Back to residency after recommending cannabis

[sacrament]

This is hilarious. Now look, I'm 100% pro-legalization. I have absolutely no issue with anybody smoking. I don't even care if doctors, pilots, cops, etc. smoke on their off-time, just like I don't care if they have a beer on their off-time. It's a pretty benign drug. But this nonsense about it being a miraculous cure-all is really amusing. "Patients are sad, and then I get them stoned, and then they are happy! All my patients love what I do for them!" Yeah, no kidding. You are getting them high. They love you for it. They feel great. Everybody feels great when they're getting high on the reg. Which is fine. No problem. But don't confuse yourself into thinking you are actually improving their health. Weed enthusiasts love to theorize that "mainstream" doctors are just tools of industry, but who really sounds like a mindless drone here? Maybe the person who claims that their product is completely safe, completely wonderful, and cures everything? The natural world doesn't work that way. There are no wonder drugs. There are no magic herbs. There is no free lunch.

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[RadOncDoc21]

This is hilarious. Now look, I'm 100% pro-legalization. I have absolutely no issue with anybody smoking. I don't even care if doctors, pilots, cops, etc. smoke on their off-time, just like I don't care if they have a beer on their off-time. It's a pretty benign drug. But this nonsense about it being a miraculous cure-all is really amusing. "Patients are sad, and then I get them stoned, and then they are happy! All my patients love what I do for them!" Yeah, no kidding. You are getting them high. They love you for it. They feel great. Everybody feels great when they're getting high on the reg. Which is fine. No problem. But don't confuse yourself into thinking you are actually improving their health. Weed enthusiasts love to theorize that "mainstream" doctors are just tools of industry, but who really sounds like a mindless drone here? Maybe the person who claims that their product is completely safe, completely wonderful, and cures everything? The natural world doesn't work that way. There are no wonder drugs. There are no magic herbs. There is no free lunch.

Total buzzkill!

 

[rainbowdoctor88]

I do think it's important to note that once recreational weed goes legal that "pot docs" are largely out of business.
This is not accurate. See Colorado and Washington.


OP, if you want a residency the cost of that residency will likely be shutting up about weed for a few years.

Thank you for the advice.

 

[rainbowdoctor88]

This is hilarious. Now look, I'm 100% pro-legalization. I have absolutely no issue with anybody smoking. I don't even care if doctors, pilots, cops, etc. smoke on their off-time, just like I don't care if they have a beer on their off-time. It's a pretty benign drug. But this nonsense about it being a miraculous cure-all is really amusing. "Patients are sad, and then I get them stoned, and then they are happy! All my patients love what I do for them!" Yeah, no kidding. You are getting them high. They love you for it. They feel great. Everybody feels great when they're getting high on the reg. Which is fine. No problem. But don't confuse yourself into thinking you are actually improving their health. Weed enthusiasts love to theorize that "mainstream" doctors are just tools of industry, but who really sounds like a mindless drone here? Maybe the person who claims that their product is completely safe, completely wonderful, and cures everything? The natural world doesn't work that way. There are no wonder drugs. There are no magic herbs. There is no free lunch.

I am glad you got a chuckle out of this.
You are using the same old rhetoric, spoon fed and full of holes.
There are safe herbs and cannabis happens to be one of the safest.
So how many people have died from overdose of cannabis? Or had serious permanent adverse drug reactions?
How do you feel about CBD? What is your understanding of the endocannabinoid system? How about topical application? Am I getting "high" by using a cannabis cream on my knee?
Am I getting "high" using raw cannabis that has not been de-carboxylated? You dont have any idea what I am talking about, do you?
The children with dravets syndrome, they are not seeing improved health with seizure reduction?
What do you know about the natural world?

 

[NotAProgDirector]

I'm trying to remain as objective as possible.

The honest truth is that we don't know whether medical MJ is really effective or not. There is little good quality evidence, and because it is scheduled as a Class I drug, it's very difficult to do any research on it. In addition, there are so many differences between various strains that it's hard to make and generalizable statements.

Calling it an "herb" doesn't change anything. So is tobacco. And digitalis.

Is it safe? Probably, and probably much more so than many things that are legal in this country. It's probably more safe than tobacco and alcohol. Whether it's safe to operate an automobile (or work) while using MJ is unknown, and we don't have any good way to measure "levels". Is it safe in overdose? I think so -- although there are rare overdose death reports in the literature, there are often confounders. Is it totally safe? There definitely is a growing recognition of the Cannabis Hyperemesis Syndrome -- this isn't a reason to stop all research/use of MJ, as it's more of an "annoyance" than a serious side effect, but it's a potential problem.

CBD is interesting. It's being studied now, looking at childhood seizure disorders. This site is from the pharm company that's looking into it. The early open label study is promising, but the blinded data is not out yet. Studies on adults with seizure disorder (listed on the site) were all small. Two early studies were encouraging, two later studies were negative. If it works for kids, there's no guarantee it will work for adults also as the mechanism for childhood vs adult seizures is probably different.

Topical cannabis is unlikely to be effective. The skin is designed to prevent absorption of chemicals. Lidocaine patches are really no better than placebo -- I have no idea how they were approved. Topical NSAIDS are also mostly useless. But, I'm all for a study to see if it works, and I'd be pleasantly surprised if it did.

Which brings me to my main point. I hope cannabis is as effective as you say it is. I really do. If it works so well, we'll have a new tool in our toolbox for addressing many issues. But what I do know is that the placebo effect is very strong. Most studies looking at pure placebos -- where there is no active ingredient at all -- show a 25+% improvement in subjective symptoms. Hence, before I'm willing to support you in your push to treat everyone with medical cannabis, I want to see a well designed, appropriately powered, randomized and blinded trial to show that it really works. And we'll need some sort of standardization of the "product". Otherwise, all we have are anecdotes. Perhaps those anecdotes underlie a real benefit. Or perhaps they are all placebo effect and preconceived ideas. I don't know. I want to know. The FDA should allow a well done trial to look at it. That's what's happening with CBD, and it's to be applauded.

