So your state has legalized the use of medical cannabis for treating the symptoms of your medical condition and you want to have a conversation with your physician about your options. Where to begin? Let's start with a definition of conversation: "the informal exchange of ideas by spoken words." Conversations are evolving opportunities to share and discover new ideas, and with that in mind, let's delve in with a few thoughts to keep your conversation on track and ensure you have addressed all the points necessary for you and your physician to leave the interaction satisfied that each has been heard, and that next steps and time-frames within which to act have been defined. I will also give you a link at the end of this article to a handy Checklist for Speaking With Your Physician About Medical Cannabis, which you can download, print, and take with you when you meet with your doctor.
First, let's clarify a few points you may have not yet considered:
1. In order to qualify for medical marijuana, patients must have received a diagnosis from a licensed physician of a condition that has been determined by the state within which the patient and physician reside to be a qualifying medical condition eligible for medical cannabis therapy. Many states recognize the same medical conditions, but some recognize conditions that others do not. States' lists of qualifying medical conditions may change, as many states have provisions whereby patients can petition the board responsible for administering the program to include conditions which were previously excluded (although some states have reciprocity, I will save that for another article). Visit your state's medical cannabis agency website for the most up to date information.
2. In some states, physicians are required to be certified before they are able to prescribe cannabis as a treatment option. Without this certification, your physician may not be able to issue a recommendation for the use of medical cannabis in treating your qualifying medical condition. While many physicians actively seek to become certified, many have already decided that they will not recommend cannabis. Additionally, many physicians are affiliated with physician practice groups. These physician practice groups will either permit or prohibit physicians affiliated with, or employed by, their group to recommend cannabis as a treatment option. Finding this information is simply a matter of a phone call to the physician's office, or a direct question to your physician.
3. Your physician may be willing to recommend medical cannabis, but due to the current disparity between state's laws and federal law, physicians may believe their federal Drug Enforcement Agency (DEA) license - which is their license to prescribe medications - could be placed in jeopardy. According to the CEO of Midwest Compassion Center, Nicole van Rensburg, "Since cannabis is a Schedule I Controlled Substance illegal at the federal level, some assert that certifying patients under a license issued and regulated by a federal agency is problematic. As an added worry, practitioners question whether cannabis certifications will make them more susceptible to an audit, inciting the State Medical Board or Department of Health to possibly become more suspicious of their scope of practice, and consequently, what effect this might have on their relationships with insurance carriers." This worry may be academic since it is the state that certifies a physician's ability to recommend cannabis. The physician's state certification number is used, rather than the DEA number, making it a state-specific transactional event.
4. Physicians are not only held to the prevailing professional standards of care ascribed to their occupation, they frame their care within the context of their own personal knowledge, education, training and experience. This context is not only informed by the practitioner's education and the latest scientific research, it is also subject to their personal belief systems, and their personal experiences. Multiple physicians may perform a medical examination and workup on the same patient, and arrive at either the same or a different diagnosis, and initiate a treatment plan based upon their knowledge, education, training and experience. This is not surprising information (although it may seem so since it is rarely articulated), but we can know this from our own experience: we tend to repeat methods we have used in the past that have resulted in successful outcomes.
5. The last item to consider ties into Number 4, above, but it is a matter worth keeping in mind. There have been a number of cases where patients with a qualifying medical condition have been diagnosed and treated by the same physician for years, but that physician refuses to certify the patient as having the very condition for which they have been treating the patient, because of their own opinions about cannabis. That is a complicated matter with legal, ethical and personal implications, and I am not offering an opinion on that; I am simply pointing it out. That said, I personally find benefit in determining for myself whether I am going to choose to fight the old or create the new. In clarifying that, I can prepare for what I need to do next in order to achieve my objectives, without draining myself emotionally.
Clarify your personal objectives
Now that you have a clearer vision of your present reality - you have established your eligibility for and your physician's ability to recommend medical cannabis as a treatment option for your medical condition - it's time to clarify your objectives. There are a variety of medical cannabis strains that may produce anywhere from strong psychoactive responses to strains that produce none at all, and various levels in between. Clarify for yourself whether your primary interest in cannabis is simply for the psychotropic effect and whether you are open to medical cannabis therapies that have no psychotropic effect. Clarifying your true intention will enable you to evaluate your own credibility as you prepare to present your case to your physician.
Do your homework
Know what medical cannabis options are available in your state and how they respond to your qualifying medical condition. We all know about the psychoactive effects of marijuana, but did you know that it comes in forms that do not produce intoxication? You've heard of smoking, vaporizing and edible cannabis, but have you heard about tinctures and hash oils, sublinguals, cannabis nasal sprays, skin patches, dissolvable strips and suppositories? These are all routes of administration with specific dosing delivery proven effective for patients with severe medical conditions, some of whom can barely breathe, or swallow, or are covered in burns, or experience horrendous reactions to traditional medical therapies. Not all delivery methods are legal (e.g., smoking medical marijuana through combustion is prohibited in many states). Various types of cannabis can produce healing effects with or without a psychotropic component, and there is a wealth of information available online and at medical cannabis dispensaries like Bloom Medicinals, which has one of the most comprehensive training programs for its dispensary agents in the country. Having this information in advance will facilitate a productive conversation with your physician.
Schedule your appointment
As you start your conversation with your physician, work with the idea of eliminating street slang when referring to cannabis. Be able to recall your history with traditional medical therapies and what impact they have had on you in the past. Understand the risks, benefits and side effects from the pharmaceutical drugs you are presently taking, including any indicators for abuse or addiction, and be prepared to assert that knowledge. Many drug companies go through litigation because of the harm their drug may have caused - know whether or not the maker of the medication you are presently taking is one of them, and again, be prepared to assert that knowledge.
Gather the elements of your lifestyle together. Be ready to explain your employment, family and personal responsibilities. Medical cannabis options can provide medicinal benefits, psychotropic benefits, and any combination of both, and being able to articulate what your daily responsibilities are may help you and your physician make informed, responsible decisions regarding the options that are appropriate for you, thus protecting your employment, your family and yourself from untoward events.
Last, be willing to listen. If you have clarified your objectives, done your homework, gathered the necessary information, and have engaged in a transparent and comprehensive dialog with your physician, listen to what s/he has to say. Maybe there are other options about which you were unaware; consider them. Take notes, conduct additional research, and keep the conversation going. Consider that you may be the very first patient your physician has engaged with who has presented an educated perspective and informed position. Reflect on your own past responses to new ideas presented in compelling ways, and the time that was required before you were able to slowly open your mind to those new ideas. Hold open the possibility that several conversations may be required.
You are an official partner on your own healthcare team. Your ability to own and assert that role with understanding and grace will help ensure ongoing, productive conversations with your treating healthcare providers.
Download your "Checklist for Speaking With Your Physician About Medical Cannabis" here: https://shopatbloom.com/doctor-questionnaire/
ABOUT THE AUTHOR
RJ Starr is an operations professional with over 25 years' experience in managed care, pharmaceuticals, and regulatory compliance. He is the Head of Regulatory Affairs for Bloom Medicinals and Midwest Compassion Center, creating business process architecture for medical cannabis programs ensuring compliance with the requirements of state boards of medicine, pharmacy, health, commerce, and revenue; as well as state laws and jurisdictional law enforcement agencies. Bloom Medicinals is a licensed medical cannabis dispensary located in Germantown, Maryland. Midwest Compassion Center is an Illinois licensed medical cannabis dispensary located in the Greater Chicago Area.
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