Speak with your patients about cannabis

As healers, we are most comfortable and confident when we can rely on the long-established armamentarium of countless medications created by the American pharmaceutical industry.

This arsenal of disease-fighting weapons is evidence based, precisely measurable and usually supported by decades of well-documented research and clinical experience.

And then there is cannabis. More than perhaps any other medicinal substance, it has remained a source of ignorance, confusion, misinformation and even fear — as in fear of prosecution. Most of us have understandably shied away from incorporating it into our practice and have left it to our patients to figure out on their own whether the supposed benefits are worth the risks — known and unknown.

But major change is upon us. Not only have 38 states already legalized medical marijuana, but the Biden administration has just initiated historic steps to remove marijuana from the schedule 1 class of dangerous drugs, officially recognizing the medical benefits of cannabis and opening the door to additional federal research that will better identify its actual advantages and dangers for use in a variety of ailments.

This is potentially the biggest drug policy change in half a century. As a physician who has devoted his career to promoting integrative approaches to whole-person care, I believe that we must seize the opportunity to educate ourselves and our patients about the potential value of cannabis in delivering that care, particularly for our patients with cancer.

As most of us already know, cannabis has been scientifically demonstrated to safely relieve some of the most debilitating symptoms of cancer such as nausea, weight loss, anxiety, insomnia and possibly neuropathy and other forms of pain. With every passing year, surveys show that increasing numbers of physicians agree that the evidence supports a wider use of cannabis. But that acceptance has not yet translated into action for most of us.

At the Healing Works Foundation, we are trying to help by publishing a “Cannabis and Cancer Pocket Guide” to help providers become comfortable with the idea of partnering with their patients to explore this unfamiliar substance and possibly use it to help reduce the use of opioids. I believe strongly enough in embracing this challenge that I also have devoted attention to it in my newly published book Healing and Cancer.

Since legalization in many states, some medical schools are taking long-overdue steps to incorporate education on cannabis into the curriculum for medical students. Cannabis certification programs, like the one at Sidney Kimmel Cancer Center at Thomas Jefferson University in Philadelphia, train their doctors on the available evidence, the variety of cannabis products and methods of administration such as vaporization, ingestion, topical, suppository, etc. Perhaps most importantly, they also train teams of doctors about how to talk to their patients and help reduce the uncertainties inherent in the process.

As highly educated and well-trained professionals, we are not comfortable with our own ignorance. Most of us know only the basic chemistry; that the cannabis plant contains more than 100 different cannabinoids, among them THC, which has psychoactive effects, and CBD, an effective antiseizure medication that is being studied as a treatment for Parkinson’s, schizophrenia and other ailments.

But the fact is that in many states, a trained “budtender” at a legally certified marijuana dispensary knows far more than we do about the complexities of this ancient botanical and its various strains. Most of us are not aware that the indica strain tends to relax people, the sativa energizes them and the hybrid strains mix these benefits — and their potential side effects.

Our patients are often far ahead of us. They are seeking answers for their insomnia and pain and exploring on their own the wide variety of products available, beyond just smoking a joint. They are vaping, swallowing edibles and anointing themselves with various kinds of cannabis oils, tinctures and salves.

But they are also facing a bewildering array of questions: How can I register to use medical cannabis? What kind of cannabis really works? What doesn’t? What could make me worse? Who can I trust for good guidance? How can I get the product paid for by insurance? In some cases, they are failing to ask the right questions and putting themselves at serious risk. High-dose cannabis oil, for example, may actually cause some cancers to metastasize.

So how do we guide our patients through the wild, wild west of weed? Our patients will increasingly be coming in and asking us about this. And our response is crucial. Will we help guide them and build their trust? Or will we essentially cop out by claiming that we just don’t have enough solid information?

I believe we can’t wait for a gold standard of proof of benefits, but instead must join our patients in an open-minded and nonjudgmental search for the best answers possible for them now. I face this in my own practice because my practice is in a government clinic and I cannot legally prescribe cannabis. Yet I have encouraged patients to seek answers, pointing them to the best resources and cautioning them to start low and go slow in terms of dosages. I also urge them to report back to me to let me know what’s working and what’s not because that’s the only way I’ll be able to help them now and in the future.

References:

• Cannabis and Cancer Pocket Guide. https://healingworksfoundation.org/resource/cannabis-cancer-pocket-guide/. Accessed May 13, 2024.
• Cannabis medicine certification. https://www.jefferson.edu/academics/colleges-schools-institutes/health-professions/emerging-health-professions/academic-programs/certificates/cannabis-medicine.html. Accessed May 13, 2024.
• Jonas WB, McManamon A. Healing and Cancer. Rodin Books. 2024.
• What should I know about medical cannabis? https://howwehealcampaign.com/resource/what-should-i-know-about-medical-cannabis/. Accessed May 13, 2024.

For more information:

Wayne Jonas, MD, can be reached at Healing@HealingWorksFoundation.org or via LinkedIn.