Mark\u2019s past career choices were murder on his body. As a photojournalist, he carried around heavy camera bags for a decade. Then, as a touring musician, he lugged equipment on and off for 15 years, leaving him with chronic pain in his back and neck.<\/p>\n
\u201cThe only things that work to alleviate the pain are smoking or eating cannabis, combined with monthly massage therapy,\u201d he says.<\/p>\n
But Mark won\u2019t tell his doctor he uses cannabis. He suspects many doctors in Texas, where he lives, might label him a deviant, a lawbreaker and a drug user\u00a0if he admits he uses marijuana. Even hip doctors often don\u2019t want to know. \u201cOne of my recent doctors said straight up, \u2018If we were in a different state, it wouldn\u2019t be an issue. But as long as Texas doesn\u2019t have a medical marijuana law, I can\u2019t know that you use that.\u2019\u201d<\/p>\n
This unofficial \u201cdon\u2019t ask, don\u2019t tell\u201d policy means many patients aren\u2019t getting comprehensive healthcare. Access to healthcare professionals who are educated about medicinal cannabis is a patients\u2019 rights issue, says Eileen Konieczny<\/a>, a registered nurse and former president of the American Cannabis Nurses Association<\/a>. \u201cWhy in California can you access something that in Georgia and Louisiana, you can\u2019t? It shouldn\u2019t matter where you live.”<\/p>\n Although polls indicate<\/a>\u00a0that most Americans approve of marijuana for medical use, many patients and doctors are leery about bringing up the topic during visits. That\u2019s partly because the legal stakes are high: In January, Attorney General Jeff Sessions<\/a> said the Justice Department should feel free to prosecute marijuana-related transactions, even in states where medical marijuana is legal. It\u2019s also because many doctors just don\u2019t know enough about cannabis to competently answer patients’ questions about it.<\/p>\n A 2017 survey<\/a> of nearly 500 primary care physicians in Washington state, where marijuana is legal even for recreational use, revealed that although half of them were legally allowed to prescribe medical marijuana to their patients, only 27 percent had done so. The others didn\u2019t feel confident enough in their knowledge of the drug to get out their prescription pads.<\/p>\n When researchers at Washington University in St. Louis surveyed residents and fellows training at the Barnes-Jewish Hospital<\/a>, 90 percent didn\u2019t feel capable of prescribing medical marijuana. Eighty-five percent said they\u2019d learned nothing about it in medical school or other residency programs. Those stats aren\u2019t too surprising when you consider that only 9 percent of medical schools cover medical marijuana, according to data from the Association of American Medical Colleges<\/a>.<\/p>\n Marijuana\u2019s classification<\/a> by the U.S. Drug Enforcement Agency as a Schedule I drug \u2014 a status it shares with heroin and LSD \u2014 is likely why most medical schools avoid the subject in their curricula, says Beatriz H. Carlini, a public health researcher at the University of Washington\u2019s Alcohol and Drug Abuse Institute. According to the federal government, Schedule I drugs have no medical benefit and a very high potential for abuse.<\/p>\n But the reality is that many patients, like Mark, are already self-medicating with marijuana, which makes doctors\u2019 lack of knowledge about it alarming. Patients who use cannabis for cancer pain deserve to have an educated medical staff, says Ronald F. Tuma, a physiology professor at the Lewis Katz School of Medicine at Temple University in Philadelphia.<\/p>\n Nearly one-quarter of cancer patients use cannabis to help manage their symptoms, a 2017 study<\/a> found. Yet in a recent study<\/a>, only 30 percent of oncologists surveyed said they felt confident answering their patients\u2019 questions about it.<\/p>\n \u201cSome of the best info out there is on dispensary websites, but that\u2019s not a source I\u2019d want to rely on as a physician.”<\/p><\/blockquote>\n Doctors tend to agree<\/a> that they need to learn more about marijuana, but figuring out how and where they should study up isn\u2019t so clear. In the 29 states and the District of Columbia<\/a> where medical marijuana is legal, requirements for healthcare professionals who want to prescribe it vary. Florida<\/a> requires a two-hour training course, while Maryland<\/a> only requires doctors to verify their credentials and say they understand state regulations related to medical cannabis. Health professionals in any state can take one of two approved four-hour courses<\/a> that are mandatory for medical marijuana prescribers in New York.<\/p>\n Dr. Matthew Mintz,<\/a> a Maryland primary care physician, took one of the New York medical marijuana courses, even though it wasn\u2019t required by state law. Getting certified in Maryland was easy, he says, but finding reliable, large-scale studies supporting the efficacy of cannabis wasn\u2019t.<\/p>\n \u201cSome of the best info out there is on dispensary websites, but that\u2019s not a source I\u2019d want to rely on as a physician,\u201d says Mintz, a former George Washington University School of Medicine professor now in private practice in Bethesda, Maryland. \u201cOne of the problems with outside resources, especially if you\u2019re on a dispensary website, is that they\u2019re trying to sell products, so you\u2019re not getting unbiased information.