I am a practicing family physician. Since Pennsylvania began allowing physicians to certify patients for participation in the statewide medical marijuana program in November 2017, I have also become a cannabis medicine physician.
Medical cannabis skeptics question the notion of cannabis as medicine, but I am confident that it legitimately belongs in the modern pharmacopoeia as a safe and often effective treatment for a wide range of conditions.
No doubt, cannabis is also a recreational intoxicant and occasionally a drug of abuse. My role as a cannabis medicine physician is to help suffering patients therapeutically use cannabis safely, effectively and responsibly.
Contrary to a common misconception, medical cannabis can — and often will — deliver a “high” due to the presence of the psychoactive cannabinoid THC. Sometimes the high is essential to cannabis’ therapeutic effect, as in the treatment of post-traumatic stress disorder. Other times, the high is considered a side effect, as in the treatment of epilepsy.
Although non-psychoactive cannabis products are available — even over-the-counter — in cannabidiol (CBD) preparations derived from non-THC-containing industrial hemp, current thought suggests that the therapeutic benefits of cannabis are best achieved through the combined actions of the multiple compounds present in THC-containing “drug cannabis.” This phenomenon is known as the “entourage effect.” Many patients report the therapeutic superiority of full-spectrum, THC-containing cannabis products over CBD-only products as well as the synthetic THC medication dronabinol (Marinol).
Many patients who therapeutically use cannabis seek to minimize its psychoactive effects, especially during daytime hours when they wish to be productive. They do this by administering low doses and consuming preparations with lower THC concentrations. In fact, many medical cannabis patients regularly use at least two preparations, a less-intoxicating preparation for daytime and a stronger, higher THC preparation for evening use.
A minority of medical cannabis patients medicate repeatedly throughout the day. A majority of medical cannabis patients, especially those with chronic pain — which is by far the most common reason for medical cannabis use — medicate once or twice per day, especially at night prior to going to bed. Many medical cannabis patients, such as those with Crohn’s disease or migraines, only medicate when they have a flare-up, which might be once per week or even once per month. Every patient is unique.
Getting high is not the point of medical cannabis. Relief is. Nonetheless, most medical cannabis patients will get at least a little bit high at least some of the time.
Nobody has ever died from a cannabis overdose. Cannabis does not cause physical dependence. And cannabis does not cause its users to pursue more dangerous drugs. To the contrary, my patients often tell me that they want to use medical cannabis to decrease or eliminate their use of much more dangerous prescription drugs such as opioids like Oxycontin and benzodiazepines like Xanax.
Medical cannabis patients find relief with cannabis. A side effect of cannabis therapy is being high, and sometimes patients enjoy the high in addition to the relief.
I’m comfortable with that. All medications have side effects. Is it such a bad thing if the side effects of an effective and safe medication are increased creativity, peacefulness and heightened awareness?
Many patients who seek out my services as a cannabis medicine physician are desperate for help, hopeful that this newly available option will relieve them of their suffering where other treatments have not.
Other patients have already been successfully self-medicating with cannabis and just want to go legal, even though they can obtain cannabis less expensively through illegal means.
Still others simply like the idea of herbal medicine, freeing themselves from the perceived evils of big pharma. While my medical philosophy is firmly rooted in rationality and science, I support all of these motivations.
Medical cannabis is not a panacea. It probably will not cure cancer or even a simple urinary tract infection. It is not right for everybody. Some patients who seek its relief will unfortunately be disappointed in its lack of effectiveness for them. Other patients will not tolerate its psychoactive effects or other side effects.
In that sense, it is just like any other medicine. Unlike most other medicines, though, it is remarkably safe, remarkably versatile and derived from a plant that healers around the world have cherished for thousands of years. Cannabis is medicine. To intentionally misquote Blue Oyster Cult’s 1976 classic song, don’t fear the reefer. PJC
Adam Rothschild, M.D., is the founding physician of PGH MMJ, a medical cannabis practice located in Pittsburgh’s East Liberty neighborhood. He is also a family physician at Handelsman Family Practice in Munhall and medical informaticist at M*Modal in Squirrel Hill.