Legalized marijuana

This forum made possible through the generous support of SDN members, donors, and sponsors. Thank you.
Agast

Agast

Full Member
15+ Year Member
Joined
Sep 14, 2009
Messages
5,663
Reaction score
7,800
Members don't see this ad.
How do pain doctors who live in legal states handle marijuana? I mean aside from a relaxing Friday night.

I know a couple docs who sell CBD out of their office. It did nothing for my dog so I think it’s mostly placebo.
 
Smoke em if u got em
 
I personally feel strongly it should not be legal.

professionally I don’t make any recommendations about it, if asked I say do at your own risk.
 
Agast said:
How do pain doctors who live in legal states handle marijuana? I mean aside from a relaxing Friday night.

I know a couple docs who sell CBD out of their office. It did nothing for my dog so I think it’s mostly placebo.
Click to expand...

Legal in my state.

If they are on it, they don't get controlled substances.

If they are on it, I tell them to stop.

If they ask about it, I tell them it is federally illegal, state allowance is trumped by federal law.

95% of them are a mess socially and physically.
 
I don’t prescribe opioids so it doesn’t affect me. Lots of people ask me about CBD oil. I tell them I don’t have strong feelings one way or the other on it. I mean, sort of a biased sample to go by what I hear from people because if it is working great for them they aren’t coming to see me. If they are on opioids I tell them to make sure to clear it with their prescribing provider first since there can be purity issues.
 
I worry if it marijuana becomes way too mainstream (with this blue senate coming up it probably will) , I will have to learn to prescribe it (even tho I don’t agree with it) just to stay relevant . Pain docs will likely be the first batch of physicians “trained” in prescribing it, don’t you think?
 
painfree23 said:
I worry if it marijuana becomes way too mainstream (with this blue senate coming up it probably will) , I will have to learn to prescribe it (even tho I don’t agree with it) just to stay relevant . Pain docs will likely be the first batch of physicians “trained” in prescribing it, don’t you think?
Click to expand...
I didn't think even in the legal states you prescribed it. I thought you just certified that the patient had a condition that the state says marijuana helps treat.
 
The dea has been called a scientific agency by the ag. Biden has for decades been a proponent of a titanic disgrace some refer to as the “war on drugs.” Where people get the idea that the country will suddenly develop Jupiter rings of ganja smoke is beyond me. However, it should be legalized, and should be studied by actual scientists. In the end, what we are after is the truth, is it not?
 
ateria radicularis magna said:
The dea has been called a scientific agency by the ag. Biden has for decades been a proponent of a titanic disgrace some refer to as the “war on drugs.” Where people get the idea that the country will suddenly develop Jupiter rings of ganja smoke is beyond me. However, it should be legalized, and should be studied by actual scientists. In the end, what we are after is the truth, is it not?
Click to expand...
It has been studies long enough and well enough to know that people only want to get high. And when added to opiates, higher.
 
lobelsteve said:
It has been studies long enough and well enough to know that people only want to get high. And when added to opiates, higher.
Click to expand...

Here's a good interview with one of the worlds leading authorities on CBD. There's some interesting working going on cannabinoid micro-dose IT pump therapy too...

www.cannabissciencetech.com

The Latest Medical Cannabis Research: Dr. Ethan Russo Discusses Neurological Research, Dosing, and More

Dr. Ethan Russo, Director of Research and Development for the International Cannabis and Cannabinoids Institute (ICCI), recently spoke with us about some of his recent research efforts, cannabis dosing, and his continued push to change the stigma against cannabis as a medicine.
www.cannabissciencetech.com www.cannabissciencetech.com

How are people handling psilocybin?
 
lobelsteve said:
It has been studies long enough and well enough to know that people only want to get high. And when added to opiates, higher.
Click to expand...

I don’t understand what you wrote. Studies have shown “people only want to get high”?

And the next part, how does it follow from the first?

Studies have shown people wanting to get high on opiates want to get higher on thc? Or did I misread that?

I don’t follow.

Also, these seem like heavily biased opinions, rather than science. Unless we are going into the realm of cognitive science, I think a study about whether people “want” to get high or higher or highest would be pretty hard to pull off, especially with a substance that has been banned for actual scientific study. The reason it was banned was political, not scientific. The result of banning it, criminalizing it, has been the mass incarceration of primarily poor, brown people, not to mention empowerment of third world narcos, violent people with guns here and abroad, giant for-profit prisons here, etc etc etc.

This is a story we should all know by now, in my humble opinion. I am happy to consider alternative narratives. I am not a hardcore red or blue and I really don’t care about either party. The truth is what interests me.
 