EDIT: one more interesting thought about CBD. It's being tested by a drug company now. What happens if it is effective? I assume they own the patent on it, and will charge $$$$ for it, given it's an orphan drug with few end users. I wonder if they will sue whomever tries to grow strains with a high concentration of CBD, stating that it's their property -- much like Monsanto and the GMO seeds. We shall see.

 

[rainbowdoctor88]

I bet they do

You bet, especially the Veterans. It is an honor to provide care to them.

 

[rainbowdoctor88]

How can a stoner be this uptight and aggressive? So confusing.

I hear the same old uninformed, outdated, naive rhetoric, day in and day out. I am sick and tired of it, and Im not afraid to speak up. This plant is a great tool and people need to know the truth about it.

 

[rainbowdoctor88]

"It works and it's safe" are conclusions that can only be made following clinical and laboratory trials for each indication. None of these studies have yet been done, largely because in 99.99% of cases this is really about recreational use. But that's irrelevant.

If you want to get into residency you are going to have to wear the hat of an evidenced based medical doctor, not the hat of a pot advocate. You won't be allowed to proscribe or recommend pot to your patients during your training and you may well be subject to drug testing and discipline for drug metabolites in your serum/urine at various points during your training. Because of your vocal position, employers could even be considered negligent if they don't periodically drug check you. And as mentioned you'd actually be a much more compelling applicant for training if this was something you regretted or were embarrassed about, rather than advocating. I wasn't joking when I suggested that doing anti-MJ research might make you a more intriguing applicant. Nobody gives the reigns to a stoner but we all admire the success story who overcomes a habit and works to help others from making the same mistake.

At any rate I see no likelihood for you to get from point a to point b while espousing this agenda, so this whole thread is moot. I personally don't care if people get high in the privacy of their own homes, but I sure wouldn't hire anyone whose advocacy goals are more important to them than the conduct expectations of the job I have to offer.

Hmm, interesting, the way I see it, we will soon see damages awarded to patients who have been denied cannabis or denied treatment or are discriminated against b/c of their use of it.
99.99% recreational? Just wow. wow.

 

[rokshana]

Hmm, interesting, the way I see it, we will soon see damages awarded to pateints who have been denied cannabis or denied treatment or are discriminated against b/c of their use of it.
99.99% recreational? You are way out of your league and have no business talking about things you obviously know nothing about.
Just wow. wow.

i may not always agree with L2D, but not knowing what he is talking about? dude ...its you who has no idea...again the point is not whether you believe that pot is the panacea of all panaceas, bur whether you can tone down the rhetoric and accept the fact that you will not be able to do as you wish in residency...that there will be attendings and seniors who you will have to listen to and, to a great extent, have control of what you can or can't do...and in no way shape or form will you be able to recommend or prescribe marijuana to ANY patient while you are a resident...if you can't accept this or at least pretend to for 3 years...well its a waste of your time to even think about going back to residency...

in residency Evidence Based Medicine is king....you will have to learn to play along...

 

[rainbowdoctor88]

Like others, I'm pretty skeptical that you're for real considering you're coming across, as Law2Doc points out, more as a one-sided pot advocate than an evidence-based medicine practitioner. Did you really recommend cannabis to brain injury patients? It's just about the last thing any of them should be using... I hope the brain injuries were at least a number of years old--I just can't believe any physician would do that. You're literally causing more harm than good and impairing their recovery.

I grew up in CA and consider myself a liberal independent. I'm fine with people doing MJ in their own home and I'd certainly be open to patients using it for medicinal purposes if the research was there (which as everyone points out, it's not except for weight gain and nausea in oncology patients). But if I were a PD and saw your postings here I think I would honestly prefer my residency go unfilled than match someone who's putting their political agenda above everything else.

I understand you feel very strongly about MJ, but your primary goal should be doing what's best and what's right for your patient and their health. As a physician that should always be your first priority, not advocating for the use of pot. That means finishing residency to further your medical knowledge. Listen to the advice of people here that know what will best improve your odds of making that happen--you've gotten recommendations from quite a few big names.

Did you really recommend cannabis to brain injury patients? It's just about the last thing any of them should be using... I hope the brain injuries were at least a number of years old--I just can't believe any physician would do that. You're literally causing more harm than good and impairing their recovery.

I do not agree. Could you please explain your logic and or provide a reference?

Am Surg. 2014 Oct;80(10):979-83.
Effect of marijuana use on outcomes in traumatic brain injury.
Nguyen BM1, Kim D, Bricker S, Bongard F, Neville A, Putnam B, Smith J, Plurad D.

A positive THC screen is associated with decreased mortality in adult patients sustaining TBI.

It prevents glumate exitotoxicity, acts as an antiinflammatory and is neuroprotective.

Anandamide, an endogenous cannabinoid protects against neuronal injury.
Van der Stelt M, et al. 2001. Protection of rat brain by anandamide against neuronal injury. The Journal of Neuroscience. 21(17):6475-6479.

THC, CBD and whole plant cannabis preparations will soon be utilized a lot more for TBI, stroke, and other neurotrauma insults.
In ancient manuscripts it was referred to as the "head shield", and given to warriors after battle. Many NFL and college football players use cannabis. They are protecting their brains.

 

[rainbowdoctor88]

i may not always agree with L2D, but not knowing what he is talking about? dude ...its you who has no idea...again the point is not whether you believe that pot is the panacea of all panaceas, bur whether you can tone down the rhetoric and accept the fact that you will not be able to do as you wish in residency...that there will be attendings and seniors who you will have to listen to and, to a great extent, have control of what you can or can't do...and in no way shape or form will you be able to recommend or prescribe marijuana to ANY patient while you are a resident...if you can't accept this or at least pretend to for 3 years...well its a waste of your time to even think about going back to residency...

in residency Evidence Based Medicine is king....you will have to learn to play along...

