Legalized marijuana

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kakalinasewald said:
I think marijuana helps people dealing with anxiety and other diseases. For example, this helps people who have cancer.
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Think what you want, but marijuana has been shown to worsen anxiety, paranoia, depression, psychosis, suicidal thoughts, and coping.
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Had six patients in the last 3 months who wanted to try THC for chronic back and neck pain; and gave up after 2-3 attempts due to lack of pain relief
 
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I’ve had several old ladies recent tell me in embarrassed and half-whispered tones: “When it hurts bad I’ll put some pot cream on it and that helps.”
I tell patients I don’t have a strong opinion one way or the other but in general topical medications are pretty low risk as long as it’s a reputable supplier.
 
Agast said:
How do pain doctors who live in legal states handle marijuana? I mean aside from a relaxing Friday night.

I know a couple docs who sell CBD out of their office. It did nothing for my dog so I think it’s mostly placebo.
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It is federally illegal. It is therefore illegal. Definitely no opioids or benzos if patient is using. I never endorse it and will recommend against it if they ask about it. Usually they don't ask about it, they like to brag about it since it is working so well (which is why they are seeing a pain specialist I guess?).
 
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Had a paraplegic (many years ago) who used THC to help him sleep at night (pain related). He got hospitalized so they called me. I gave him Marinol, he was happy but after he left the hospital he still wanted it. So I continued it and saw him every 6 months like a chronic opioid user. When I retired THC had become legal and I tapered him off Marinol before I retired. I checked with the state board they were OK with that. Now many many years ago I would write a script that looked like this. " My understanding is that prescribing marijuana is illegal but I think it might help this patient." It always worked and I never had to renew the script. There were quasi legal dispensaries in CA that seemed to be OK with that. Never got into any trouble with it although an addictionologist told me I was in a gray area and admin would not like it. YMMV!
 
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willabeast said:
Had a paraplegic (many years ago) who used THC to help him sleep at night (pain related). He got hospitalized so they called me. I gave him Marinol, he was happy but after he left the hospital he still wanted it. So I continued it and saw him every 6 months like a chronic opioid user. When I retired THC had become legal and I tapered him off Marinol before I retired. I checked with the state board they were OK with that. Now many many years ago I would write a script that looked like this. " My understanding is that prescribing marijuana is illegal but I think it might help this patient." It always worked and I never had to renew the script. There were quasi legal dispensaries in CA that seemed to be OK with that. Never got into any trouble with it although an addictionologist told me I was in a gray area and admin would not like it. YMMV!
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I personally would never write a script. If patient wants to use marijuana it’s on them. I agree your “script” is in the gray area, for one it doesn’t even prescribe a medicine, doesn’t give an indication, and you are prescribing something g that is federally still illegal.
 
I mean Marijuana isn’t recommended for PEDs/adolescents. What happened to the 14 y/o is the main reason we don’t use it in kids. The only case I’d even consider for Peds is if they are dying from cancer. Too many bad effects on the growing body and mind. I knew 14 y/o growing up who smoked marijuana several times per day and that was decades ago. And it’s still illegal for use just like EtOH. These cases have been going on for decades.

Also, no one recommends use in pregnancy. But some percentage of people will continue to use drugs, tobacco, EtOH during pregnancy no matter what anyone recommends.

Anecdotally, I tried CBD oil a few times. Not really sure what it was supposed to do, but didn’t do anything. High doses will saturate CP450 and will elevate liver enzymes. So I don’t think anyone should be self medicating, especially if on other medications. But the political movement will continue to slowly make it legal everywhere…and of course doctors will be to blame for the negative effects even if legal.
 
I have many Colorado patients who use edibles only at night to relax and to aid sleep.

Many do better with this than prescription medications, and so I don’t interfere. Most of them can also use less QHS pain meds as a result.

Important to remember there are plenty of side effects including habit forming, AM grogginess, medication interactions, for patients using prescription sleep aids/neuropathics/muscle relaxers, etc.
No drug is completely benign.
 
