HOW DID YOU AND YOUR FAMILY GET INVOLVED IN THE MEDICAL MARIJUANA BUSINESS?
While my sister and I were still in residency, our mom started evaluating patients for cannabis use after being asked to fill in at a card clinic in Portland. She had been retired from 32 years of anesthesia for a few years and running her own wellness practice at the time. Her involvement piqued our interest and ultimately lead to the family’s involvement in the field.
What really motivated us was the lack of scientific and medical knowledge being applied clinically. It is still the case that many providers approve the use of cannabis for their patients while not understanding how it should be applied for a given medical condition. The reality is that the current scientific literature does provide pragmatic guidance to using cannabis intentionally and practically, and patients deserve to be cared for by physicians who have done their homework and can responsibly guide and oversee their use.
WHO ARE THE PRIMARY USERS OF MEDICINAL MARIJUANA?
The fastest growing demographic of cannabis users are adults aged 55 and older. In states that have legalized the plant for medical use, baby boomers appear to be turning in their prescription drugs for the much less toxic and effective option in cannabis. The most common reason patients seek medical cannabis is pain, making up 89% of Oregon patients who join or renew in the OMMP every year.
The slowest adopting demographic of users are people of color. Prohibition and the war on drugs have done a number on the collective psychology of our communities, and changing the narrative of cannabis in our communities is and will continue to be a challenge. That being said, people of color have the most to benefit from using cannabis as medicine.
WHAT ARE SOME OF THE ILLNESSES AND/OR CHRONIC DISEASES THAT CAN BE TREATED BY CANNABIS?
Cannabis treats a myriad of seemingly unrelated conditions. Common applications include pain, spasm, spasticity, nausea, anxiety, PTSD, poor appetite, and side effects from prescription drugs, like chemotherapy. More and more we are seeing patients seeking cannabis for use beyond symptom control, using it to specifically treat and shrink cancer.
Because cannabis contains many anti-inflammatory components it can truly be applied to any inflammatory condition, and that includes high blood pressure, high cholesterol, and diabetes – the leading causes of morbidity and mortality (sickness and death) in communities of color. Not only this, African-Americans are nearly twice as likely to die from these conditions than European-Americans, even when accounting for disparities in access to and quality of care.
WHEN DO YOU KNOW IT’S TIME TO TRY AN ALTERNATIVE TO CONVENTIONAL MEDICINE?
We should all be starting with natural medicine, the goal being to prevent the chronic diseases that we run to conventional medicine to treat, and often when it’s ‘too late.’ The leading causes of death amongst people of color are heart disease, stroke, cancer, and complications of high blood pressure and diabetes. These are our top 5 killers. All 5 can be prevented naturally. All 5 can be treated naturally. Unfortunately, we have a chronic care system that is bad at counseling patients on lifestyle and nutritional factors that could prevent and reverse these conditions, and that is great at prescribing quick fixes.
There is a time and a place for prescription drugs, but even when implemented early, a provider and patient’s goal ought to be to withdraw that drug once lifestyle and nutritional changes have reversed the condition. That being said, most people try alternatives to conventional medicine when it’s ‘too late,’ when desperation kicks as a result of conventional therapies failing to heal – which is what patients really want.
They don’t want to be ‘managed’ for the rest of their lives, relying on drugs, and continuing to feel sick, fatigued or in pain – they want to heal. My advice is that people consider natural or alternative care upfront, and alongside conventional care where necessary. It is never too early to use nature to address disease. As it pertains to people of color and African-Americans in particular, it is imperative to address nutrition and consider natural medicine, like cannabis, to address the diseases that the conventional system is failing to treat as well as it does European-Americans.
WHERE DO YOU GO TO FIND OUT IF YOU CAN GET APPROVAL USING MEDICAL CANNABIS?
Access to medical cannabis begins by residing in a state that has legalized the medical use of cannabis. Most states have strict residency requirements, meaning that one could not travel to a medical state to receive approval. Legal states typically have a medical cannabis program in which patients can enroll. Information and instruction may be found on a government webpage, and certainly in legislative statute (a public record).
The ease of finding a medical provider who will evaluate a patient may vary from state to state, but websites like www.Leafly.com or www.MedicalMarijuanaDoctors.com are useful for finding medical cannabis clinics or providers in a given state and zip code. In few cases, patients’ own primary care providers will approve use, which saves patients both time and money, avoiding the hassle (in many cases) of traveling to a specialty clinic and paying out-of-pocket for services.
WHY AREN’T MOST DOCTORS TRAINED ON NATURAL METHODS FOR PATIENT CARE?
This is a great question, and the answer is loaded. There are many theories why this is the case, and the leading beliefs are that nature isn’t patentable or profitable. That drugs and procedures are patentable, disease is profitable, and that the modern medical school was established to match drug to disease. What’s true is that healthy people don’t make medical clinics, hospitals, insurance companies or pharmaceutical companies money.
