Marijuana and Medicine

[wideopenspaces]

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.

[Brains428]

https://www.vox.com/22968976/federal-marijuana-legalization-cannabis-policy-decriminalization

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.

[Rando]

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.

[resident_1]

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.

[MPMD]

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.

[gap55u]

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.

[Hatton]

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.

[CordMcNally]

What is this?

Has there ever been studies showing that you can experience overdose or withdrawal from weed? It's not like heroin or cocaine, where certain neural pathways are activated and there are adverse physiological effects over the long term.

Cannabinoid hyperemesis syndrome is supposedly rare but it doesn't seem very rare in the ED. Maybe the most frustrating part is that the solution is simple yet a majority of people refuse to quit smoking weed every day.

[xraygoggles]

Once it goes recreational, it is natural selection... just like cigarettes, alcohol, fast food, etc.

Out of those 4, marijuana is by far the "healthiest" (or least deleterious) option - no contest.

[xraygoggles]

...I see too many cannabinoid-related disorders...

What is this?

Has there ever been studies showing that you can experience overdose or withdrawal from weed? It's not like heroin or cocaine, where certain neural pathways are activated and there are adverse physiological effects over the long term.

[Max Power]

It’s likely a better alternative than opioids for chronic pain but probably not as good as other modalities.

I don’t buy into the cure all aspects many believe it has and time will likely tell the same, too. It’s properties as a placebo are probably it’s greatest. Of the people I hear getting a medical marijuana card it’s clear they just want a legal way to smoke weed.

This has always been my take.

I write a LOT of opioids, tramadol, occasional gaba and benzos or muscle relax, do injects, topicals, PT, etc (nearly all for acute injury or surgery pains... turf out the chronic pain).

I have never Rx'd weed or its equivalents. I've never recommended for or against CBD stuff. The research is not there, and people have an obvious bias to it since it's 'cool' or they have used it prior or presently in rec form. I have plenty of patients who tell me it works, and I say that I'm glad. I basically treat it the same way I treat tumeric or Aspercreme... except that you can drive or take an exam just fine using those, and they don't give you lung cancer or dip your sex drive.

I am very glad marijuana's going recreational state by state. I think the medical was a load of crap. Docs don't want to Rx it since the risks almost certainly outweigh the benefits, and it put MDs in a tough ethical spot. Those 'Doctor 420 ' places that are/were Rx mills are an embarrassment and probably a detriment to their community. People can wait until it's recreational or buy it across a state border. The medical research is questionable at best, and the Rx'ing would simply get abused by many people (just like testosterone and Viagra and many other things). Once it goes recreational, it is natural selection... just like cigarettes, alcohol, fast food, etc.

At the end of the day, nobody is every going to earnestly say that a kid or adult is more likely to succeed, to do well in college, to be fit and energetic, to have motivation and sexual fitness, etc when you add weed or more weed use into their life. It is basically like alcohol or most other rec drugs... it provides an escape or a distraction from life, but that can be done in many other ways also. That is not even to mention that the potency of the 'medcal' and 'rec' weed is mind-blowing and poorly regulated in many cases. I have and will continue to leave the long term pain and psych meds to those appropriate specialists... most of whom I know do not Rx marijuana either.

[Hank]

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

[pierre]

CBD Gummies and tinctures helped a little with moms cancer pain. Certainly didn’t seem to make it go away, just more tolerable.

[CordMcNally]

It’s likely a better alternative than opioids for chronic pain but probably not as good as other modalities.

I don’t buy into the cure all aspects many believe it has and time will likely tell the same, too. It’s properties as a placebo are probably it’s greatest. Of the people I hear getting a medical marijuana card it’s clear they just want a legal way to smoke weed.

[jfoxcpacfp]

Doubt it will be a go at the federal level - ever - but have changed my views a lot. Not saying exactly where I stand, but age adds an unexpected layer of perspective. Of course, as you all know, I’m not-a-doc and defer to your expertise, with the understanding that the judgment of both posters and lurkers will vary widely.