I don’t understand why our society puts the stamp of approval on recreational use of mind altering substances. This includes alcohol. Perhaps if their use presented no danger to the user and those around them I could understand but that is clearly not the case. What’s the risk vs benefit? Clear risk of harm. Benefit? If the real reason to decriminalize is to keep a sector of the population out of jail and to reduce crime related to the sale of these substances then you need to decriminalize all drugs and believe that increased use will not result in increased harm.
 
ateria radicularis magna said:
I don’t understand what you wrote. Studies have shown “people only want to get high”?

And the next part, how does it follow from the first?

Studies have shown people wanting to get high on opiates want to get higher on thc? Or did I misread that?

I don’t follow.

Also, these seem like heavily biased opinions, rather than science. Unless we are going into the realm of cognitive science, I think a study about whether people “want” to get high or higher or highest would be pretty hard to pull off, especially with a substance that has been banned for actual scientific study. The reason it was banned was political, not scientific. The result of banning it, criminalizing it, has been the mass incarceration of primarily poor, brown people, not to mention empowerment of third world narcos, violent people with guns here and abroad, giant for-profit prisons here, etc etc etc.

This is a story we should all know by now, in my humble opinion. I am happy to consider alternative narratives. I am not a hardcore red or blue and I really don’t care about either party. The truth is what interests me.
Click to expand...
There is literature showing THC makes acute pain worse, makes people more sensitive to pain.

there is retrospective studies showing THC use linked to shizophrenia.

it is mind altered and an a usable drug.

why are we holding on to the hope it will be good for chronic pain.

it’s only use appears to be appetite stimulant for cancer, and the medically refractory seizures in children (forget the specific name)
 
NJPAIN said:
I don’t understand why our society puts the stamp of approval on recreational use of mind altering substances. This includes alcohol. Perhaps if their use presented no danger to the user and those around them I could understand but that is clearly not the case. What’s the risk vs benefit? Clear risk of harm. Benefit? If the real reason to decriminalize is to keep a sector of the population out of jail and to reduce crime related to the sale of these substances then you need to decriminalize all drugs and believe that increased use will not result in increased harm.
Click to expand...

I think providing free drug testing would be a good start. Definitely needle exchange. I think providing a safe place to do the drugs would help. On the same premises you can make easy access to rehabilitation. I think legalization of all drugs would be a net positive. Portugal has been trying this for a few years.
 
dipriMAN said:
There is literature showing THC makes acute pain worse, makes people more sensitive to pain.

there is retrospective studies showing THC use linked to shizophrenia.

it is mind altered and an a usable drug.

why are we holding on to the hope it will be good for chronic pain.

it’s only use appears to be appetite stimulant for cancer, and the medically refractory seizures in children (forget the specific name)
Click to expand...

I don’t think holding onto hope is an appropriate description. People are waiting for the government to stop prohibiting the study of this compound. Without study, not much is known.
 
dipriMAN said:
There is literature showing THC makes acute pain worse, makes people more sensitive to pain.

there is retrospective studies showing THC use linked to shizophrenia.

it is mind altered and an a usable drug.

why are we holding on to the hope it will be good for chronic pain.

it’s only use appears to be appetite stimulant for cancer, and the medically refractory seizures in children (forget the specific name)
Click to expand...

I recently gave a talk on this...This slide summarizes the most recent scientific thinking on the topic:

1610300917512.png


 
Last edited:
ateria radicularis magna said:
I don’t think holding onto hope is an appropriate description. People are waiting for the government to stop prohibiting the study of this compound. Without study, not much is known.
Click to expand...
Pain is so subjective, I don’t really trust that it provides pain relief as much as it just alters people. Don’t know that any studies can really differentiate this all that well.

anecdotally I’m thinking of all the pain patients that ask for benzos or adderall or other things because it “helps with their pain”. Hard to convince me it’s not the same with cannabiboids.
 
dipriMAN said:
Pain is so subjective, I don’t really trust that it provides pain relief as much as it just alters people. Don’t know that any studies can really differentiate this all that well.

anecdotally I’m thinking of all the pain patients that ask for benzos or adderall or other things because it “helps with their pain”. Hard to convince me it’s not the same with cannabiboids.
Click to expand...

I agree with all of this, but I think it’s worth investigating.
 
I think THC does have pain-relieving properties, I’m more concerned about mixing it with other substances. I talked to someone a while back in New Jersey who had set an MED limit on people with concurrent use of marijuana. Also totally fair to have people choose one or the other and not take both. That seems like it would require a THC test at every appointment. Also problematic is it takes a while to get a negative test after cessation.
 
Of course THC has pain-relieving properties. If you get stoned enough, of course you feel (or care less about your) pain.

However, legal or not in a given state, I don't see how you get around the fact that it's illegal everywhere according to the Feds. Your job depends on a federal DEA license, also, doesn't it?

