Medical Marijuana: Impact on Physician-Patient Relationships | The Doctor Weighs In
By: Seth Ginsberg
Medical marijuana, also known as marijuana for medical use (MMU) is becoming increasingly available in the United States.
Medical marijuana, also known as marijuana for medical use (MMU) is becoming increasingly available in the United States. So far, 33 different states have legalized it allowing it to be available to patients under specific circumstances.
According to a survey conducted by CreakyJoints using our ArthritisPower Research Registry, more than half of arthritis patients (57%, n=1,059) have reported trying MMU and/or cannabidiol (CBD) products for a purpose they perceived as medical. Of those who use MMU regularly for medical reasons 62 percent reportedly use MMU at least once daily.
Why do patients with chronic pain seek medical marijuana?
The attractiveness of these products stems from the unmet treatment needs of people living with rheumatic and musculoskeletal diseases and other chronic conditions. Many of these patients are seeking non-pharmacological alternative and complementary treatments to help manage their condition and symptoms.
Here is what we know about MMU use in these types of patients:
- Even in states where MMU is not legal, people with arthritis are trying MMU. According to our survey, the figure is 24%.
- Yet, we also know that of respondents who live in states where marijuana is medically legal, nearly one-third (31%) had not informed their health care provider (HCP) about their MMU use
- In non-legal states, only (46%) had informed their HCP in non-legal states.
A quandary for physicians
This sets up a quandary for physicians. Depending on where their patients live, the MMU and CBD products that they are taking are regulated in variable ways.
Even more concerning is that physicians are without any credible, peer-reviewed guidelines that provide a standard or even suggested approach to incorporating MMU (and CBD products) into the management of arthritis.
Marijuana remains a Schedule 1 substance, meaning the federal government prohibits its study as a possible prescription or OTC medication.
Related Content: Medical Marijuana: What Is CBD and How Is It Different Than THC?
It’s important that people with arthritis and other chronic disease are at the center of their care. They need to feel empowered to ask questions about their treatment and make suggestions for future management. They also need to have reasonable access to those treatments.
According to our survey, of those who consulted with a doctor about using or wanting to use MMU, 58 percent reported that their healthcare provider did not offer advice about the effectiveness or proper dosage. Nor did they consider marijuana or CBD use when making treatment changes.
Again, we can draw a direct line from the lack of clinical study to the lack of information that physicians can communicate to their patients. Given this scenario, patients are motivated to rely on anecdotes or experiment with products to determine whether MMU or CBD might make them feel better.
Physicians need to ask their patients about whether they are trying or interested in trying MMU or CBD products so that they can monitor its impact on their symptoms and/or treatment, plus incorporate it into their electronic health records. Patients need to feel confident that they can confide about their use of these adjunctive products without repercussion particularly in states where MMU is not legal.
It’s time to reschedule medical marijuana
On November 20, the House Judiciary Committee approved (24–10), the Marijuana Opportunity Reinvestment and Expungement Act of 2019 (the MORE Act). This Act would decriminalize marijuana at the federal level.
It would remove marijuana from the list of federally controlled substances. It would also allow states to set their own policies to determine access and use of marijuana. Further, it would require federal courts to expunge prior convictions for marijuana offenses.
There are other provisions that are meant to spur investment in the business of marijuana as well as substance abuse treatment. Despite approval in committee, approval in the Democratic-led House and Republican Senate is considered a longshot.
This conversation is too important to let wither on the vine.
By necessity, patients have put the cart before the horse by trying MMU and/or CBD as a supplemental and/or alternative therapy to manage the ups and downs of their chronic conditions. That’s why at CreakyJoints, we are urging the federal government to reschedule marijuana so that it can be studied in high-quality clinical trials.
Questions waiting to be answered
There are questions waiting to be answered, including:
- What is the optimal dose for people living with arthritis and other chronic diseases?
- What is the optimal administration method?
- How does MMU and/or CBD interact with prescription medications for arthritis (or other chronic diseases)?
- What is the safety profile for MMU and CBD?
The bottom line
The medical community and the federal government that regulates access to prescription medications have a responsibility to patients to better understand these products. Further, this must be done expeditiously. There is no time to waste.
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Seth Ginsberg is the President and Co-Founder of Global Healthy Living Foundation and CreakyJoints, the digital community for millions of arthritis patients and caregivers worldwide who seek education, support, activism, and patient-centered research. An arthritis patient himself, Seth has dedicated his career to advocating for the arthritis and chronic disease community.
Since 2014, Ginsberg has served as a Principal Investigator of the PCORI-funded patient-powered research network ArthritisPower®. As a web and smartphone app, ArthritisPower is an innovative registry engineered for and by people with rheumatoid arthritis and related autoimmune and inflammatory conditions. Research efforts are overseen by a patient governor group as well as a distinguished research and corporate advisory board.
Seth lives in New York City with his wife, two young children, and a dog named Little Dude. Learn more at https://creakyjoints.org/your-team/
Originally published at https://thedoctorweighsin.com on December 17, 2019.