Reluctant MDs

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By Dr. Jordan Tishler 

It appears that Congress is slowly getting around to reforming the legal status of cannabis in the U. S.  While this will be a boon to the industry and a long overdue step to protect people of color in our country, the approach currently being discussed leaves most Americans out. 

Most Americans are not interested in recreational use.  They may support recreational legalization, but most Americans would only contemplate using cannabis as a medicine.  In the U.S., there are estimated 20-30 million recreational cannabis users.  However, there are more than 180 million Americans over age of 55 who will, guaranteed, develop one or more illnesses that can be addressed with cannabis.  This includes those who will get cancer and suffer from nausea and vomiting, or inability to eat due to treatment.  It includes so many who will develop arthritis in their back, hips, knees, neck, etc.  It includes that vast number of older adults who will develop sleep disorders.  There are many mental health issues from anxiety and depression to PTSD that can benefit from careful use of cannabis.  Yet, since most people would not consider cannabis unless done under the guidance of medical professionals, you can see that most will not get treatment.  How do we improve this?

It’s interesting to note that recent studies show that most physicians are still reluctant to use cannabis for their patients.  Physicians are generally a cautious bunch.  Remember “first do no harm”?  We like facts and evidence that support the expectation that using a medicine will provide benefit and the least risk of harm.  This is a good thing. 

With regard to cannabis, there is a remarkable wealth of evidence to support its therapeutic use.  However, much of that evidence is haphazardly available, requires hundreds of hours to read and decipher, and ideally needs to be repeated on a larger scale with better methods in human beings.  

Such a wealth of complex information really precludes a full and deep understanding by most physicians, and necessitates cannabis medicine to be a specialty practice with specialist experts.  Certainly most primary care physicians do not know all the details in the fields of Cardiology or Endocrinology.  They know much of the detail and provide routine care for issues in those domains but refer patients to experts when needed. 

Specialist organizations like the Association of Cannabis Specialists (cannabis-specialist.org) provide educational resources, not only to cannabis practitioners but, to clinicians who don’t practice this sort of medicine, but need to understand its validity and when to refer.  It will take time for physicians to become comfortable with this material, and it isn’t helping that many programs have begun popping up around the country that purport to provide this education, but in fact present lore and animal data as though they were sufficient. 

There is another aspect that makes practicing this medicine difficult and makes many physicians shy away.  At present, we cannot write a prescription for cannabis.  Why is this important?  A prescription ensures that the patient will get the type and amount of medicine that that is most likely to be helpful with the least risk, as determined by the evidence and clinical experience of that physician.  Without a prescription, what we see in daily practice are patients being told factually incorrect, sales-promoting things at the dispensary by people who, though they mean well, don’t know any medicine.  This leads to patients spending much more money than they need, spending longer than necessary suffering with whatever is being treated, and losing faith in the system that provides the medicine.  

In order to solve these issues, we need federal regulation of cannabis as a medicine – not just simple legalization.  We need physicians to be able to, in fact to be required to, write a prescription.  This puts the onus on physicians to know what they’re doing and be responsible for the patients’ well-being.  It also removes the conflict of interest we see at the dispensary.  

For all those suffering, or soon to be suffering, from cancer to degenerative joint disease to insomnia, cannabis can be a great relief.  We need to view cannabis as a medicine and make the tools available to clinicians so they can provide excellent care to this great number of Americans. 

Dr. Tishler, MD is a leading expert and trained Emergency Physician in the field of Medical Cannabis therapeutics.  After years of research and learning, Dr. Tishler brings his knowledge, reason, and caring to patients to Inhale MD, and through his advocacy work at the local and national levels. Dr. Tishler graduated from both Harvard College and then Harvard Medical School, trained in Internal Medicine at the esteemed Brigham and Women’s Hospital, and has spent many years working with the underserved, particularly our Veterans.

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