Legalized marijuana

IPSIS: Formerly the Spine Intervention Society
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Pain Applicant1 said:
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.
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can you just rent out the land? that way you are guaranteed a return but dont have the risk of a drought, flood, insects, etc
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SSdoc33 said:
can you just rent out the land? that way you are guaranteed a return but dont have the risk of a drought, flood, insects, etc
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I can but I don't want those fools on it, lol. I've turned down several farmers already as well as hunters and trappers who want to work or use my land. Stupid business decision but whatev. It's more of a hobby for me than a business anyway. I hope to keep it that way.

I want to keep my farm organic and it's almost impossible to do that on a commercial basis with the crops they want to plant. I also don't sell the hay. I just bush hog it back into the earth to help build up the soil.

From what I've read so far, the funny thing about growing hemp is you have to keep it below that 0.3% THC level. THC-A converts to THC when heated which is what gets people high. You have to test your hemp prior to harvest and if the THC levels are above you have to destroy the crop. Can you imagine burning the crop of hemp, which is allowed, to destroy it? What if those fumes blow into town and get the whole town high? What about the livestock grazing next to it? Funny to think about..
 
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Not to defend cannabis but that was only for excessive use. People who use it more sparingly did not see this effect.

I don't use it but I do grow it (legal to grow here) mainly because I love growing things. I also like the way it makes the garden smell. Those aromatic terpenes are non-psychoactive.
 
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I don't have strong feelings about cannabis either way. But I do have strong feelings about protecting my medical and DEA licenses. As long as the DEA considers it schedule I, I consider it schedule I. Sucks, but it is what it is.
 
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It looks like I'm the minoroity here but I have had reasonable success with medical cannabis in my practice. We have a medical cannabis program in my state and the state dispensaries seem to do a good job.

I have had many pts that did not tolerate standard meds do well with medical cannabis, including the elderly

I have had chronic opioid pts (including high dose pts) transition to medical cannabis with success and stop opioids entirely

I have had pts be able to reduce their opioid dosing but improve pain/ function adding cannabis

It is not a big part of my practice but it has been helpful for many pts

Our state medical society has also done cannsbis CME with excellent speakers from a variety of perspectives

We do not RX, it is simply a medical cert
 
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specepic said:
It looks like I'm the minoroity here but I have had reasonable success with medical cannabis in my practice. We have a medical cannabis program in my state and the state dispensaries seem to do a good job.

I have had many pts that did not tolerate standard meds do well with medical cannabis, including the elderly

I have had chronic opioid pts (including high dose pts) transition to medical cannabis with success and stop opioids entirely

I have had pts be able to reduce their opioid dosing but improve pain/ function adding cannabis

It is not a big part of my practice but it has been helpful for many pts

Our state medical society has also done cannsbis CME with excellent speakers from a variety of perspectives

We do not RX, it is simply a medical cert
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What are they waiting for, before they make it schedule II?
 
emd123 said:
What are they waiting for, before they make it schedule II?
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Good quality studies of benefit with standardized doses of active ingredient in a dosage form that gives reliable reproducible pharmcokinetics?
 
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Ferrismonk said:
Good quality studies of benefit with standardized doses of active ingredient in a dosage form that gives reliable reproducible pharmcokinetics?
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Correct…
Also the feds need to accept DPH consequences , including ; autoaccidents (increases 25% per dept of transportation Colorado) , schizophrenenia, addiction (10%), ER admissions due to toxicity, etc.
I feel the psychiatrist societies have let us down as well on many modern day issues …
 
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Ferrismonk said:
Good quality studies of benefit with standardized doses of active ingredient in a dosage form that gives reliable reproducible pharmcokinetics?
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Speaking of, how do you all handle patients on Marinol/dronabinol who deny any recreational marijuana use?
Tox comes up for THC and I've had attendings in fellowship who were adamant against CS for these patients.
 
10KHertz said:
Correct…
Also the feds need to accept DPH consequences , including ; autoaccidents (increases 25% per dept of transportation Colorado) , schizophrenenia, addiction (10%), ER admissions due to toxicity, etc.
I feel the psychiatrist societies have let us down as well on many modern day issues …
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Or, you know, enforce the law. Raid each pot-shop and grow operation, fine banks who are financing these drug operations, fine states who are condoning and taxing/profiting from the drug trade.

