YOUR DOCTOR, NURSE & MEDICAL MARIJUANA
Medical Marijuana Doctor
"We couldn't find a single malpractice case relating to Medical Marijuana" -- Medscape
This article is a guide for California Doctors and Caregivers seriously considering the professional use of Medical Marijuana.
At the heart of the matter is a lack of quality knowledge. Some doctors just don't know about the science and practitioner's issues related to Medical Marijuana.
"A local physician had suggested to a young woman undergoing Chemo; that Marijuana might be quite helpful. However, the physician in question did not write a legal recommendation. At first, he said he would, but said he had to learn how to go about it. After a month, the doctor hesitated, even though he knew it was probably a good medicine, he wasn't sure how to provide legal coverage and cover liability issues." -- MMJ Patient Testimonial (paraphrase)
Good Science - Clinical Studies - MD Reports - Patient Testimonials
- There are more than 28,000 peer reviewed studies, clinical trials and reports by your colleagues that discuss the efficacy of Cannabis based drugs.
- The endocannabinoid system is the major regulatory mechanism of both the immune system and nervous systems in humans.
- Cannabinoids found in Medical Marijuana can modulate endocannabinoid receptors to effectively balance and help restore normal function, thereby treating symptoms and conditions.
- Cannabinoids demonstrate neuroprotective, antioxidant and antimicrobial activity among other benefits.
- The consensus opinion of experienced patients and doctors - Medical Marijuana works very well.
- Medical Marijuana has been found to be particularly effective to treat fragile people; cancer and HIV patients, elderly.
Medical Marijuana - Issues that Doctors Worry About
I am comfortable with prescribing orthodox medicines - but not Marijuana.
- You need to consider that in the State of California there are 86,000 licensed Medical Marijuana patients, all Recommended by licensed Doctors. Not one has ever been sued for malpractice. Compare that statistic with Medical malpractice claims in other areas. MMJ is extremely safe for not only patients, but for doctors too!
I really don't believe in organic medicines, especially Cannabis, I trust pharmaceuticals.
- We suggest that you read this article to become better informed and then reappraise the situation.
If I Recommend Marijuana, will my patients still trust me?
- Some patients will wonder about a doctor that mentions Marijuana, however, in our experience, far more patients trust a doctor that is liberal and in step with the times. It is now politically incorrect in many parts of the country to frown upon Medical Marijuana.
I don't know what's in MMJ.
- This is a valid point. However, the reality is that we don't know that much about most of the food and drink we consume in any case. The bottom line, the consensus opinion of researchers is that Marijuana is very safe, despite the non-standardization.
The Cannabis plant is not regulated by the FDA. and might contains toxic impurities and contaminants.
- FDA regulation could work in theory, but there is a lot of discussion regarding the need to restructure that group - to sort out their accumulating imperfections.. Meanwhile, there certainly could be an improvement in industrial testing - by accurately quantifying active ingredients. However, some Medical Marijuana groups do currently perform world-class testing on their Cannabis-based Medicines - using mass spectrometry and other sophisticated test methods. The trend is positive toward, quality.
I don't like patients controlling the dose.
- This is a good point. Of course, feedback from the patient about dose-effect is something every doctor should consider for all medications. Unfortunately, many doctors don't always get the feedback they ideally need and some patients don't take medications as they should. So, there are issues in orthodox dosing and often the situation does not approximate perfection.
Overdosing using Medical Marijuana has minimal hazards. Secondly, if a patient is aware that dosing amount and frequency and is a big issue, they'll take better notice of makes them feel best - what works well. At the end of the day, patients assume all liability in taking the medicine and the simple old school approach works for experienced practitioners and patients.
There is more money in pharmaceutical drugs.
- This statement is counter to affordable solutions like MMJ and is obviously not in the best interests and well being of patients.
We don't have any formal education in Cannabinoid / Endocannabinoid Science.
- This can be mitigated by piggy backing on the learnings of experienced doctors. See further reading section for a primer.
Medical Marijuana is not standardized and patient dose / usage is impossible to control with any degree of certainty.
- We think Doctors should encourage patients to use a supplier that can produce a current certificate of analysis; Cannabinoid profile (THC, CBD,) other constituents like terpenes and prove that the composition of active ingredients and show the Cannabis medicine is free of pesticides and herbicides. We can't Recommend growers that do not test their Marijuana regularly. We also think that until the FDA is restructured, as some presidential candidates advocate, the MMJ industry will likely to continue to progress through self-regulation. The industry, while growing organically, is surprising sophistication.