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Baron Samedi said:
I tried a CBD infused cocktail here locally and it just tasted like lawn clippings. Would not recommend.
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There was probably a $5 upcharge for those lawn clippings
 
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There is higher data to support MJ in fibromyalgia compared to opiates.
If patients are already smoking marijuana as a sleep adjunct, I ask that they instead utilize edibles in dose of 5-10 mg 45 minutes prior to sleep. While it doesn’t nexessarily have pain blocking properties, it can help improve sleep patterns and thereby lead to less fatigue in patients with fibromyalgia.


If they’re not taking MJ, I’d just utilize flexeril as a way of achieving sleep/helping with sleep in pts with fibromyalgia
 
Chronic daily use increases depression, anxiety, psychosis, and risk of schizophrenia. Acute and chronic use depresses reaction time and motor skills, slows cognition, and negatively affects memory and executive function. Risks outweigh potential benefits but our society loves it and it’s revenue so it’s here to stay for the time being.
 
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clubdeac said:
Chronic daily use increases depression, anxiety, psychosis, and risk of schizophrenia. Acute and chronic use depresses reaction time and motor skills, slows cognition, and negatively affects memory and executive function. Risks outweigh potential benefits but our society loves it and it’s revenue so it’s here to stay for the time being.
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You can say the same about alcohol, except substitute liver failure for schizophrenia.
 
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bedrock said:
I have many Colorado patients who use edibles only at night to relax and to aid sleep.

Many do better with this than prescription medications, and so I don’t interfere. Most of them can also use less QHS pain meds as a result.

Important to remember there are plenty of side effects including habit forming, AM grogginess, medication interactions, for patients using prescription sleep aids/neuropathics/muscle relaxers, etc.
No drug is completely benign.
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Ever ask the DEA how this works from a registration or legal standpoint?
 
bedrock said:
I don’t get involved if I’m not writing them any controlled substances.
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When I was Stanford, a lot of ppl were on medical marijuana. It didn't stop them from wanting opiates. I had a girl fog out her car in the parking garage before a sympathetic block.

She had an "allergy" to big pharma created drugs.

So she hot boxed her car and we did an LSB.

LOL.

BTW - I had a convo with a pt one day about whether or not the medical marijuana was helping her, and she accused me of racism for using the term marijuana.

Just an FYI, there are individuals who believe that to be true. Use the term cannabis so you don't get a bad Google review or are forced into a super annoying 15 min debate.
 
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bedrock said:
I don’t get involved if I’m not writing them any controlled substances.
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From your prior post: "Most of them can also use less QHS pain meds as a result."

If you are not writing, then who cares. Not your problem.

Anyone reading this and thinks it is ok for prescribing opiates to patients using THC: Ask the DEA what schedule they have marijuana listed as.
 
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lobelsteve said:
From your prior post: "Most of them can also use less QHS pain meds as a result."

If you are not writing, then who cares. Not your problem.

Anyone reading this and thinks it is ok for prescribing opiates to patients using THC: Ask the DEA what schedule they have marijuana listed as.
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I mostly refer to qhs flexeril, gabapentin, elavil/pamelor, but even to QHS NSAIDS in patients with relative or significant NSAID contradiction.

However, there is a local NP who does some medical pain management, but sends me patients for procedures. Some of her patients went from requiring a vicodin every night, to an edible every night (under her oversight).

Long term, that might be better than daily opioids. No true to head to studies on this, but the fewer people taking daily opioids, the better.
 
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bedrock said:
I mostly refer to qhs flexeril, gabapentin, elavil/pamelor, etc.

However, there is a local NP who does some medical pain management, but sends me patients for procedures. Some of her patients went from requiring a vicodin every night, to an edible every night (under her oversight).

Long term, that might be better than daily opioids. No true to head to studies on this, but the fewer people taking daily opioids, the better.
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My opinion is those that are motivated to come off opioids could have come off to a non opioid without any marijuana.
 
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dipriMAN said:
My opinion is those that are motivated to come off opioids could have come off to a non opioid without any marijuana.
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Agree.

