulate large corporate certification factories that contract physicians who never follow up with patients, offer little or no guidance, and create a moral hazard by only paying physicians if they certify patients. Marijuana physicians need to be educated about medical marijuana just as in their other medical specialty. They need to ask questions and offer solutions. Dispensaries need to be more judicial and flag patients they may be concerned are abusing medicinal marijuana. Perhaps, notify their certifying physician or the dispensary pharmacist can speak to the patient about how they are using marijuana and offer guidance. Clearly, the solution is not simple. But hopefully after reading this you have a better understanding. Hopefully, now you recognize that marijuana patients are normal people, people like you, your neighbors, your co-workers. They are young, they are old, they are from every economic background, they are parents and grandparents, they are patients with a medical condition that is being treated effectively and safely with marijuana.