Op-Med is a collection of original articles contributed by Doximity members.
I have one objective and one objective only when I consult with my patients: to walk them through how to safely use medical marijuana for their specific medical condition(s). The goal is to treat, not to get high, not to smoke it, and not to form an addiction.
Successfully treating patients with medical cannabis entails answering the following questions:
How do you select a marijuana product based on the cannabinoid composition for the patient’s specific medical condition(s)?
Medical marijuana is not a one-size-fits-all solution. If there’s one thing I’ve learned in the five-plus years I’ve been practicing in the field, it’s that this is a very nuanced science, just like with any other medication.
There’s also a misconception that medical benefits of marijuana are derived exclusively from cannabidiol (CBD). That’s just not the case.
In fact, some patients benefit from higher concentrations of tetrahydrocannabinol (THC), others benefit from high concentrations of CBD, and then there are those who benefit from both: CBD and THC. Finally, there are patients that need to utilize some of the other cannabinoids that marijuana produces.
Ultimately, it boils down to the combination of symptoms and diagnoses that are ailing the patient.
How do you select the most appropriate delivery method for the patient’s specific medical condition(s)?
Smoking is not the only means of consuming medical marijuana. There are a wide variety of other methods of administration: topicals, sublinguals, inhalation, orals, rectals, or vaginals.
Just like with any other medication, the preferred delivery method varies based on medical history and diagnosis.
For example, in some patients with a previous history of a gastric bypass, the oral route has proven to be ineffective. These patients often report no effects with the use of an oral medical marijuana product, adverse or otherwise.
How much should patients take?
One of our primary jobs as physicians is to titrate a patient’s medication down to an optimal dose within the therapeutic window. As a medical marijuana doctor, I do nothing different. The medication is just unique.
When and how often should patients take marijuana?
There’s a misconception that “more is better” when it comes to medication in general. This misconception carries over to medical marijuana as well. More often than not, I’m guiding my patients to reduce their frequency of use. I focus on optimal (not maximal) frequency of use.
But, it goes even beyond that. There is some logistical information to review with my patient as well. This includes taking medical marijuana with other prescription medications.
This is one of the most important discussions I have with patients. And even more important is the discussion about coming off of their other prescription medications. For many patients, this is their ultimate goal. They’re simply fed up with experiencing side effects, constantly being paranoid about getting addicted, and, quite frankly, the other prescriptions just aren’t working.
How does a patient buy medical marijuana?
This is a conversation I have to have with my patients. It’s not like a usual prescription, which you can hand to the patient for them to take to the nearest pharmacy. In states where marijuana is legalized for either medical or recreational use, marijuana is specifically dispensed at state-licensed medical marijuana dispensaries. But, most patients aren’t even aware of this fact. Funny enough, a handful of times, I’ve had patients bring their medical marijuana card to their local pharmacy to get medical marijuana. They’ve walked away empty handed, leaving behind apharmacist in total and utter shock.
There’s another important component at play here. If I don’t guide my patient on what to specifically ask for at the medical marijuana dispensary, then they’re left at the mercy of the “medical advise” of the person behind the counter doling it out — a “budtender.” Though well-intentioned, these people are more less likely to have the required medical knowledge or expertise to make the decisions for patients. The budtender may also leave patients confused and overwhelmed because they’ve now been sold 10 different products, when one specific product is required to help with their symptom or diagnosis.
With this, as with all things, clear and detailed communication is the key.