Prescribing MMJ will lower the public's perception of my status.
- Medical Marijuana is becoming politically correct, damping concerns for many.
I don't want to be associated with unsavory, seedy characters.
- Physicians and Medical practices that Recommend Medical Marijuana need only document that they do not encourage illegal activity and are not involved in the process of purchasing and acquiring Cannabis.
I would much rather give a prescription for a medicine I understand.
- On the surface, this statement makes sense, but it's really and poor excuse. Continuous education is the responsibility of good health care professionals. If Medical Marijuana is legal in your precinct, then it is an obligation, really, to research the efficacy of a medicine that might help your patients.
I am worried about side effects.
- Patients should sign a waiver assuming full responsibility relating to their MMJ use. Marijuana has side effects, especially the over 20+% THC varieties. Cannabis over consumption may affect coordination / cognition that impairs motor skills. Temporary psychosis can be an issue, but fortunately it's of the seldom self-harming. New non-psychoactive Cannabis Medicines provide a viable safe alternative.
I prefer to prescribe drugs that I can control instead of supporting the use of a street drug.
- Doctors need to decide if Medical Marijuana can help their patients or if personal control is the most important issue. Patients should assume full responsibility - in writing - of events that happen as a result of being given a Medical Marijuana Recommendation.
I am worried about liability issues.
- Just get patients to sign a waiver (see below). Malpractice is literally a non-issue.
"We couldn't find a single malpractice case relating to Medical Marijuana. Legal experts say it's difficult to see how such a lawsuit would be successful, assuming that a patient who asked for a Recommendation and received one would even want to sue." Mark Crane - Medscape Business of Medicine
Physician's Issues - Cannabis Consultation & Recommendations
What's in Medical Cannabis?
What is the content of THC, CBD and other medicinal compounds in different strains?
People that enjoy Marijuana can usually handle any strain. with worst case scenario being - if they smoke too much hi-grade pot, they'll be glued to the couch for the evening and nothing more. Overconsumption by THC hyper-responders on the other hand- will cause some to freak out as they say. Moderate doses of THC:CBD on the other hand, are palatable most patients.
Generally speaking, this is an issue. Often there is a lab test report of the strain's composition or Cannabinoid profile. Lab data for a strain can be either accurate or approximate - as potency and character can vary from grower to grower, crop to crop. Ideally, every harvest should be tested.
What about synthetic Marijuana?
Standardized pharmaceutical Marijuana formulations typically have one singular active ingredient, such as THC. The consensus opinion of bona-fide researchers is that THC alone, whether synthetic or organic, does not work as well as whole plant extracts. Patients generally do much better with balanced strains and medicines containing balanced amounts of CBD:THC where the tendency for some patients to experience side effects such as paranoia is greatly reduced.
What is the correct dose?
Optimizing the dosage is tricky business in any case. If a doctor reflects on what dose is best - for any medicine - there are many factors to consider, such as race, sex, age and genetically-individual tolerance. In the case of MMJ, the effective dose must be left to each individual patient to find, and this makes some physicians uncomfortable.
At any rate, people should know that a dose of tens of mg of Cannabinoids can be clinically effective, while hundreds of mg actually made symptoms worse.
A Veteran Physician in the Field of Cannabis Therapeutics Shares Findings and Advice with other Doctors.
"The effective dose must be left to each individual patient to find, and this makes some physicians uncomfortable."
"Most patients are already using Cannabis at the time they present for a Cannabis approval."
"A patient who also happened to be a police officer, stopped to talk before leaving the office and said - would you please start writing more Recommendations for Medical Marijuana? I find pot in people’s possession and I ask them for their Recommendation, and if they don’t have one I have to take them in. I don’t want to waste our time anymore. Please do your part to help. That was the day I decided to add Medical Cannabis Recommendations to my full scope family practice."
Stacey Kerr, MD, Santa Rosa, CA
- Get educated about Cannabinoids - see PubMed and Further Reading (below)
- Create informed Consent & Recommendation forms for your practice
- Talk to your patients & document your discussions / findings
420EvaluationsOnline Notes: We provide MMJ Evaluations, Recommendations, Medical Marijuana ID cards, Cannabis Consultations, 24/7 validation and more. We need Partners, including licensed physicians in all geographic areas - to help service our rapidly growing client base. All documentation is completed entirely online and upon the patient's approval, records can be emailed immediately to the referred / preferred physician.
FURTHER READING - DOCTORS & MMJ