I did not mean to imply that he was clueless about my best chance to go back to residency, I know I am in deep doodoo if I keep this up. I was referring to his 99.99% statistic. I understand I need to shut up about cannabis if I am to have any chance at returning to residency. But some of this is just unreal and people need to know. It is insulting, but I need to calm down, so I am going to calm down and edit that post. Thank you for the consideration. I really appreciate this conversation, and thank you to all of those who have taken an interest in my situation. I know cannabis is not the answer to everything, but it is a powerful tool that is helping people right now and could make so much difference. I guess there are so many things going on the world that are unfair, unjust and messed-up, and some people are striving for change. I can accept things as they are, but change is coming, and I need to be more patient. I dont like suffering, and this plant relieves tons of it.

 

[Perrotfish]

I hear the same old uninformed, outdated, naive rhetoric, day in and day out. I am sick and tired of it, and Im not afraid to speak up. This plant is a great tool and people need to know the truth about it.

As many, many others have said, you need to appreciate that we don't know if its a good tool or not. Almost everything you've written about marijuana could have been written 300 years ago about opium. Its a natural plant that grows everywhere. Its been used by healers around the globe for most of recorded history. It seems to relieve physical and psychiatric symptoms from a wide variety of illnesses. When you prescribe it patients return to you with rave reviews and think you're a miracle worker. It took us centuries of good studies and observation to realize that, even though every patient on an opiate swears otherwise, chronic use of opium and its derivatives actually put patients on a trajectory that leaves them sicker than before, for almost every condition it has ever been prescribed for. So when you come to us ad say that you have another drug with some acute euphoric effects and you think its a miracle because everyone who takes it comes back to you with rave reviews, those of us who have studied medical history harbor strong doubts. No one is saying that it doesn't work for anything (we haven't quite given up on opiates yet either), but I have a strong feeling that most of these effects you're claiming will diminish or disappear when examined by well controlled studies.

Based on your previous posts I think you understand that having IRL conversations like this about Marijuana is going to get you barred from/kicked out of residency, but I'm concerned that you still don't understand why. The main problem isn't that people disagree with you about how marijuana works, its that they disagree with you about how science works. The physician scientist develops a theory says 'I'm sure this will work, and I'm going to prove it'. What follows is an IRB, and then a project, and then proof. The physician that proves his point through research is the one who is inspirational, and who may merit a movie starting Will Smith. On the other hand when a physician develops a theory and says 'I'm sure this will work and I'm going to prescribe it' that's reckless, and unethical, and merits a program firing you. Every time you make a post about how cannabis 'definitely' works because your patients come back and they say that it works you make everyone doubt that you understand evidence based medicine at all. What if next week you decide that the magic cure is lead? Or Mercury? 'How can your residency trust that you'll be a safe physician when you're already so comfortable prescribing without proof?

 

[KnuxNole]

As long as you bottle up all this talk for 3 years, you are good. Don't say a word to the attendings, and staff. Most of your co-residents will not want to hear about it. The ones that used to smoke weed or still do would even not want to hear about it.

 

[gutonc]

Am Surg. 2014 Oct;80(10):979-83.
Effect of marijuana use on outcomes in traumatic brain injury.
Nguyen BM1, Kim D, Bricker S, Bongard F, Neville A, Putnam B, Smith J, Plurad D.

A positive THC screen is associated with decreased mortality in adult patients sustaining TBI.

It prevents glumate exitotoxicity, acts as an antiinflammatory and is neuroprotective.

If you do get a residency spot, you're going to need to do a better job of critically reading the literature. This study basically tells us what every Gen Surg intern knows to be true after their first month on the Trauma service. The more f***ed up you are when you wrap your car around a tree, the less likely you are to get hurt.

Look man, I am actually a huge proponent of weed to help relieve suffering. I think the lack of real data about it's benefits (and risks...because it has risks) are due to it's Schedule I status, and we've come to the point where that's not doing anybody any good.

About 20-30% of my patients use it, all with my blessing. And I'd likely be a user too if I could do so and not risk my job/license. I live and work in a much more weed friendly state than you do. I campaigned for recreational legalization here.

But you need to slow your roll if you really want to have any hope at all of getting, and keeping, a residency spot. If the way you interact with people here is even remotely indicative of the way you react with people IRL, then you should probably just double down on being a weed doc, plan to move your practice from state to state as needed, and make a plan to retire to Costa Rica in 10 years when legalization hits.

 

[tkim]

Let me cut to the chase - dude, you are NEVER getting back into residency. If you get an interview, they will ask what you've been doing for the years after you quit residency ... And then you will start talking. And then they will not rank you.

You're done.

 

[WGSgrad]

Fun and lively discussion. I want to go back to residency. I made a choice, at the time it was the right one.
I left residency because I was interested in treating patients with cannabis, which I have done for the last three years. I also wanted to live in California. I also had family stressors and other factors. Everything pointed me west. I was interested in the history of its use, its safety profile, lack of side effects, potential to treat a wide range of diseases and symptoms, the therapeutic effects of cultivating of your own medicine, and it personally helped my pain and depression. (before residency obviously)

My job is great. I do have great hours. I don't deal with insurance. Almost every patient leaves happy. I can focus my time on what I think is important. However, it is isolating, I don't get to treat the very sick people in the hospital who really need it, and I have other treatment interests and skills that I am not able to share.

I am not a perfect person and medicine is not a perfect art. Never has been, never will be. A lot of well meaning people have done questionable things in the name of "science". I am not interested in maintaining the status quo, or in pushing the agenda of a multi-national corporation. Lets just relieve suffering. Right?