Natural medicine, of which the most foundational principle is ‘let food be thy medicine’ (Hippocrates), can quickly reverse inflammatory disease. Why would we be trained to do that? But this is why there’s so much excitement surrounding the paleo and ketogenic diets these days. People are taking it upon themselves to get educated on nutrition. And scientific study has even validated the superior effectiveness of diet on reversing heart disease and diabetes. But when you only receive 4 credit hours on nutrition in medical school, which was my case, a medical doctor is hardly equipped to meaningfully counsel or manage a patient using food.
HOW DO YOU TAKE IT? ARE THERE OTHER METHODS OF ADMINISTERING IT BESIDES SMOKING?
Smoking cannabis (in a joint, blunt, pipe, bong) remains the most common form of consumption, but there has been a significant rise in the use of vaporizers, vape pens, capsules, tinctures and topicals (lotions, rubs). Cannabis patches and suppositories are becoming a big hit as well.
My patients use a variety of administration methods, often times not choosing just one method. This is because each method has its on onset of action and duration of effect, and a many variables may be at play when choosing when, where and how one uses or consumes their cannabis. And not only this, many patients want to be discreet with their use. Vape pens, capsules and tinctures, for example, are odorless and, especially with capsules and tinctures, unassuming.
IS IT TRUE THAT MEDICAL MARIJUANA CAN HELP SEIZURE SUFFERERS?
It is true that cannabis does help seizure sufferers. In fact, the federal government has held a patent on cannabis (cannabinoids) since 1999 on its use as a neuroprotectant and antioxidant, and useful for concussions, CTE, Alzheimers, stroke and seizures. The FDA also just approved a cannabis extract made by a pharmaceutical company, called Epidiolex, for specific seizure types that are difficult to treat with conventional drugs. It is no secret that cannabis can treat seizures.
WHAT’S THE AGE REQUIREMENT FOR MEDICAL MARIJUANA?
There is no age requirement for the medical use of cannabis set by statute in any state, that I believe. Adult use states have set the legal possession and purchase age to 21, but with respect to medicine, providers are allowed to approve the use of cannabis for children when warranted. In Oregon, Washington and California (where I practice), parents commonly seek cannabis use children suffering from seizures, cancers, and pain and spasticity from cerebral palsy or other debilitating conditions.
WILL YOUR MEDICAL INSURANCE HELP PAY THE COST OF MEDICAL MARIJUANA?
WHAT’S THE DIFFERENCE BETWEEN MEDICAL MARIJUANA AND REGULAR MARIJUANA?
There is no difference. Legislation and regulations may arbitrarily differentiate between the two by setting different potency parameters and tax rates, and users may arbitrarily differentiate between the two by why and how they are using it, but there is no physical difference between the two. Cannabis is cannabis.
WHAT ARE THE BENEFITS OF MEDICAL MARIJUANA?
The benefits are many and varied, and I touched upon the most common uses (where benefit is found) earlier on. The broadest benefit is system inflammation reduction (total body inflammation reduction). This is why you may start to hear healthcare providers recommending cannabis as a daily supplement.
The most common benefits I hear from my patients are pain reduction, appetite improvement, anxiety reduction, nightmare reduction, spasm or seizure control, improved sleep, and prescription drug reduction or cessation. Patients have been able to get off of their prescription drugs with cannabis.
ONCE A PATIENT IS TAKING MEDICAL MARIJUANA, HOW CAN YOU WEAN THEM OFF OF IT?
Most patients taking medical cannabis won’t and shouldn’t wean from it. Given its wide safety profile, it is a suitable substance for lifelong therapy if warranted. That being said, it has been postulated that cannabis use carries a 9% addiction/abuse rate – a number most experts believe is confounded, given that many minor cannabis offenses have been reduced in exchange for participation in rehab programs, meaning that cannabis offenders get labeled and counted as cannabis addicts/abusers by virtue of enrollment in a rehabilitation program, and not because they are a dependency problem.
But in cases where a person is addicted to or abusing cannabis, cessation can cause withdrawal symptoms for a small number of people whose use was heavy and chronic (we’re talking heavy daily users). In this subsets of cases, weaning (lowering the dose) slowly is warranted to avoid withdrawal symptoms like nausea, vomiting, headache, sweats. Cannabis withdrawal does not carry the risk of death as does the withdrawal from opiates and alcohol.
WHAT’S THE BEST WAY TO FIND A PHYSICIAN THAT SPECIALIZES IN MEDICAL MARIJUANA TREATMENT? CAN YOU RECOMMEND A DIRECTORY OR SITE TO FIND A PHYSICIAN?
A portion of my practice at the American Cannabinoid Clinics is online, and we see patients from across the country (and world) on a weekly basis for cannabis counseling through our telemedicine platform. We can only write cannabis use authorizations for patients in states we are licensed in. You can find us at www.theacclinics.com or www.americancannabinoidclinics.com. Other websites, as I mentioned earlier, are www.eafly.com, and www.MedicalMarijuanaDoctors.com.
Dr. Knox answers your ‘Text Tom’ questions on the next page.