Proceed accordingly.
 
emd123 said:
Of course THC has pain-relieving properties. If you get stoned enough, of course you feel (or care less about your) pain.

However, legal or not in a given state, I don't see how you get around the fact that it's illegal everywhere according to the Feds. Your job depends on a federal DEA license, also, doesn't it?

Proceed accordingly.
Click to expand...

It’s not legal in my state and I imagine we will be one of the last hold outs. But it’s not a stretch to imagine it may become legal at the federal level in the next few years. Then what do we do? I prefer to work out a plan ahead of time.
 
It’s going to be recreational legal federally sooner rather than later. Does anyone really not see this? I personally think alcohol is a much worse drug than weed. At my fellowship we don’t give prescriptions but we do refer to neurologists that do and encourage patients to try it if they want because it’s a low risk option and if it helps that’s great. Doesn’t affect how we prescribe opioids (which is sparingly). Honestly don’t know how y’all could go through the entire “opioid epidemic” and still have a problem with marijuana.
 
Agast said:
It’s not legal in my state and I imagine we will be one of the last hold outs. But it’s not a stretch to imagine it may become legal at the federal level in the next few years. Then what do we do? I prefer to work out a plan ahead of time.
Click to expand...
If your not prescribing cannabinoids and set a limit on MME when using it, then you just keep your current practice even if federal decriminalized in the future.
 
As long as the dea tells me it’s SC 1 I don’t allow MJ to coexist with any controlled substance I prescribe. Other than that the patients can do what they want if it’s legal. Should it become SC 2 or something I will probably still limit patients to one or the other. Too many people just chemically coping: the same way I tell people they can’t drink in opioids. It’s legal but the two together is a big no for me.
 
dipriMAN said:
If your not prescribing cannabinoids and set a limit on MME when using it, then you just keep your current practice even if federal decriminalized in the future.
Click to expand...

I would place marijuana on a spectrum between smoking and alcohol in terms of concurrent risks with opioids. I don't prescribe opioids if they drink alcohol. Of they smoke I encourage them to quit and am otherwise less likely to prescribe since I consider the risk/benefit worse.

If marijuana became federally legal, I'd take it case by case but certainly less inclined to prescribe opioids.
 
NJPAIN said:
I don’t understand why our society puts the stamp of approval on recreational use of mind altering substances. This includes alcohol. Perhaps if their use presented no danger to the user and those around them I could understand but that is clearly not the case. What’s the risk vs benefit? Clear risk of harm. Benefit? If the real reason to decriminalize is to keep a sector of the population out of jail and to reduce crime related to the sale of these substances then you need to decriminalize all drugs and believe that increased use will not result in increased harm.
Click to expand...
other perspective: people will use something regardless. total ban on alcohol didn't work out too well in past, for example.

there are social political reasons to decriminalize marijuana only, the medical effects tend to be less catastrophic for the most part compared to other illicit drugs, and decriminalizing all drugs might encourage substance abuse counselling rather than punitive measures.
Trazor said:
It’s going to be recreational legal federally sooner rather than later. Does anyone really not see this? I personally think alcohol is a much worse drug than weed. At my fellowship we don’t give prescriptions but we do refer to neurologists that do and encourage patients to try it if they want because it’s a low risk option and if it helps that’s great. Doesn’t affect how we prescribe opioids (which is sparingly). Honestly don’t know how y’all could go through the entire “opioid epidemic” and still have a problem with marijuana.
Click to expand...
addiction is a curse almost irrespective of the substance.

my dumpling addiction will get me into trouble some day...
 
Agree with ducttape, you can’t legislate morality. If you try and prevent people from having some type of blow off valve they will go to great lengths to find one. If people really want to harm themselves they will. They can buff glue, or gasoline.
 
1. You are never forced to prescribe anything you don't agree with.
2. Currently THC is schedule-1, so that's a no go with opiates. I'm sure this will change, particularly with democrats in power in Washington, but it's still a bad idea in my book. I always recommend they stop.
3. Every reputable study I've found demonstrates increased risks and little to no pain relief or decrease in opiate consumption.
4. Every study I've seen that is pro-THC is either from a website that has "cannabis" in it's name, is a poorly designed "study", is an opinion, or simply relies on people who are already using THC that say it helps with pain.
5. I've haven't met anyone who has never used THC, started at the recommendation of a physician, and feels that is helped them without intolerable side effects. Ever.
6. I don't recommend psychoactive plants as medicine. I also don't recommend people use as medication as they personally feel is appropriate for their condition. If Marijuana has some beneficial properties, let's study it, isolate the compounds that are useful, subject them to randomized, controlled, double-blind studies after being tested for safety in animals, and put in a reliable dosage form.
7. Smoking is not a safe medication delivery form.
8. Our goal is to make people more functional. THC use has proven to lead to more workplace accidents and decrease in function.