Is it possible that I am wrong about cannabis? Sure. Maybe all these thousands of people are all lying to me, just to get high. Oh well, at least they arent in jail for it, are sleeping better, eating better, are off their RX meds, laughing and interacting with a plant intelligence that might help them connect with the natural world.
Sorry to be rude to so many, but damn, I have heard the rhetoric a hundred times, and it gets old. Reefer madness, fetal birth defects, schizophrenia, brain changes, laziness, stupidity, doesnt work for pain, gives you boobs, no evidence for effectiveness in this or that, etc. Bullsheet. It works and it is safe. First do no harm? What is preferred for intractable epilepsy? A trial of a safe herb? Or a temporal lobotomy?

How many times have I have heard a patient tell me that their Primary doctor is unsupportive of their cannabis use, or are contractually obligated NOT to discuss? This is why I have a job. And I will have a job after legalization. When did we stop listening to our patients? These patients are already using cannabis and they know it helps! They dont want to take RX meds, or at least they want to minimize their use of them. Don't you? These are successful people, parents, executives, dentists, doctors, movie stars, mega-millionaires, as well as homeless, forgotten meth addicts. No one can tell me that cannabis does not help. Maybe 4 years ago. People need cannabis, and those standing in the way of access need to get out of the way.

It helps with so many conditions, it IS somewhat ridiculous, check out the endocannabinoid system to understand why.
Cannabis is one of the most diverse plant species cultivated. It grows in all 50 states, all over the world and it produces hundreds of compounds, depending on genetics, cultivation techniques, and the way it is used (what temperature it is vaporized, applied topically, ingested, transdermally applied, eye drops, rectally, vaginally, hashish, wax, dabbed).
All weed is not the same, and not all patients are the same. Most think of cannabis as one thing. Nope. Not by a long shot. Thousands of varieties all with unique cannabinoid and terpinoid profiles. It's not just the THC, it's not just the CBD. Its the whole plant. Just as vitamin C by itself is not as effective as Vitamin C with bioflavinoids. The problem with cannabis is that is challenges the single molecule hypothesis that works with FDA approval of pharmaceuticals. Its cheap and easy to produce and process, impossible to patent, it smells great, and it dissolves boundaries.
If I was expounding on the virtues of oxycontin or clonezepam, obviously we would have a problem as these substances have real potential for harm, addiction, abuse and overdose. But we are talking about an ancient plant, utilized for thousands of years without a single case of overdose. Sure, it can be abused. I can use a hammer to smash my thumb, or I can drive a nail. This plant is a powerful tool, always has been, always will be.

So can I tone down my "agenda" so that I can further my career? It does not make sense to my patients or to me, but who says life makes sense?
If I lived in the 1960s and was in love with a person of a different skin tone, would I stop loving them because the laws of my state said I was commiting a crime? No, but I would move to a place where people are cool with that and wait for everyone else to catch up.

I hope that this gives some understanding of why I am doing what I am doing.
It is a goldmine of wellness for patients. It is only growing. Its not even used in the hospital yet. Someday soon it will be vaporized in the hospital for pain, anxiety, asthma, and more. But as an herbal remedy it is tough to standardize and dose. Its no cure-all, and we do need more research, but if it helps, why block access?

I dont think it will be legalized nationally in the next five years. Its all about money. Money to be gained in locking people up, money that will be lost as people don't need their valium, oxy, benzos, sleeping pills or back surgery.

OP, I don't know you and I don't know your history on this site (and/or with this particular group of posters). What I can say is that you seem genuine in your belief that cannabis is severely underrated as a natural medicine. I am not a doctor (or medical researcher) so I am unfamiliar with the research that does (or does not) exist in support (or against) your claims. That being said, even as someone who is receptive to many of the underpinning features of your argument (see the bolded text), I find your demeanor a bit difficult to engage. Ultimately, I don't know how you will fair in securing a residency and I certainly don't have a strategy for you, however, what I will offer is that there is something lost in failing to engage another where they are as opposed to where you would like them to be.

Again, as someone fairly receptive to your social perspective (?), I wish you the best of luck in securing a new residency and your career. Hopefully, some of the advice provided in this thread turns about to be beneficial to you.

 

[RangerBob]

Did you really recommend cannabis to brain injury patients? It's just about the last thing any of them should be using... I hope the brain injuries were at least a number of years old--I just can't believe any physician would do that. You're literally causing more harm than good and impairing their recovery.

I do not agree. Could you please explain your logic and or provide a reference?

Am Surg. 2014 Oct;80(10):979-83.
Effect of marijuana use on outcomes in traumatic brain injury.
Nguyen BM1, Kim D, Bricker S, Bongard F, Neville A, Putnam B, Smith J, Plurad D.

A positive THC screen is associated with decreased mortality in adult patients sustaining TBI.

It prevents glumate exitotoxicity, acts as an antiinflammatory and is neuroprotective.

Anandamide, an endogenous cannabinoid protects against neuronal injury.
Van der Stelt M, et al. 2001. Protection of rat brain by anandamide against neuronal injury. The Journal of Neuroscience. 21(17):6475-6479.

THC, CBD and whole plant cannabis preparations will soon be utilized a lot more for TBI, stroke, and other neurotrauma insults.
In ancient manuscripts it was referred to as the "head shield", and given to warriors after battle. Many NFL and college football players use cannabis. They are protecting their brains.

As glutonc points out, this is dealing with having THC in your system at the time of injury. Higher EtOH levels are also associated with better odds of survival.

I hope you're aware that having either of these in your system is what generally causes the brain injury (or spinal cord injury, or other trauma) in the first place (EtOH being the bigger culprit of course). So while they be more a little more likely to survive, they are far more likely to sustain an injury. And much worse is they are far more likely to cause an injury in somewhat else.