Opiate is not insulin; pain is not blood sugar.
 
callmeanesthesia said:
You can say the same about alcohol, except substitute liver failure for schizophrenia.
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true... and I think our society would be much better with more limited alcohol consumption. alcohol related deaths exceeded Covid deaths for those under 65 last year. Also alcohol is implicated in approximately 40-50% of all homicides, 2/3rds of domestic abuse, and a large proportion of aggravated and sexual assault. it's a huge problem no one wants to talk about. Humans love their alcohol
 
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clubdeac said:
true... and I think our society would be much better with more limited alcohol consumption. alcohol related deaths exceeded Covid deaths for those under 65 last year. Also alcohol is implicated in approximately 40-50% of all homicides, 2/3rds of domestic abuse, and a large proportion of aggravated and sexual assault. it's a huge problem no one wants to talk about. Humans love their alcohol, to their own fault
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Agree. But I think adults should be able to choose for themselves.

I think that alcohol, cigarettes, and marijuana should all be treated the same.

They should all be legal, but only after age 21 (for all three).

Or none of them should be legal at all.
 
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What’s magic about 21 that’s not there when you’re 18?

A 19-year-old who moves out of their parent’s house and gets a full time job, starts paying their own bills and taxes, is probably more responsible than a 21-year-old frat boy enjoying college
 
I'd say 25 for all three. College will be a lot less fun but hey maybe it's worth it to have less domestic abuse, rape and overall violence. The human brain is still developing until age 25
 
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Agast said:
What’s magic about 21 that’s not there when you’re 18?

A 19-year-old who moves out of their parent’s house and gets a full time job, starts paying their own bills and taxes, is probably more responsible than a 21-year-old frat boy enjoying college
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Agree with deac. Multiple studies this century demonstrate that the brain is still developing until 25 yrs, particularly the frontal cortex. This was not well understood at the time when the drinking age and voting age were reduced to 18 in the last century, though the drinking age was later raised to 21.

Teenagers AND college undergrads are disasters waiting to happen if you give them total freedom. They are not truly adults yet and their brains have not matured.

That is why I don't think that alcohol, cigarettes, or weed should be legal until age 21. I also don't believe people should be allowed to vote until age 21 for the same reason. They are not sufficiently intellectually nor emotionally mature for the responsibility.

An argument could certainty be made to extend all 4 limitations until age 25, however 21 yrs of age is a reasonable compromise for everyone. 18 years old is too young for all 4.
 
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anujacket said:
There is higher data to support MJ in fibromyalgia compared to opiates.
If patients are already smoking marijuana as a sleep adjunct, I ask that they instead utilize edibles in dose of 5-10 mg 45 minutes prior to sleep. While it doesn’t nexessarily have pain blocking properties, it can help improve sleep patterns and thereby lead to less fatigue in patients with fibromyalgia.

If they’re not taking MJ, I’d just utilize flexeril as a way of achieving sleep/helping with sleep in pts with fibromyalgia
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Perhaps that's because opiates don't work for Fibro and may, in fact, make it worse.

MitchLevi said:
BTW - I had a convo with a pt one day about whether or not the medical marijuana was helping her, and she accused me of racism for using the term marijuana.

Just an FYI, there are individuals who believe that to be true. Use the term cannabis so you don't get a bad Google review or are forced into a super annoying 15 min debate.
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Yeah, I would stop treating that patient. A bad review is just a matter of time anyway.
 
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If they can send you to war, you sure as hell better be allowed to vote. I know the same argument is made for alcohol, tobacco (and probably weed), but IMHO its not the same. I would be ok with those 3 being set to 25, though agree that 21 is probably a good compromise.
 
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Happy 4/20

May all your patients pass their UDS
 
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Just read chronic pot smokers are 6x more likely to suffer from schizophrenia and 25% of all new cases of schizophrenia in 18-30 yr olds are due to marijuana

Pot will be like opioids. We’ll come to realize that the wonder drug with little to no addictive potential was actually destroying lives
 
clubdeac said:
Just read chronic pot smokers are 6x more likely to suffer from schizophrenia and 25% of all new cases of schizophrenia in 18-30 yr olds are due to marijuana

Pot will be like opioids. We’ll come to realize that the wonder drug with little to no addictive potential was actually destroying lives
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Elections have consequences.
 
I get crap on here every time I mention this…

I have had some success with Marinol.

To some of my patients I have said - just go get the MJ. All of them that I have mentioned this too have returned and told me they hated the way MJ made them feel and Marinol doesn’t make them at all stoned, but helps with the pain and helps them sleep.

