There are few subjects that can stir up stronger emotions among doctors, scientists, researchers, policymakers, and the public than medical marijuana. Is it safe? Should it be legal? Decriminalized? Has its effectiveness been proven? What conditions is it useful for? Is it addictive? How do we keep it out of the hands of teenagers? Is it really the “wonder drug” that people claim it is? Is medical marijuana just a ploy to legalize marijuana in general?

These are just a few of the excellent questions around this subject, questions that I am going to studiously avoid so we can focus on two specific areas: why do patients find it useful, and how can they discuss it with their doctor?

Marijuana without the high

The least controversial is the extract from the hemp plant known as CBD (which stands for cannabidiol) because this component of marijuana has little if any, intoxicating properties. Marijuana itself has more than 100 active components. THC (which stands for tetrahydrocannabinol) is the chemical that causes the “high” that goes along with marijuana consumption. CBD-dominant strains have little or no THC, so patients report very little if any alteration in consciousness.

Patients do, however, report many benefits of CBD, from relieving insomnia, anxiety, spasticity, and pain to treating potentially life-threatening conditions such as epilepsy. One particular form of childhood epilepsy called Dravet syndrome is almost impossible to control but responds dramatically to a CBD-dominant strain of marijuana called Charlotte’s Web. The videos of this are dramatic.

Uses of medical marijuana

In the US, pain management is medical marijuana’s most popular usage. Marijuana is highly good for the chronic pain that afflicts millions of Americans, especially as they age, even though it is not strong enough to treat severe pain (such as post-surgical pain or a broken bone).

One of its allures is that it is unquestionably safer than opiates (it is impossible to overdose on and significantly less addictive), and it can substitute for NSAIDs like Advil or Aleve if patients are unable to take them owing to kidney, ulcer, or GERD issues.

Marijuana appears to be very effective at reducing nerve pain and the discomfort associated with multiple sclerosis. There aren’t many alternatives in this area, and the ones that do, like Neurontin, Lyrica, or opiates, are very sedating. Patients report that cannabis enables them to continue their prior tasks without feeling entirely groggy and uninterested.
In a similar vein, marijuana is reputed to be an excellent muscle relaxant, and many swear by its capacity to diminish Parkinson’s disease-related tremors. Additionally, I’ve heard of its successful application to fibromyalgia, endometriosis, interstitial cystitis, and the majority of other illnesses whose persistent pain is the final common pathway.

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In addition to being used to treat glaucoma, marijuana is also utilized to manage nausea and weight loss. Its application to treat PTSD in veterans who have just returned from battle zones is a very promising field of research.

Many veterans and their therapists see a marked improvement and call for additional research as well as a relaxation of legislative constraints on the field’s study.

Patients with irritable bowel syndrome, Crohn’s disease, HIV-related discomfort, and wasting syndrome are also said to benefit from medical marijuana.

This is not meant to be an exhaustive list, but rather a quick overview of the several ailments that medical marijuana can treat. Claims of effectiveness should be scrutinized and handled cautiously, as with any cure.

Talking with your doctor

Many patients find themselves in the situation of wanting to learn more about medical marijuana but feel embarrassed to bring this up with their doctor. This is in part because the medical community has been, as a whole, overly dismissive of this issue. Doctors are now playing catch-up and trying to keep ahead of their patients’ knowledge on this issue. Other patients are already using medical marijuana, but don’t know how to tell their doctors about this for fear of being chided or criticized.

I would advise patients to have high expectations of their doctors and to be completely honest and transparent with them. Inform them that you view this as a component of your care and that you anticipate them to be knowledgeable about it and able to at the very least guide you in the direction of the facts you require.

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Although we lack rigorous studies and “gold standard” proof of the advantages and disadvantages of medical marijuana, I advise doctors to learn about it, be open-minded, and most importantly, be non-judgmental.

Patients are embracing medical marijuana, whether you are for it or against it. Otherwise, our patients will seek out other, less trustworthy sources of information; they will continue to utilize them, just not tell us, and our doctor-patient relationship would be far weaker.

Other doctors frequently argue that there isn’t enough data to support the use of medical marijuana, but there is even less evidence to support burying our heads in the sand.

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