Pot and EtOH both significantly impair cognitive recovery after a brain injury. It's one of the first things we learn on our brain injury rotation.

 

[j4pac]

This is hilarious. Now look, I'm 100% pro-legalization. I have absolutely no issue with anybody smoking. I don't even care if doctors, pilots, cops, etc. smoke on their off-time, just like I don't care if they have a beer on their off-time. It's a pretty benign drug. But this nonsense about it being a miraculous cure-all is really amusing. "Patients are sad, and then I get them stoned, and then they are happy! All my patients love what I do for them!" Yeah, no kidding. You are getting them high. They love you for it. They feel great. Everybody feels great when they're getting high on the reg. Which is fine. No problem. But don't confuse yourself into thinking you are actually improving their health. Weed enthusiasts love to theorize that "mainstream" doctors are just tools of industry, but who really sounds like a mindless drone here? Maybe the person who claims that their product is completely safe, completely wonderful, and cures everything? The natural world doesn't work that way. There are no wonder drugs. There are no magic herbs. There is no free lunch.

You know what would be an excellent treatment for your Intermittent Explosive Disorder? Weed.

(by the way...this is not medical advice)

 

[Psai]

Hm this is more of a pro marijuana thread than a what are my chances thread

 

[gotname]

Unless you have worked in this field, you really dont understand what it is like to be able to utilize this treatment modality.

You seem extremely passionate about what you do and that's great. However, if you believe these people don't know enough about weed to speak on it as they "haven't worked in the field" then is it not logical to assume that maybe you don't know enough about what you need to get back into residency (they do) because you are not privy to the ins & outs of the medical field as you're not in it?

I ask because you willingly asked for advice but seem to argue when it is given. This seems more like you are explaining why you love your job than why you want to go back to residency.

And you mentioned despising suffering, wanting to end it and how weed helps a lot of it. As a patient, I think that suffering is like on of those huge Taco Bell burritos I see advertised on TV - there are very many layers to it. Everyone is different in regards to what will make them feel better. However, many times, feeling better may not be synonymous with actually being better.

 

[VA Hopeful Dr]

Hmm, interesting, the way I see it, we will soon see damages awarded to patients who have been denied cannabis or denied treatment or are discriminated against b/c of their use of it.
99.99% recreational? Just wow. wow.

Not as long as its schedule 1 we won't

 

[chudat]

I have to say, however, ive personally treated patients with intractable nausea/vomiting with cannabis and it seems to work wonders

 

[WingedOx]

Sorry, but in what capacity were you licensed when you worked as a "cannabis doc"?

 

[gutonc]

Sorry, but in what capacity were you licensed when you worked as a "cannabis doc"?

In his initial post he said he had a CA medical license after completing a year of residency.

 

[Raryn]

I have to say, however, ive personally treated patients with intractable nausea/vomiting with cannabis and it seems to work wonders

I've personally seen 5+ patients with intractable nausea/vomiting caused by cannabis abuse. And whats funny is, people like the OP have convinced them that pot is completely harmless and that there's no possible way it could be causing their symptoms.

(Cannabinoid hyperemesis is a funny thing... The pathognomonic sign of sx improving with a hot shower always amazes me when it shows up.)

 

[WingedOx]

In his initial post he said he had a CA medical license after completing a year of residency.

ah, brain fart. The last couple states I've lived in have required at least two years for an unrestricted license.

 

[WingedOx]

I hope you're aware that having either of these in your system is what generally causes the brain injury (or spinal cord injury, or other trauma) in the first place (EtOH being the bigger culprit of course). So while they be more a little more likely to survive, they are far more likely to sustain an injury. And much worse is they are far more likely to cause an injury in somewhat else.

I swear, seeing some of the substance-induced* injuries I've seen in the Neuro ICU and their related costs to our heathcare system will kill your faith in humanity.

*yes, this includes cannabis.

 

[WingedOx]

However, many times, feeling better may not be synonymous with actually being better.

You mean I shouldn't be prescribing QID xanax for every PTSD patient that walks into my office?

 

[OldPsychDoc]

...
So most people are saying that I if I want to get back into residency, I have a hole to dig myself out of, a mountain to climb and brownies to bake for many program directors. ....

'Scuse me if I take a pass on those brownies...

 

[gotname]

You mean I shouldn't be prescribing QID xanax for every PTSD patient that walks into my office?

Even then, you're clearly doing it wrong. You must keep up! Have you not heard...

 

[WingedOx]

Even then, you're clearly doing it wrong. You must keep up! Have you not heard...

The MJ for PTSD thing has been bouncing in and out of our state panels for a while now. Thankfully as a fed I'm insulated from it.

 

[clausewitz2]

You mean I shouldn't be prescribing QID xanax for every PTSD patient that walks into my office?

As my partner put it the other day: "why isn't there like a PRN for depression? Oh, wait, I guess that's heroin."

 

[rainbowdoctor88]

Wow, this will be an interesting year for me. My chances for returning look ****ty, just the kind of motivation I need.

I think one of the main things to consider is that aside from one Doctor who lives in an adult use state, the rest of the posters only hear about cannabis use when it is associated with a negative outcome, like a positive UA during admission (which does not indicate impairment one bit), or cannabis hyperemesis. So IF a patient were to be honest with you and tell you how helpful it is for their arthritis, mentrual cramps, migraine, insomnia, glaucoma, nausea, anxiety, etc. would you look down on them, tell them you have read the evidenc based medical literature on their condition, and that their is no way that is really helping them, they are only getting high and them demand they stop using cannabis at the threat of no longer seeing them?