\u201d<\/p>\n There is good published research<\/a> supporting the benefits of medical marijuana for patients with cancer, HIV and AIDS<\/a>, epilepsy<\/a>, PTSD<\/a> and chronic pain<\/a>. But merely knowing marijuana might help doesn\u2019t make it easy to prescribe. There\u2019s much less scientific evidence<\/a> that medical marijuana reduces headache pain and anxiety, for example, yet those are two common reasons people request prescriptions.<\/p>\n The knowledge gaps hardly end there: There’s a lack of research on how different marijuana strains affect the body. Doctors don\u2019t know what the best delivery method is, or the optimal amount to consume. Scientists aren\u2019t sure how marijuana works synergistically with other medications, or which drugs it shouldn\u2019t be combined with.<\/p>\n \u201cAt this point, it seems there are no accepted dosage guidelines for specific ailments,\u201d says Dr. Edward Alvarez, a cosmetic and reconstructive dentist in the New York area. \u201cOne \u2018joint\u2019 may be more potent than another, based on so many factors, and that can\u2019t be arbitrary when we are dealing with a therapeutic medication.\u201d<\/p>\n Some doctors are less concerned about filling in the blanks. If cannabis works, they say, why not prescribe it?<\/p>\n \u201cBecause the negative effects of marijuana are no worse than those of tobacco or alcohol, I see no reason why patients, especially those for whom Western medicine has failed, shouldn\u2019t be allowed to try it and see if it helps their ailment,\u201d says Dr. Bradley Katz, a neuro-ophthalmologist and co-founder of Axon Optics<\/a>, a company that makes eyewear for people with light sensitivity. \u201cBut I feel bad that I can\u2019t be more helpful in terms of what maladies it\u2019s useful for, where to buy it or how much to use.\u201d<\/p>\n Mintz, like many medical marijuana prescribers, says he depends on the patient-care experts or \u201cbudtenders\u201d at dispensaries for information about strains, dosages and delivery methods. Yet while some dispensary employees are knowledgeable, others might hinder good patient care, says cannabis specialist Dr. Jordan Tishler.<\/a><\/p>\n \u201cOn a regular basis, my patients are upsold a plan that isn\u2019t good for them,\u201d Tishler says. \u201cI end up having to ask them what they\u2019re taking, because what I told them to take might not have anything to do with what the person at the dispensary gave them.\u201d<\/p>\n At least one of his patients was told at a dispensary, \u201cI don\u2019t understand what your doctor\u2019s doing, so forget what he said, I\u2019ll tell you what to do.\u201d<\/p>\n \u201cHow do you take care of people in those circumstances?\u201d Tishler says.<\/p>\n Tishler, a former emergency room doctor at veterans affairs hospitals, currently serves as both treasurer of the organization Doctors for Cannabis Regulation<\/a> and\u00a0president and CEO of the\u00a0Association of Cannabis Specialists<\/a>. In addition to working with dispensaries to create a credentialing program, the nonprofit is developing a medicinal cannabis educational program for health professionals, as well as lobbying for better medical marijuana access and responsible regulation. Primary care physicians rarely have the expertise or even the time during visits to discuss medicinal cannabis with patients in the depth they should. But patients still need expert guidance, he says, and they\u2019d be better off seeing doctors certified as cannabis specialists by the association than being directed to dispensaries for advice.<\/p>\n \u201cThe model developed since California legalized cannabis for medical use in 1996 is this idea that the doctor\u2019s job is just to say yes or no,\u201d he says. \u201cIf that were the case in any other area of medicine, it would be considered malpractice. If someone has high blood pressure, you don\u2019t just tell them, \u2018Go get medicine.\u2019 What medicine, what will it do, how much does the patient take? That basic level of informed consent is the basis of how we live up to the patient-doctor relationship of trust.\u201d<\/p>\n \u201cThe endocannabinoid system is the largest receptor system in our bodies, and it isn\u2019t being taught. There\u2019s something wrong with that.\u201d<\/p><\/blockquote>\n Ann, a professor at the University of South Florida, was recently certified as a medical marijuana patient to treat her Crohn\u2019s disease. The prescriptions she gets from Trulieve<\/a>, a Florida cannabis provider, specify the proper delivery method, dosage and concentration of her low-THC cannabis, as well as the number of times she should take it each day. But while medical marijuana became legal for Florida residents<\/a> in 2017, it can be difficult for patients to obtain. Waiting lists are reportedly long, and Ann says she only managed to get a medical marijuana card because her friend guided her through the process. \u201cI wouldn’t have known where to start,\u201d Ann says.