Menu

Medical Marijuana

Home The Lounge Medical Marijuana

  • Drop it into MD Drop it into MD 
    Participant
    Status: Physician
    Posts: 440
    Joined: 09/20/2018

    First thing.  Lets keep this civil so we do not get closed by the moderators.  Thank you.

     

    This is a hard subject to talk about because it quickly digresses to politics and opinions with little facts.  It came up at our local specialty conference and people just got upset and yelled at each other.  Seriously a room of physician.

     

    Anyways, I live in NY and it has been allowed for the past few years.  I have not had any involvement and I do not plan to.  However I do have a few patients who have been certified.  They have started asking me questions about treatment, side effects, interactions, etc.  I do not have answers for them and the doc who certified them does not want to hear from them again until they go back next year to be re-certified.

    How have you dealt with these issues in your practice?

    #184571 Reply
    Zaphod Zaphod 
    Participant
    Status: Physician, Small Business Owner
    Posts: 6327
    Joined: 01/12/2016

    He doesnt want to hear from them TFB, thats part of the deal.

    How great if we could just churn and see the easy stuff and not deal with reality.

    Avatar Panscan 
    Participant
    Status: Resident
    Posts: 1140
    Joined: 03/18/2017

    No different than any other issue if you don’t know anything about it or don’t wish to, then refer them to someone else who does. As long as it’s not an emergency which obviously this isn’t.

    This is just going to be an increasing frequency issue though so especially if you’re primary care I would get familiar at least. You don’t have to prescribe but a decent amount of patients will probably utilize so it’s worth knowing about.

    #184587 Reply
    Drop it into MD Drop it into MD 
    Participant
    Status: Physician
    Posts: 440
    Joined: 09/20/2018

    No different than any other issue if you don’t know anything about it or don’t wish to, then refer them to someone else who does. As long as it’s not an emergency which obviously this isn’t.

    This is just going to be an increasing frequency issue though so especially if you’re primary care I would get familiar at least. You don’t have to prescribe but a decent amount of patients will probably utilize so it’s worth knowing about.

    Click to expand…

    I agree but that is the issue there is no one to refer too.  The doc who certify people do not seem to know any more then I do.

    I am looking for ways to get some more unbiased information on the subject.  Unfortunately there are few studies and expert opinion seems to be very biased.

    Anyone have any good resources?

    #184598 Reply
    Avatar OUSOONERDOC 
    Participant
    Status: Physician
    Posts: 20
    Joined: 01/05/2017

    Unfortunately there is not a lot, if any, legit medical studies about the effects of THC due to it being an illegal drug. Its hard to do studies on illegal drugs. Hopefully, as medical marijuana becomes legal there will be more legit studies. Right now there just aren’t any legitimate ones to base any recommendations on (Other than chemo nausea/cancer pain and appetite/seizures.)

    #184600 Reply
    CordMcNally CordMcNally 
    Participant
    Status: Physician
    Posts: 3033
    Joined: 01/03/2017

    I don’t deal with these patients but I would be interested in some good resources since I’m starting to get asked by more patients about it. I suspect, in the end, it won’t be the miracle drug that some people make it out to be.

    “But investing isn’t about beating others at their game. It’s about controlling yourself at your own game.”
    ― Benjamin Graham, The Intelligent Investor

    #184602 Reply
    Zaphod Zaphod 
    Participant
    Status: Physician, Small Business Owner
    Posts: 6327
    Joined: 01/12/2016

    I don’t deal with these patients but I would be interested in some good resources since I’m starting to get asked by more patients about it. I suspect, in the end, it won’t be the miracle drug that some people make it out to be.

    Click to expand…

    I thought this was already well known, for the things its supposed to do well with there are already more powerful drugs on the market.

    Once legal everywhere it will be fine, like alcohol the ‘medical’ side will grind to a halt.

    #184612 Reply
    portlandia portlandia 
    Participant
    Status: Physician
    Posts: 414
    Joined: 07/07/2017

    Once legal everywhere it will be fine, like alcohol the ‘medical’ side will grind to a halt.

    Click to expand…

    Perhaps. But if taxes remain high on legal weed, people will clamor for the medical variety with its lower/no tax and thus lower cost. This is what we are already seeing in my state.

    #184623 Reply
    Zaphod Zaphod 
    Participant
    Status: Physician, Small Business Owner
    Posts: 6327
    Joined: 01/12/2016

    Once legal everywhere it will be fine, like alcohol the ‘medical’ side will grind to a halt.

    Click to expand…

    Perhaps. But if taxes remain high on legal weed, people will clamor for the medical variety with its lower/no tax and thus lower cost. This is what we are already seeing in my state.

    Click to expand…

    Black market as well. Yes this is just a dumb thing, that I cant believe they fell for so hard. Obvious its very price sensitive legal or not. At least wait 5 years or so before going wild and over taxing it. They didnt even let the black market crumble at all first. They have to lower them really. In the end its a crop, aka, a commodity and will get very cheap depending on regulations and such.