I’ll keep using it on occasion.
 
epidural man said:
I get crap on here every time I mention this…

I have had some success with Marinol.

To some of my patients I have said - just go get the MJ. All of them that I have mentioned this too have returned and told me they hated the way MJ made them feel and Marinol doesn’t make them at all stoned, but helps with the pain and helps them sleep.

I’ll keep using it on occasion.
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www.ncbi.nlm.nih.gov

Dronabinol Is a Safe Long-Term Treatment Option for Neuropathic Pain Patients

Treatment of neuropathic pain (NP) symptoms associated with multiple sclerosis (MS) is frequently insufficient. Yet, cannabis is still rarely offered for treatment of pain. This clinical trial aimed at showing the positive benefit-risk ratio of dronabinol. ...
www.ncbi.nlm.nih.gov www.ncbi.nlm.nih.gov

Pain intensity during 16-weeks dronabinol and placebo treatment was reduced by 1.92 and 1.81 points without significant difference in between (p = 0.676).

1683629485725.png
 
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Why would anyone recommend marijuana, CBD or any type of derivative for pain management? If you're going to recommend dope, give an actual opiate like Norco.
 
because recommending opiates will lead to long term consequences that you as the doctor have to be responsible for.

if someone wants to go take something that is legal, and not in your purview to prevent them from doing so, then caveat emptor.
 
Ducttape said:
because recommending opiates will lead to long term consequences that you as the doctor have to be responsible for.

if someone wants to go take something that is legal, and not in your purview to prevent them from doing so, then caveat emptor.
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You're inconsistent
 
how so?

i cant stop someone from buying weed if it is legal, can i? i can tell them that i dont think it will work, and it could be dangerous...
 
Ducttape said:
how so?

i cant stop someone from buying weed if it is legal, can i? i can tell them that i dont think it will work, and it could be dangerous...
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You routinely advise against any treatment not supported by high quality evidence, and you've repeatedly said desperation in a pt is not an indication for any number of different treatments.

There's no good evidence for anything with regard to cannabis.

Every physician should flatly reject this BS bc it's clearly not harmless.

You mention Norco being problematic, but chronic cannabis use is similarly problematic and it's inconsistently inconsistent on a dose by dose basis.

Whether or not it is legal at the state level is irrelevant.
 
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Saw an interesting talk on marijuana and the youth from one of the pediatric addiciton doctors. Turns out that you drive just as bad as if you are drinking alcohol but believe that you actually drive better than baseline (they actually set up a study to look at this). Marijuana seems to preferentially shut down the part of the brain that allows introspection/insight.

Also a couple of cases of fentanyl found in marijuana off the street with overdose. A scary time to be experimenting out there.
 
agree there is not good evidence.

if you make the assumption i am going out of my way to suggest people use marijuana, then you have added that to my posts, because no where have i recommended its use. is it your preconceived notions that make you think that i would recommend marijuana where i have never done so?

if they ask my opinion, i tell them that noone i am taking care of finds that it really benefits them. are there people out there getting benefit? maybe. but im not seeing them. and i do suggest that they be cautious and safe - buy from a reputable source (ie legal source), dont drive or drink or do other drugs, make sure someone knows you are taking, buy naloxone just in case, etc.


if it is legal and someone wants to do it, then with the exception of my prescribing opioids, thats on them. i am not a THC nazi.


even if i am prescribing opioids, i cant stop them from using weed. but i will stop prescribing them opioids, because that is an action i control.
 
Ducttape said:
because recommending opiates will lead to long term consequences that you as the doctor have to be responsible for.

if someone wants to go take something that is legal, and not in your purview to prevent them from doing so, then caveat emptor.
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This post sux as a reply to what I posted.

Both Norco and reefer have long term side effects, but with the former I can actually say it helps with pain for SOME length of time.

You can't say that at all regarding marijuana.
 
epidural man said:
I disagree.

The problems of long term opioid use seem worse, not similar to the problems of long term marajuana use.
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Define worse?

It's easier to measure perhaps, but make no mistake...Chronic use of marijuana is largely negative.
 
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