Anecdotally, as an anesthesiologist, THC use make basically every anesthetic drug less useful. They all need more propofol, opiates, benzos, and gas to get the same effect. It only makes sense it is that way outpatient as well.

My state allows recreational use as well as "medical" use. Patients can do as they want, but my recommendation is no THC.
 
I allow patients to use THC if not on schedule 2-3 meds. I don’t require that they stop it for lyrica/tramadol.
They do have to give it up for schedule 2-3 meds however.

I have a number of patients who take it at night only, for insomnia and insomnia due to pain.
They did better on edible THC , than sleep agents (non scheduled) or opioids QHS.
 
Gaulithan said:
A doctor who sells marijuana on the side is easy to figure out, so there are very few cases where a neurologist has been caught selling drugs. Nowadays, any person would go to another state where marijuana is legalized, buy a few grams, and enjoy it on Fridays. I know there are many stores in California that do cannabis delivery and provide parcel tracking. Tracking is convenient and allows people to be calm. I like the legalization of marijuana, don't you? That's great. I smoke it for preventive localization purposes.
Click to expand...
HUH?
 
Gaulithan said:
A doctor who sells marijuana on the side is easy to figure out, so there are very few cases where a neurologist has been caught selling drugs. Nowadays, any person would go to another state where marijuana is legalized, buy a few grams, and enjoy it on Fridays. I know there are many stores in California that do cannabis delivery and provide parcel tracking. Tracking is convenient and allows people to be calm. I like the legalization of marijuana, don't you? That's great. I smoke it for preventive localization purposes.
Click to expand...

This is some crappy AI
 
My philosophy is as follows: Start 5-10 mg and titrate up Marijuana at night for insomnia/insomnia from pain (1 hour before bedtime). Can increase up to 100 mg (depending on symptoms). Never inhalation. No concomitant opiates/BZ.
Works well for Fibromyalgia. Though limited by state laws (illegal in NC, legal in Virginia)
 
anujacket said:
My philosophy is as follows: Start 5-10 mg and titrate up Marijuana at night for insomnia/insomnia from pain (1 hour before bedtime). Can increase up to 100 mg (depending on symptoms). Never inhalation. No concomitant opiates/BZ.
Works well for Fibromyalgia. Though limited by state laws (illegal in NC, legal in Virginia)
Click to expand...
W a t? R u just making this up?
 
anujacket said:
My philosophy is as follows: Start 5-10 mg and titrate up Marijuana at night for insomnia/insomnia from pain (1 hour before bedtime). Can increase up to 100 mg (depending on symptoms). Never inhalation. No concomitant opiates/BZ.
Works well for Fibromyalgia. Though limited by state laws (illegal in NC, legal in Virginia)
Click to expand...
yeah I hear ya. I do this with alcohol. Start with 1 natty light and titrate up to effect or intolerable hang over. I try not to exceed a case per night
 
I don't have strong feelings one way or the other on using cannabis. I don't use it personally but to each their own I guess.

With that noted, I'm looking into raising hemp crops. I hear you can net $30-50,000 an acre depending on how far you want to process it (eg. oils, fibers). I raise a hay field of about 40 acres I'm thinking of converting over. The numbers look good. I'm curious if they'll hold up to reality.
 
Ferrismonk said:
You titrate UP natty light? I always titrate natty to d/c as fast as possible. But then again I live in Michigan which has great beers.
Click to expand...
in Michigan, Bells brewery.

2 hearted ale was voted best beer by American Homebrewers Association.

would really like to try their No, Yeah golden ale...
 
Ducttape said:
in Michigan, Bells brewery.

2 hearted ale was voted best beer by American Homebrewers Association.

would really like to try their No, Yeah golden ale...
Click to expand...
Bells has some amazing ones. Two-hearted is good. Hopsolution is really good but the best one is HopSlam. Unfortunately that's seasonal though.
 
You must log in or register to reply here.

Similar threads

E
Marijuana and procedures
Replies
7
Views
1K
Ducttape
D
bedrock
Legal age for driver
Replies
25
Views
1K
Tboned
T
Agast
Rare disciplinary case against Pa. doctor offers glimpse into big business of medical marijuana cards
Replies
3
Views
753
wendalltwolf
W
Yo GabbaPentin
Medical marijuana and opioids
Replies
19
Views
3K
drrosenrosen
drrosenrosen
DrMDAware
Any tips to legally and easily bill Level 5?
2
Replies
50
Views
5K
lobelsteve
lobelsteve
Top