With thirty-nine states and the District of Columbia having given approval to medical cannabis, it’s safe to say that more doctors, physician assistants, and advanced practice nurses are being exposed to the idea of cannabis recommendations. A big question among clinicians is what types of clinical situations would call for such a recommendation.
The answer to that question lies in two things:
- The qualifying conditions on a state’s official list; and
- The appropriateness of medical cannabis in relation to a patient’s current condition and state of health.
Medical cannabis’ nature is such that attempting to come up with a black-and-white protocol for recommending medical cannabis just isn’t possible. There is too much in play. Medical providers need to rely on their knowledge of the law combined with their best judgment to decide about an individual recommendation.
Common Clinical Situations
A look at state patient data reveals why patients request medical cannabis cards. BeehiveMed, in Salt Lake City, UT, says that some 85% of the state’s medical cannabis users rely on the therapy for chronic pain relief. It is no surprise that chronic pain is one of the most common clinical situations calling for a medical cannabis recommendation. Here are some others:
- Pain – Acute and neuropathic pain is often treated in a traditional setting with prescription NSAIDs, anti-inflammatory medications, and opioids. But pain resistant to such treatments is often a good candidate for medical cannabis therapy.
- Cancer – Cancer patients experience symptoms from both the disease and their treatments. Pain and chronic nausea are two of the most common symptoms. It turns out that medical cannabis can relieve both. In some patients, cannabis therapy also stimulates appetite. That’s good for cancer patients also dealing with weight loss.
- Seizure Disorders – Certain types of seizure disorders respond very well to medical cannabis. In fact, the FDA has already given approval to two cannabis-related medications for treating epilepsy.
- HIV/AIDS – HIV and AIDS patients experience several symptoms that can be treated with medical cannabis. They include pain, severe nausea, loss of appetite, and wasting syndrome.
- Muscle Disorders – A clinician dealing with a muscle disorder, like uncontrolled spasms or multiple sclerosis, may try unsuccessfully to treat symptoms with conventional therapies. Medical cannabis is an option in some states.
- PTSD – While controversial in some states, medical cannabis treatment for PTSD (posttraumatic stress disorder) is fully accepted in others. It is believed that cannabis can help reduce PTSD anxiety.
In all these clinical situations, there is a common thread: a clinician would have to believe that medical cannabis is an appropriate treatment before making a recommendation. Cannabis could be recommended as a complementary, supplemental, or standalone therapy. But it must be appropriate for the patient and his current condition.
Clinicians Have Plenty to Consider
Medical cannabis recommendations should never be taken lightly in the clinical setting. Medical providers have plenty to consider regardless of the treatment that might ultimately be recommended. For example, what does the patient’s medical history look like?
A history indicating drug or alcohol misuse would be a red flag suggesting medical cannabis might not be appropriate. Medical cannabis might also be inappropriate for a patient with a history of not following prescription guidelines.
Clinicians need to consider everything from current health to patient age to co-occurring conditions. Only with a complete understanding of patient’s situation can a doctor reasonably expect to know whether to make a medical cannabis recommendation. Needless to say that recommending cannabis is not as straightforward as it might sound. I would not want to have to make the decision.
