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  • #16
    Tiny sample size but I have one elderly guy who came completely off opioids with a topical CBD off Amazon. I will occasionally recommend that (with caveats) to patients. I have one patient with chronic n/v, chronic daily migraine. At one point on marinol not any more. It’s very unclear if she gets canniboid hyperemesis or just uncontrolled n/v, multiple specialists and inpatient folks generally say stop it, she keeps thinking it helps. 🤷🏼‍♂️ And I have a few who have clearly had cannabis hyperemesis.

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    • #17
      Originally posted by Hank View Post
      Frankly, it’s ridiculous that the Democrats have the White House and both houses of Congress and they can’t get marijuana off of Schedule 1.
      Substantial majorities of Americans support legalization. Even Republicans are split about 50:50 on the topic. https://news.gallup.com/poll/356939/...cord-high.aspx
      endorse

      i don't really know anyone who feels that strongly about weed anymore, even super conservative people i know don't really seem to care.

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      • #18
        Good article here: Medical Marijuana What physicians need to know (https://www.psychiatrist.com/jcp/add...-need-to-know/)

        Despite states approving cannabis left and right for psychiatric conditions there is little actual evidence for it for psychiatric conditions. Particularly concerning is rising psychotic disorder rates.

        But in terms of deciding where to direct efforts related to substance use, its better to spend it on Alcohol, tobacco, opioids, cocaine/meth. Don't bother with Cannabis.

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        • #19
          Recreational MJ is illegal in my state. People can get it with a cannabis card but the process is convoluted.

          Even after going to a lecture on it last year I still don't have a good handle on it. I feel like the state governments are sort of passing the buck, saying they want to make it available for medical necessities while it hasn't been studied in any traditional way for medical indications.

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          • #20
            https://www.vox.com/22968976/federal...riminalization

            Pretty comprehensive write up about why it hasn't passed yet.

            I think it should be decriminalized and taken off schedule 1 to actually figure out the efficacy. I also think that it isn't completely benign and there is chance for abuse (cue funny clip from Half Baked said by the late Bob Saget), as well as a small subset of the population who could go down the paranoia route.

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            • #21
              Originally posted by Hatton View Post
              I always thought that medical MJ was just an excuse for people to get high legally. Last year I injured my hamstring and had my SI joint come out of joint. I did several months of PT. The only thing that relaxed that hamstring was edible MJ. I have changed my views. Medical MJ has recently passed in my state. No dispensaries yet. It is much stronger than I remember from my misspent youth.
              That's because pot IS much stronger than it was in the past. It has like double the amount of THC on average (ish. I can't remember exact numbers). But I'm glad you found something that worked for you!

              THC isn't legal in my state for rec use but is for medical use. I encourage my patients who use it to pay for the card because it gives them some legal protections. But I wouldn't ever rx it. There just isn't much evidence for it and risks of psychosis or paranoia or just driving while high or whatever are too high for me to be willing to risk it. I rarely rx benzos either for some similar safety concerns. I have no judgment about use and I just counsel pts on how it could be impacting current sx/risk modification.

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              • #22
                I've seen marijuana-induced psychosis and plenty of cases of cannabis hyperemesis syndrome so it's not a benign drug. Currently, I don't feel comfortable recommending or prescribing marijuana since there is a lack of data on its efficacy but I am willing to learn. I think it's only officially approved for post chemotherapy nausea/vomiting and certain hereditary seizure disorders. I think categorizing marijuana as Schedule I, the same category as heroin, is ridiculous. It makes research virtually impossible so what ends up happening is legalization at the state level with no regulation and no data. The stuff that gets sold at dispensaries probably has way too much THC/CBD than is needed for any kind of medical benefit. I guess we will just have to rely on our neighbor to tell us if/how to use marijuana in medicine.

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                • #23
                  Originally posted by wideopenspaces View Post
                  That's because pot IS much stronger than it was in the past. It has like double the amount of THC on average (ish. I can't remember exact numbers).
                  Try 5-10x.

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                  • #24
                    Originally posted by MPMD View Post

                    endorse

                    i don't really know anyone who feels that strongly about weed anymore, even super conservative people i know don't really seem to care.
                    The daily habit developed in high school and early college seems to have ruined motivation for two nephews and a lot of their friends. Recreational ABUSE is catastrophic on families. Basically the impact on motivation. Just observations, no data.

                    “Alcohol, tobacco, opioids, cocaine/meth.” I don’t think recreational ABUSE of these means weed should be encouraged.

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                    • #25
                      Originally posted by Tim View Post
                      The daily habit developed in high school and early college seems to have ruined motivation for two nephews and a lot of their friends. Recreational ABUSE is catastrophic on families. Basically the impact on motivation. Just observations, no data.

                      “Alcohol, tobacco, opioids, cocaine/meth.” I don’t think recreational ABUSE of these means weed should be encouraged.
                      correlation or causation.

                      i know plenty of people with no motivation who barely drink.

                      i know plenty of MJ users who are hyper productive.

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                      • #26
                        Originally posted by MPMD View Post

                        correlation or causation.

                        i know plenty of people with no motivation who barely drink.

                        i know plenty of MJ users who are hyper productive.
                        ABUSER was intentionally capitalized. Each of the items impact differently. Tobacco doesn’t “impair”.
                        I doubt you would take action if an ED doc smoked a cigarette on the way to work vs getting high and trying to work or was loaded. Recreation an abuse are two different things.
                        Alcohol or MJ abuse can both cause serious problems if ABUSED.
                        Tobacco- I dealt with a nephew Saturday. He was smoking on the porch at an engagement party for his sister. I took him down 25 floors to the street where he could smoke. Yes, he is one that had an MJ problem. I don’t know if he kicked the daily MJ problem. I really don’t care the cause. He has issues, but not my problem. I handled the tobacco issue. Not his parents, but they complain and paying his student loans. He could do better, I doubt he would be a high achiever. Getting high daily certainly wouldn’t help. I hope he isn’t drunk daily. He has a kid and a partner living with parents. Sad case. I hope he gets productive.

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                        • #27
                          Originally posted by MPMD View Post

                          correlation or causation.

                          i know plenty of people with no motivation who barely drink.

                          i know plenty of MJ users who are hyper productive.
                          So what you’re saying, is that there are exceptions to every rule or trend. Of course.

                          On the whole, I find it hard to argue that heavy marijuana use or abuse does not contribute to decreased motivation—and not uncommonly to a significant degree.

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                          • #28
                            Honestly, Id rather a patient use a quality controlled CBD product than chronic opioids or even long term NSAIDs.

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                            • #29
                              So would you accept light marijuana use in a physician or surgeon who is treating you ? Just like, maybe a little before the or to calm the nerves?

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                              • #30
                                Originally posted by Random1 View Post
                                So would you accept light marijuana use in a physician or surgeon who is treating you ? Just like, maybe a little before the or to calm the nerves?
                                To be clear, my comment was towards CBD-only/minimal THC products.

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