I made a transition of working in the Emergency Department at Denver Health to “Recommending” Medical Marijuana (MMJ) four years ago. I fear that my time might be limited seeing patients regarding MMJ. I wanted to create an information highway learning about the benefits & bad effects of MMJ. As an unexpected consequence of talking to people about MMJ I now believe the pharmaceutical companies are behaving in an evil manner. Narcotic pain meds and their manufacturers are not to be trusted. I believe Pharmaceutical companies have been operating only in the interest of profit since before I became a Doctor in 2000. Since leaving The Emergency Department my role has changed from being a cog in the Federally supported Narcotics dispensing system working in the Emergency Department, to now being an agent in the State tolerated Medical Marijuana dispensing system.
I think it is safe to say we all agree Narcotics are devastating several generations of Americans. 64,000 dead in 2016 because of Narcotics overdose. I am questioning are there ANY target populations for narcotics, outside of end of life uses, where the benefits outweigh the risks.
So how does MMJ play into this? I have seen 3,000 people (about 3% of the Colorado Medical Marijuana Patients) annually for access to Medical Marijuana. I have written Doctors SOAP notes on every single patient visit. I gather data regarding Prescription drug use, allergies to medications, why they use Marijuana and if they find it effective or if there are adverse reactions to MMJ, other medical problems. I do a brief physical exam & make a plan with the patient regarding marijuana use. People come to me with desire to quit prescription meds. I high FIVE them when the are successful. I high FIVE Patients who quit alcohol, opioids & synthetic opioids, sleeping pills & anxiety medications & antidepressants. Using MMJ I was able to quit drinking alcohol. My brother Josh ended his life using alcohol. My clarity on alcohol comes from my own story including my brother’s story which tells me it alcohol is a socially accepted personal & societal killing poison. I meet people every day I work who are excited to leave these anchors in their rear view mirror.
Several critical functions should be provided by a well functioning Medical Marijuana system. Primarily, it should focus on directed education. I don’t think smoking is good for health so I educate people on edibles & tinctures. Edibles can provide doses of THC CBD in distinct quantities. “Understanding” how to dose CBD & THC has been limited to word of mouth education from Bud Tenders. Bud Tenders then became responsible for making suggestions of a wide range of therapies & dosing with no understanding of the patients condition, other medical problems, medications with MMJ interactions, physiology or biology that are at play. I commonly recommend 1/4th the average recommended “recreational” dose of 10mg THC when getting started. In terms of CBD usage there is even less information out there about dosing. I have created a dosing template which is hand tailored for each patient. There are distinctions between using THC by itself and CBD, THC & a potential parade of cannabinoides ie CBN. How will we learn about adverse reactions unless we see patients and ask them questions? How will we learn about continued effectiveness/ tolerance or effective dosing. Drug to drug interactions will not come to public awareness as fast if it becomes only recreational. What about THC use for conscious sedation in hospitals? That can never occurs unless we think of alternative & safe uses & trial them. The dosing template I have come up with is not as meaningful without follow up where people give input as to if it is working or at what dose etc.
Allowing patients to grow their own Medication is another critical function of the Colorado Medical Marijuana system. Why let patients grow their own Marijuana? Regulation of the Marijuana growing for Medical Marijuana is unmonitored for pesticide use. Recreational marijuana is only monitored for use of illegal pesticide use by whistleblowers. Do I trust the growers to do all the right things if they are not being monitored? No. Do I trust a whistleblower system to care about my brain, lungs or my digestive tract? No. Do I as a Marijuana grower/user know what was added to my soil and water and seed? YES.
How many plants is enough plants? This is a moving target and I have always felt that if a person wants to they should be able to grow enough of the plant to satisfy their personal use without visiting dispensaries. People growing outside or for other reasons may only have one harvest per year. This could make sense if you grow outdoors using the sun as your energy source. It may also make sense if you can grow enough for the entire year in one cycle conserving time and potentially energy. Do you need a Sea of Green which are smaller plants transitioned faster between Vegetative & Flowering states where you get less MMJ but faster? Two Medical Marijuana Physicians I know or have worked with have had their Medical licenses suspended regarding their recommending of higher plant counts. While growing my own plants I have learned of the challenges in growing plants & the volume of MMJ obtained from plants. This information has allowed me to adjusted the number of plants I recommend a Patient be able to grow. I require medical records regarding their medical problem for every person who requests a higher plant count. I have decreased the number of plants I will write for a patient to be able to grow as I have learned about how yields can increase in the hands of an expert balanced with most of the patients I see are not expert. My target patient is someone with interest in personal, mental, physical health & the use of MMJ in that process. I feel we need to be able to maintain the freedom to grow our MMJ. I feel growing marijuana should be more protected than making your own beer or wine. Neither beer nor wine have positively contributed to my health over my lifetime while MMJ has helped me become the healthiest I have been in my lifetime now nearing 50 years old. I am trying to balance a desire to allow people to grow their own medication, the potential for abuse of the system & MMJ as a substance by the patient & a desire to be able to keep my Medical License which allows me to continue to practice Medicine.
My perspective is one of a Doctor who is at a crossroads of Opioids & Marijuana. Doctor means Teacher. That is what I do every day. I teach. I teach people about how to safely get started, where to go, how much to try, what might happen if they take to much and how not to take too much. What to do if they do take to much. My office is very busy office. I prefer it that way. I want to be a helpful teacher. I believe in the Medicinal uses of MMJ. We are in process of gathering useful information on if or how well MMJ works for “X”. “X” being all the things people tell me it helps them with. Pain, nausea, muscle spasm, anxiety, phobias, creativity, anxiety relief, focus, concentration, improving quality of life, getting along with others, getting out of the house, out of bed, getting more comfortable in the bed they will die in, getting them out of a wheelchair or not using a cane, back on the slopes, hiking again, riding a horse, a motorcycle, a bicycle, getting along with a loved one, getting along with anyone, seeing something beautiful or writing lyrics, creating, helping with the pain of a paralyzed or broken body or the phantom pain of a body part lost, helping with the knowledge that the end for them is near. It is easy for me to be helpful to people interested in alternatives to Narcotics and Prescribed medications.
I love cutting through outdated propaganda. I am excited for data & studies. In a world where too many of us are dying using federally supported pain KILLERS now is time we celebrate, protect and grow what we have started with the Colorado Medical Marijuana system. We have a system in place to help some of the people who will be stopping narcotics, muscle relaxers, sleeping pills, anxiety medications as Physicians are forced to stop prescribing or face the consequences which for some patients has meant NO MORE MEDS IMMEDIATELY. I challenge us to stop trying to smash THC CBD CBN .... which I feel are helpful tools for some who are currently addicted to a medication they will no longer be able to get legally. People are being cut off from medications they have been taking for 30 years with no education or treatment. Cold Turkey. Now is the time to take off the 1973 blinders and look closely at MMJ as a helpful tool for people at the end of their rope at the end of a dead end street. I fear we have only seen the tip of the Opioid Iceberg. We need to find alternatives for treatment of pain. Previous experience tells us that many current prescribed medication users will move to less controlled, less legal alternatives once they can’t get what their body has become accustomed to having. For those out there who believe that our current opioid epidemic started at the end of a marijuana joint I will tell you this, the opioid epidemic started at the tip of a Physician’s pen generating fortunes for some companies.
Peter Pryor, MD MPH
P (720) 630-8999