    #184624 Reply
    Avatar goatmom 
    Participant
    Status: Physician
    Posts: 56
    Joined: 09/21/2016

    I would refer them back to the prescribing doctor.  He doesn’t want to hear from them?  How does that work?  Maybe he is in the wrong business.  Maybe they do not want to go to see him because since it is for medical marijuana the doctor cannot bill insurance and it would be another cash visit.  I would be tempted to call the doc up myself – he should not be prescribing meds he does not understand.

    #184625 Reply
    Drop it into MD Drop it into MD 
    Participant
    Status: Physician
    Posts: 440
    Joined: 09/20/2018

    I would refer them back to the prescribing doctor.  He doesn’t want to hear from them?  How does that work?  Maybe he is in the wrong business.  Maybe they do not want to go to see him because since it is for medical marijuana the doctor cannot bill insurance and it would be another cash visit.  I would be tempted to call the doc up myself – he should not be prescribing meds he does not understand.

    Click to expand…

    I have only encountered this with a few patients but it is the same in all 3.  They had a phone conversation with a doctor somewhere else in the state who they told what medical problems they had.  He deemed that they fit into the particular diagnosis allowed and he certified them.  After they paid the $250-300 of course.

    I have referred my patients back to these docs but the patients claim they are falling on deaf ears.  Maybe you are right and it is a money issue.  I wonder if they will charge me to call and ask questions?

    #184632 Reply
    Liked by Tim
    Avatar mainah 
    Participant
    Status: Advanced Practice Provider
    Posts: 39
    Joined: 10/04/2018

    Both medical and recreational THC are legal in my state. There is a NP in our clinic who is certified to rx it and from what I hear from other patients, it’s pretty easy to get if you say you are anxious, and I don’t think I’ve ever heard of anyone applying for a card being denied. I haven’t talked with him about this aspect of his practice at all though. I just saw an epilepsy patient today who is going to see him tomorrow, and I asked her what her neurologist thought about the appt, and it sounds like he was against it. There is another doctor who travels around the state doing certification clinics for cash ($125 for initial certification) but I imagine followup is quite poor for the stuff in between yearly certifications. My policy is to say “you need to follow up with the person who prescribed this to you about it” when patients ask me questions, and if they are just considering it but haven’t started it, I say what has already been echoed above, there isn’t a ton of evidence to support it just yet.  I have had an increase in patients with medical cards coming in with cannabis hyperemesis after starting it, and they usually aren’t pleased to hear me say their sx are caused by the THC. Our state board has also made it clear, though disciplinary hearings, that they don’t feel that rx medical THC with benzos or opiates is appropriate ever, which sometimes is an issue for patients on chronic opiates or benzos for pain/anxiety with THC coming up in their drug screens.

    #184633 Reply
    Drop it into MD Drop it into MD 
    Participant
    Status: Physician
    Posts: 440
    Joined: 09/20/2018

    Once legal everywhere it will be fine, like alcohol the ‘medical’ side will grind to a halt.

    Click to expand…

    Perhaps. But if taxes remain high on legal weed, people will clamor for the medical variety with its lower/no tax and thus lower cost. This is what we are already seeing in my state.

    Click to expand…

    Black market as well. Yes this is just a dumb thing, that I cant believe they fell for so hard. Obvious its very price sensitive legal or not. At least wait 5 years or so before going wild and over taxing it. They didnt even let the black market crumble at all first. They have to lower them really. In the end its a crop, aka, a commodity and will get very cheap depending on regulations and such.

    Click to expand…

    I guess the medical variety is rather expensive.  Of course it is not covered by insurance and I guess you have to pay cash because CC companies and banks want no part of it.  I have heard around $200 a month.  I do not know what legal recreational costs as that is not legal in my state.  Yet…

    #184634 Reply
    Rando Rando 
    Participant
    Status: Physician
    Posts: 204
    Joined: 01/08/2016

    The way it is handled in my state is a physician verifies the pt has a condition that might be helped by the cannabis product and is referred to a dispensary where the correct dosage is determined, and the product is sold.  This gets around the physician actually prescribing cannabis.

    I have one patient for whom I filled out the form, and I sure am not advertising it.  I plan on restricting this to established patients that I know well.  I can only think of a handful that might legitimately qualify.

    So here are a couple pdfs if you want more education on the medical use of cannabis.  This one is to existing studies on cannabis:   http://www.health.state.mn.us/topics/cannabis/practitioners/dosagesandcompositions2018.pdf.

    This is to general info on it http://www.hc-sc.gc.ca/dhp-mps/alt_formats/pdf/marihuana/med/infoprof-eng.pdf .

    I’m not particularly impressed by the quality of research on this, on the other hand I do have a few patients that I know have legitimate problems and have tried about everything else.

    #184644 Reply
    Liked by childay
    childay childay 
    Participant
    Status: Physician
    Posts: 1071
    Joined: 01/09/2016

    The research is crap.  Sure it’s worth further researching.  But it should be treated as a drug and go through FDA approval if we are using it for medicine.

    I’m pro-legalization and anti-medical.  The medical indications are questionable.  I doubt these dispensaries are full of debilitated MS patients with muscle spasticity..

    #184646 Reply

Reply To: Medical Marijuana

In case of a glitch or error, please save your text elsewhere, clear browser cache, close browser, open browser and refresh the page.

Notifications Mark all as read  |  Clear