<\/p>\n One of the few medical schools that cover medicinal cannabis instruction, Philadelphia\u2019s Temple University, instructs students about the biological system known as the endogenous cannabinoid system and the physiological effects that cannabinoids (natural chemicals in cannabis that include CBD and THC) have on the body, explained Tuma, the Temple professor. More schools are following suit, but progress is slow. The University of California, Davis, started offering an undergraduate course covering the \u201cbiology of cannabis\u201d<\/a> in 2017, and says a similar course is being developed for med students.<\/p>\n The Washington attorney general\u2019s office awarded a grant in 2013 to develop a training program for state healthcare providers regarding the scientific basis, clinical implications and legal ramifications of using medicinal cannabis to treat and manage chronic pain, Carlini says. Although the program was developed by the University of Washington<\/a>, it isn\u2019t offered at the university\u2019s medical school. Health professionals who want to learn about medical marijuana can take the course no matter where they live, and those practicing in Washington state can be certified to prescribe medical cannabis after completion.<\/p>\n Like the Association of Cannabis Specialists, the American Cannabis Nurses Association<\/a> is developing a certification program for cannabis nurses, as well as urging nursing schools to include medical marijuana in their curricula. A host of schools have cropped up to train budtenders about cannabis. But, Konieczny says, \u201cunless you\u2019re a healthcare professional, you can\u2019t use the information the same way a nurse can.\u201d<\/p>\n \u201cThis isn\u2019t voodoo medicine \u2014 there\u2019s real science behind it,\u201d she says. \u201cThe endocannabinoid system, which was discovered in the \u201990s, is the largest receptor system in our bodies, and it isn\u2019t being taught. There\u2019s something wrong with that.\u201d<\/p>\n Tishler agrees that cannabinoids need to be included in pain management education. \u201cThey exist and they can help,\u201d he says. \u201cIt would be like having a course on treating pain with medication and not mentioning opioids. We have to get to place where cannabis is destigmatized enough where we can look at it objectively.\u201d<\/p>\n In fact, given the opioid crisis in the U.S., medical schools should be teaching sections on chronic pain and pain management, says Dr. Andreas Mitchell, a resident at the University of California, San Francisco, Medical Center.<\/p>\n \u201cI didn’t learn much about the causes, the pathophysiology, screening or treatment of chronic pain [in med school],\u201d Mitchell says. \u201cAt some point during my third-year rotations, someone handed me a chart with some medications and dosages that I could reach for, but medical marijuana was not included.\u201d<\/p>\n Mitchell co-authored an opinion piece<\/a> about medical marijuana education for Stat News<\/i> with first-year Harvard Medical School student Suhas Gondi. Mitchell and Gondi argued in the piece that case-based learning would be a good way to present medical information about cannabis.<\/p>\n A medical marijuana discussion could be easily incorporated into a case focusing more broadly on a patient with persistent lower back pain who isn\u2019t responding to non-opioid analgesics such as acetaminophen (Tylenol).\u00a0In case-based learning, the instructor-slash-physician presents a real or fictitious case of a patient with some type of chronic pain, for example. Then students come up with ideas for questions to ask the patient and evaluate the significance of their responses.<\/p>\n \u201cThe professor can then use the specific case to walk students through the decision points, risks and benefits of medical marijuana and how the actual recommendation process works, depending on the state,” Gondi says.<\/p>\n Tishler has offered to lecture Harvard Medical School students about medical marijuana, and Mintz volunteered to share his cannabis expertise with students at George Washington University. So far, neither school has taken them up on their offers.<\/p>\n \u201cIt\u2019s not legal everywhere and not fully accepted by the medical community, so it\u2019s understandable that they might not want to spend precious class time on it,\u201d Mintz says. \u201cBut I make the case that by the time these students graduate and are practicing, it\u2019ll be more accepted. And it would be better that they know about it now rather than waiting.\u201d<\/p>\n When it comes to an Rx for pot, patients have plenty of questions. But doctors rarely have the answers. Here’s what some experts are doing to get the medical field up to speed on weed. <\/p>\n","protected":false},"author":12,"featured_media":17550,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[229],"tags":[90,40,46,132],"class_list":["post-17486","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-healthcare-trends","tag-feature","tag-medical-marijuana","tag-pain-relief","tag-research","reviewer-dr-nassim-assefi","specialist_by_city-find-primary-care-physicians-near-you"],"yoast_head":"\nKnowledge gaps<\/h2>\n
Doctors and dispensaries<\/h2>\n
Cannabis-based curriculum<\/h2>\n
\nReady to book a doctor’s appointment? Visit Zocdoc.<\/a><\/h1>\n","protected":false},"excerpt":{"rendered":"