"Medicine is a healing profession that utilizes science as a TOOL to inform decision-making but looks first to the individual patient for data." Cannabinomics 2010 C. Fitchner, M.D. p 74

Meanwhile I have had OPEN discussions about cannabis use with quite a few patients over the last three years and there is no doubt in my mind that it has merits for them. Evidenced based medicine is great, especially when pharma tells us what treatment we MUST provide. What happened to common sense? No one has ever died from cannabis OD. Alcohol kills more people than ever. Prescription drugs are now the number one killer. Some people cant eat peanut butter. I like peanut butter.

Most people posting here..
1) are not at liberty to discuss cannabis with their patients
2) must undergo random drug testing and cannot utilize cannabis
This is an example of, we can't do, so it must have no value, and no one else is using it for medicine.
Another example....There is no homosexual problem in Iran, because in Iran there are no homosexuals. Right.

I may never be accepted back into residency, but cannabis is a medicine.
If it was easy to patent and control, pharma would already have whole plant cannabis on the market (not just THC or one synthetic cannabinoid homologue).

The patent for cannabis is owned by the US gov.
Cannabinoids as antioxidants and neuroprotectants
US 6630507 B1
ABSTRACT
Cannabinoids have been found to have antioxidant properties, unrelated to NMDA receptor antagonism. This new found property makes cannabinoids useful in the treatment and prophylaxis of wide variety of oxidation associated diseases, such as ischemic, age-related, inflammatory and autoimmune diseases. The cannabinoids are found to have particular application as neuroprotectants, for example in limiting neurological damage following ischemic insults, such as stroke and trauma, or in the treatment of neurodegenerative diseases, such as Alzheimer's disease, Parkinson's disease and HIV dementia. Nonpsychoactive cannabinoids, such as cannabidoil, are particularly advantageous to use because they avoid toxicity that is encountered with psychoactive cannabinoids at high doses useful in the method of the present invention. A particular disclosed class of cannabinoids useful as neuroprotective antioxidants is formula (I) wherein the R group is independently selected from the group consisting of H, CH3, and COCH3.

 

[rainbowdoctor88]

As glutonc points out, this is dealing with having THC in your system at the time of injury. Higher EtOH levels are also associated with better odds of survival.

I hope you're aware that having either of these in your system is what generally causes the brain injury (or spinal cord injury, or other trauma) in the first place (EtOH being the bigger culprit of course). So while they be more a little more likely to survive, they are far more likely to sustain an injury. And much worse is they are far more likely to cause an injury in somewhat else.

Pot and EtOH both significantly impair cognitive recovery after a brain injury. It's one of the first things we learn on our brain injury rotation.

Please provide some evidence, or at least some logical argument as to why Cannabis belongs in the same category as EtOH!
EtOH is a flammable liquid that kills brain cells. Cannabis contains neuroprotective, antioxidants and as I posted above, prevents glutamate exitotoxicity and is the only neurotransmitter that works in a retrograde fashion. Post-synaptic cell is encouraged to release inhibitory molecules, which prevents pre-synaptic excitation.

 

[rainbowdoctor88]

I've personally seen 5+ patients with intractable nausea/vomiting caused by cannabis abuse. And whats funny is, people like the OP have convinced them that pot is completely harmless and that there's no possible way it could be causing their symptoms.

(Cannabinoid hyperemesis is a funny thing... The pathognomonic sign of sx improving with a hot shower always amazes me when it shows up.)

Cannabis Hyperemesis is ruining America! Run for your lives! 5 adverse effects from cannabis and they felt better after cleaning their dirty bong and taking a shower. Some people can't eat peanut butter.

 

[NotAProgDirector]

boThis will be my last post on this thread. It's clear we're talking past each other.

Wow, this will be an interesting year for me. My chances for returning look ****ty, just the kind of motivation I need.

Actually, if you take some advice on this thread, you will have some chance of getting a spot. I don't think that you need to give up / turn against cannabis completely, but you need to tone it down, stop prescribing unless allowed in the state you're training in and approved by your program

I think one of the main things to consider is that aside from one Doctor who lives in an adult use state, the rest of the posters only hear about cannabis use when it is associated with a negative outcome, like a positive UA during admission (which does not indicate impairment one bit), or cannabis hyperemesis. So IF a patient were to be honest with you and tell you how helpful it is for their mentrual cramps, or migraine, or insomnia, or anxiety, etc. would you likely look down on them and stop seeing them?

What are you smoking? (That's a joke, in case it wasn't obvious) That's not what I'm saying at all. Many of my patients have, and will use cannabis. And in fact, I've written "MJ Letters" so they can get it if they qualify. But I think that the evidence that MJ is actually effective is terrible. And I want more evidence. Will I refuse to give MJ to someone because there is no evidence? Nope. (Or, yes, I will give it to them). But I won't go wild recommending it for a bunch of things that we have no idea if it works.

What happened to common sense?

Here's our disagreement, in a nut shell. Your common sense happens to equal my concern that this is all placebo effect. And that's the rub. You're position might be that, if it really was all placebo effect, who cares? They feel better, so mission accomplished. My position is that we don't treat people with placebos. There is a vocal group in medicine who feels we should consider bringing back placebos, since they actually work quite well for subjective complaints.

No one has ever died from cannabis OD.

Probably not. But cannabis addiction does happen. And the more we use it, the more likely we are to get some subgroup addicted. This is exactly what we have seen from the expansion of use of narcotics. We were told by well meaning people that people in pain don't get addicted. And now it's clear that it happens, and increasing the supply gets bystanders addicted.

Alcohol kills more people than ever. Prescription drugs are now the number one killer. Some people cant eat peanut butter. I like peanut butter.

Prescription drugs are not the #1 killer in the US. And when we do look at prescription drugs that kill, its the narcotics that lead the way. And we should be using less of them. I have no idea what peanut butter has to do with anything.

