Research

What is the Medical Profession saying about Medical Cannabis?

Background: As the treating doctor for over 300 PTSD Canadian Forces Veterans, I have been experienced varying attitudes from my professional peers regarding medical cannabis. Below are some common questions I have been asked as well as my responses.

1. It’s too early to have an opinion, and it’s not responsible to prescribe something that is not defined or researched.

Response: Marijuana through history may well represent thousands of different strains, grown in uncontrolled back yards and environments, with pesticides, molds, and “additives”. However, we are in a new age in which strains are cultivated specifically to address specific health conditions. These strains are pure, clean and more importantly… they can be reproduced. Doses can be controlled and calculated while vaporizers can deliver a known amount of product. Newer formats of product will be even better, as they become available from “Health Canada” or FDA.

Components of high grade medical cannabis have been defined. These include more than just THC, but also antioxidants, terpenes and CBD levels. Even brain receptors responses to these products are now well defined. Neuro-feedback technology can also “map” the brain’s response to such products. The natural marriage of components in medical cannabis have not been reproduced by the pharmaceutical industry, much to their dismay as this fact has denied them of billions of dollars in profit.

2. I don’t want to be responsible for writing a prescription for a substance that will make my patient stoned and dangerous behind the wheel. There could be an unknown liability for having prescribed this product.

Response: The same can be said about any narcotic or “nerve pill”, which remain far more dangerous and deadly than medical cannabis has been shown to be. As with any prescription for a drug that can initially cause a “stoned feeling”, it needs to go through the usual precautions and education for safe implementation to the patient’s lifestyle. The problem here is that the average doctor has not been educated in the safe methods of medical cannabis usage and may feel inadequate attempting to explain cannabis therapy to the patient.

There is no denying that the initial titration of medical cannabis must include precautions and education towards the ultimate endpoint for proper response, which would include driving, using any machinery or dealing with the public. The titrated end point should be a very functional, safe and comfortable place for the patient who requires this medicine. The stable functional dose for patients such as for chronic pain or PTSD produce a very focused, social, comfortable place that produces far less risk than an untreated patient, much like the chronic stable narcotic user. We often use an educational video for the “new medical cannabis” patient…or even better, a temporary “buddy system” from other stable and experienced users of medical cannabis, to actually be with the patient in the initial stages of titration, or be available for questions and coaching if needed.

The question often comes up about driving heavy equipment while using medical cannabis and the answer remains that no use of marijuana in commercial vehicles that involve other persons such as an airplane or a schoolbus is allowed, however DOT has the same “Grey Zone” when it comes to the driving a private vehicle. If the person is found to be functional then no issues exist in the “eyes of the law”. If the person is driving a “payloader” at the worksite, and declares his/her use of medical cannabis to a supervisor, performance testing such as dropping the “rock in the bucket” often shows a functional worker that is to be labeled as “with precautions”.

3. I’m worried about addiction and withdrawal side effects.

Response: The current statistic of a 9% addiction rate among cannabis users needs to be viewed from a certain perspective. If a product such as cannabis resolves an undiagnosed depression or anxiety, then we cannot use the term “addiction” when the patient resists removal or denial of a product that makes him/her feel better. The percentage of undiagnosed depression/anxiety in the general population has been quoted to be as high as 30% and cannabis has been shown to help this diagnosis in adults.

In my personal experience, withdrawal is rare, and simply represents the return of the underlying symptoms that existed well before marijuana was ever used. Even in the rare situation that might have been said to be a possible case of withdrawal, the symptoms of craving and agitation lasted only about 3 to 4 days and were not very uncomfortable. This is vastly different to narcotics, benzodiazepines or even antidepressants.

An incidental note here is that if you ask the average PTSD patient without chronic pain if they could see their life without medical cannabis, they will usually state that they would much rather not have need for any treatments, and that they would like to return to a life without any medical treatments at all, including cannabis.

4. I can’t condone the smoking of marijuana as it might cause lung cancer.

Response: I fully agree that smoking any product may increase the risk of lung and cardiovascular problems. The healthiest solution is to “Vaporize” the product which is very effective and provides an almost equal response time as smoking, with the added advantages of a much more efficient use of the costly product. There is also lingering smell and the added advantages of a much more measured and controlled dose with the newer devices.

The risk/benefit ratio is unknown.

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Conclusion: Medical cannabis is certainly not a first line treatment yet. The expectation remains that if a patient is requesting consideration for therapy, he/she would have tried several if not many other standard treatments first. These treatments would have failed for valid reasons, including serious side effects or poor risk/benefit ratios for the other drugs. If some form of treatment is required , then this situation certainly sways the formula towards a better risk/benefit ratio for cannabis.

In the case of PTSD, almost all patients have tried and failed with standard therapies and have experienced a long list of side effects including an increase in suicidal thoughts or tendencies. In this specific group where suicidal thoughts and/or tendencies are very high as compared to other diagnoses, the risk of not treating this group is far more dangerous than the decision to treat.