Most people posting here..
1) are not at liberty to discuss cannabis with their patients
2) must undergo random drug testing and cannot utilize cannabis
This is an example of, we can't do, so it must have no value, and no one else is using it for medicine.

This is ridiculous. I can talk to my patients about cannabis. I was only tested when hired, never since. We don't get randomly tested. Your conclusion is incorrect.

You're so convinced that you're right, you can't see the other side of the discussion. And honestly, that's terrifying.

Over and out.

 

[Wordead]

Wow, this will be an interesting year for me. My chances for returning look ****ty, just the kind of motivation I need.

I think one of the main things to consider is that aside from one Doctor who lives in an adult use state, the rest of the posters only hear about cannabis use when it is associated with a negative outcome, like a positive UA during admission (which does not indicate impairment one bit), or cannabis hyperemesis. So IF a patient were to be honest with you and tell you how helpful it is for their arthritis, mentrual cramps, migraine, insomnia, glaucoma, nausea, anxiety, etc. would you look down on them, tell them you have read the evidenc based medical literature on their condition, and that their is no way that is really helping them, they are only getting high and them demand they stop using cannabis at the threat of no longer seeing them?

"Medicine is a healing profession that utilizes science as a TOOL to inform decision-making but looks first to the individual patient for data." Cannabinomics 2010 C. Fitchner, M.D. p 74

Meanwhile I have had OPEN discussions about cannabis use with quite a few patients over the last three years and there is no doubt in my mind that it has merits for them. Evidenced based medicine is great, especially when pharma tells us what treatment we MUST provide. What happened to common sense? No one has ever died from cannabis OD. Alcohol kills more people than ever. Prescription drugs are now the number one killer. Some people cant eat peanut butter. I like peanut butter.

Most people posting here..
1) are not at liberty to discuss cannabis with their patients
2) must undergo random drug testing and cannot utilize cannabis
This is an example of, we can't do, so it must have no value, and no one else is using it for medicine.
Another example....There is no homosexual problem in Iran, because in Iran there are no homosexuals. Right.

I may never be accepted back into residency, but cannabis is a medicine.
If it was easy to patent and control, pharma would already have whole plant cannabis on the market (not just THC or one synthetic cannabinoid homologue).

The patent for cannabis is owned by the US gov.
Cannabinoids as antioxidants and neuroprotectants
US 6630507 B1
ABSTRACT
Cannabinoids have been found to have antioxidant properties, unrelated to NMDA receptor antagonism. This new found property makes cannabinoids useful in the treatment and prophylaxis of wide variety of oxidation associated diseases, such as ischemic, age-related, inflammatory and autoimmune diseases. The cannabinoids are found to have particular application as neuroprotectants, for example in limiting neurological damage following ischemic insults, such as stroke and trauma, or in the treatment of neurodegenerative diseases, such as Alzheimer's disease, Parkinson's disease and HIV dementia. Nonpsychoactive cannabinoids, such as cannabidoil, are particularly advantageous to use because they avoid toxicity that is encountered with psychoactive cannabinoids at high doses useful in the method of the present invention. A particular disclosed class of cannabinoids useful as neuroprotective antioxidants is formula (I) wherein the R group is independently selected from the group consisting of H, CH3, and COCH3.

Paranoia, cxonspiracy theories, tangential thoughts, constantly obsessing over peanut butter munchies

Sure, seems harmless

 

[rokshana]

the next post he makes is gonna compare someone to hitler i'm sure of it!!

 

[blebb]

Can we get a psych eval for OP? Sounds like he's manic. We all know weed is benign. Just don't talk about it at work.

 

[exsanguination]

It's like the OP is creating some debate just to hear himself espouse the wonders of marijuana. I don't even know who or what he's responding to. Good rational responses and advice has been given with clear goals of genuinely trying to help the guy out. But he just doesn't register it. It's actually pretty impressive to say the least!

OP, your head is so far up your @ss that you can't even register the good advice that's being thrown your way. People here are trying to give you a viable path to FM residency.

Literally all you have to do is shut up about the glory of cannabis. That's it. Keep your ideas about its efficacy, keep your opinions about its healing powers, and keep your desire to help others with cannabis. Just shut up about it for the 6 hours it takes to interview at a family medicine program.

But even here you can't follow this for a SINGLE post.

You are your own worst enemy on your path to trying to get an FM residency.

Good luck, you'll need it.

 

[RangerBob]

Please provide some evidence, or at least some logical argument as to why Cannabis belongs in the same category as EtOH!

EtOH is a flammable liquid that kills brain cells. Cannabis contains neuroprotective, antioxidants and as I posted above, prevents glutamate exitotoxicity and is the only neurotransmitter that works in a retrograde fashion. Post-synaptic cell is encouraged to release inhibitory molecules, which prevents pre-synaptic excitation.

It's fairly simple--any medication that causes cognitive impairment will hinder recovery from TBI. It's not just MJ and EtOH, but most other psychoactive substance, including many of the legal ones we prescribe. The brain is even more magical than marijuana--it heals itself, but it needs time and the resources to do it. MJ gets in the way of that. So does too much TV, having too many friends over, etc.

I can see I'm not getting anywhere--you've already made up your mind regarding how magical MJ is you're sticking with it. That's how people get hurt--when you refuse to look at the actual evidence and consider the wisdom of those who know better than you (you've got one year of residency under your belt, and you have attending physicians here giving you feedback that you continue to ignore. Ignore me all you want--I'm only two years ahead of you, but go talk to any brain injury expert and they'll say "Yeah, MJ isn't as bad as EtOH after brain injury, but it's going to impair recovery."

I hope for your patients' sake that MJ does turn out to be a cure-all. And I hope that you become more open-minded as you'll need that to get into residency (which is certainly still possible for you) and to learn to become a holistic physician.

 

[curiousneuro]

Cannabis Hyperemesis is ruining America! Run for your lives! 5 adverse effects from cannabis and they felt better after cleaning their dirty bong and taking a shower. Some people can't eat peanut butter.

Now I've gotta get me some Reeses...

 

[BigRedBeta]

This is the best thread ever...

To the OP, I think some situational awareness is needed:
1) you have to have realized by now that the people who actually make it to becoming doctors have done so by playing by the rules. From the time they started kindergarten until the moment they've worked 80 hours a week for 3-7 years, they've seen what's asked of them and said "sure I'll do that". That's a long standing behavior/reward pattern that is strongly, strongly ingrained - follow the rules, get ahead - that you're dealing with. It doesn't make them bad people or close minded or whatever sort of derogatory label you want to place on them, it's just what the system produces. That's not right, wrong, good or bad, it just is. You and your career path to this point are a rarity and that makes others uneasy.

2) Most of the people who have replied to you seem to agree in principle with your assertion that MJ has benefits for the right type of patients, and that it is overwhelmingly safe. But the reasoned, rational flipside to that is nothing is 100% side effect free and there can be negative consequences to anything. We in the medical community certainly put up with a lot more negative side effects than those produced by MJ, but to argue that MJ has none is a fallacy. A more nuanced approach of your support would get you a lot further with everyone. The best advocates are able to convey their message in a manner that is palatable to their target audience.

3) The current state of the scientific method in 2016 has an extremely hard time with a polychemical substance like MJ, which I think you recognize. Again, not good, bad, right or wrong, just what it is. Perhaps technology will push us further in the future to better assess the biochemical/physiologic mechanisms in play in combination with MJ use but until that time, we're left with lots and lots and lots of confounding, not the least of which is that people like to get high. Data is king and finding true cause and effect mechanisms does matter.

In sum, realizing the landscape should help you navigate it. I hope you can actually learn from this thread, because I do think there's good advice here. I also hope that you're able to find, match, and finish a residency so that you can be a more effective voice for your patients and that you'll be able to combine MJ with other effective medications to help your patients. Best of luck.

 

[Shikima]

The arguments sound like an addict rationalizing.

 

[IMPD]

I've enjoyed the comments from many about the pros and cons of (medical) marijuana. My personal opinion is that this thread is actually pretty representative of my colleagues -- it's a polychemical plant that many people enjoy and calling it's use "medical" is just a backdoor to legalization. My reading of the tea leaves is that widespread recreational legalization is coming. The use of it's components as part of our regular pharma may eventually arrive, but it will be in a single-drug form that has passed FDA scrutiny. And it won't be smokable. Or nearly as enjoyable, I'm sure.

When I started training we could still order "beer" or "cocktail" for patients from our inhouse pharmacies. I never did, but the idea made me laugh. Beer and liquor have since been eliminated from hospital pharmacies (everywhere? not sure), and I think this time will eventually be seen as a transitional time for marijuana as well.

 

[VA Hopeful Dr]

When I started training we could still order "beer" or "cocktail" for patients from our inhouse pharmacies. I never did, but the idea made me laugh. Beer and liquor have since been eliminated from hospital pharmacies (everywhere? not sure), and I think this time will eventually be seen as a transitional time for marijuana as well.

When I left residency in 2013, beer and wine were still part of the in-house hospice order set at the hospital.

 

[dpmd]

I've enjoyed the comments from many about the pros and cons of (medical) marijuana. My personal opinion is that this thread is actually pretty representative of my colleagues -- it's a polychemical plant that many people enjoy and calling it's use "medical" is just a backdoor to legalization. My reading of the tea leaves is that widespread recreational legalization is coming. The use of it's components as part of our regular pharma may eventually arrive, but it will be in a single-drug form that has passed FDA scrutiny. And it won't be smokable. Or nearly as enjoyable, I'm sure.

When I started training we could still order "beer" or "cocktail" for patients from our inhouse pharmacies. I never did, but the idea made me laugh. Beer and liquor have since been eliminated from hospital pharmacies (everywhere? not sure), and I think this time will eventually be seen as a transitional time for marijuana as well.

I have ordered it and found it much more useful than benzos for the patient with no desire to stop their alcohol abuse. But it came from dietary not pharmacy so it got taken away because they didn't have a liquor license.

 

[IMPD]

When I left residency in 2013, beer and wine were still part of the in-house hospice order set at the hospital.

I spoke with our pharmacist about how they bought the beer and wine for the pharmacy back in the day. He said he went to the local liquor store and got whatever was on sale. If my last days are in-house, I will dis-inherit any of my family that allows Natty light to be my last taste of fermented hops and Franzia the last gasp of wine.

 

[Cytarabine]

I'm 100% for legalization of recreational marijuana, but few things grate on me like freaking pot disciples

 

[Raryn]

I've enjoyed the comments from many about the pros and cons of (medical) marijuana. My personal opinion is that this thread is actually pretty representative of my colleagues -- it's a polychemical plant that many people enjoy and calling it's use "medical" is just a backdoor to legalization. My reading of the tea leaves is that widespread recreational legalization is coming. The use of it's components as part of our regular pharma may eventually arrive, but it will be in a single-drug form that has passed FDA scrutiny. And it won't be smokable. Or nearly as enjoyable, I'm sure.

When I started training we could still order "beer" or "cocktail" for patients from our inhouse pharmacies. I never did, but the idea made me laugh. Beer and liquor have since been eliminated from hospital pharmacies (everywhere? not sure), and I think this time will eventually be seen as a transitional time for marijuana as well.

Our surgeons order 2 beers tid all the time to avoid alcohol withdrawal. One of our ICU attendings actually did the same... putting it down the NG tube if necessary. I always thought benzos were a cleaner method, but what do I know?

It looks disgusting btw. Hospital breakfast with 2 bud lights.