This may sound extreme, but I live in a marijuana "legal" state and see zero good come and lots of bad come from it. It's crazy to me our elected officials can just elect to not enforce the law and everyone seems okay with this.
 
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adiradirim said:
Speaking of, how do you all handle patients on Marinol/dronabinol who deny any recreational marijuana use?
Tox comes up for THC and I've had attendings in fellowship who were adamant against CS for these patients.
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If they're prescribed Marinol for refractory chemo-induced nausea and vomiting by an oncologist or for anorexia/cachexia from AIDS by a hematologist/infectious disease doc, I'm okay with it. The Rx shows up on the PDMP.

If it's given by a GI doc off-label for nausea, no go. You'll be surprised how many of these people suddenly can't afford marinol once you okay it or their insurance won't cover it anymore so they want to use "medical" THC instead...
 
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Seems insane to me that the active ingredient, THC, can be in a schedule II med, while the plant is schedule 1 and at the same time cocaine is schedule II.
 
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Seems like all the recent shooters are smoking mj
 
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Ferrismonk said:
I saw this correlation too, then I realized that 90% of my medicaid patients are smoking THC as well.
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I hear Amsterdam is a hotbed of mass shooting
 
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risks outweigh any potential benefits. I sat in on several lectures on pot for pain in March from several well respected thought leaders in the US and Canada and the data is very mixed regarding efficacy. Actually it's quite poor. The documented risks and adverse events however are well known and the evidence is only growing the more widely it's used. Just one more substance in the chemical coper armamentarium. And for everyone who says what about alcohol and opioids, I think it goes w/o saying that those too have caused more harm to society and humanity than benefit.

In fact more adults under 65 died from alcohol-related factors (74,408) than from COVID-19 (74,075) in 2020.

 
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cocaine does have some specific medical applications, particularly in its role as a vasoconstrictor.


misleading regarding alcohol and covid deaths...
1. covid was a factor for 9 out of 12 months of 2020 compared to alcohol.
2. statistics in that study was only for 2020. the numbers for 2021 are starkly different, with many more people under 65 dying from covid than alcohol.
3. that being said, covid has always been more fatal to elderly patients.


alcohol has been so imbedded in our history, that it would be difficult to imagine history without alcohol. id agree that there has been more harm than benefit...
 
I think it's the THC that's the culprit in doing most of the harm. CBD seems to be more beneficial.

My issue with cannabis is that I don't really like people telling others what they can or can't do. I understand the impact on society, etc but I guess that's the consequence of living in a free society. I don't use cannabis because I find it boring but people should be responsible for making their own decisions and live with the aftermath for better or worse.

I also don't like the idea of someone telling me what I can or can't grow. These things are plants. It's ridiculous for the government to regulate them. Psychoactive plants are all around us, including many in the supermarket. People just don't realize this. Even things like opium, from poppy, grow everywhere throughout the US. It's also easy to raise in your own garden, as are cannabis and psilocybin. It's not even difficult to extract the morphine and codeine alkaloids from the residue on poppy seeds in the supermarket.

Coca, tobacco, peyote, psilocybin, opium, etc have been around forever and have been used responsibly by many cultures. It's not my fault western culture decided to isolate certain components and strengthen and abuse them. Same issue with sugar. Most sugar is extracted from beets. Isolate the simple carb and do away with the healthy parts. That's probably the worst drug out there causing the most morbidity.

You can't do away with illicit drugs. They're here and they aren't going anywhere and people are going to continue to use and abuse them no matter what laws are passed.

I don't doubt that negative consequences will increase in the early stages of the legalization of cannabis as use will increase. But, I predict that once it's no longer cool or a big deal to use anymore the usage rates will decrease.
 
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Pain Applicant1 said:
I think it's the THC that's the culprit in doing most of the harm. CBD seems to be more beneficial.

My issue with cannabis is that I don't really like people telling others what they can or can't do. I understand the impact on society, etc but I guess that's the consequence of living in a free society. I don't use cannabis because I find it boring but people should be responsible for making their own decisions and live with the aftermath for better or worse.

I also don't like the idea of someone telling me what I can or can't grow. These things are plants. It's ridiculous for the government to regulate them. Psychoactive plants are all around us, including many in the supermarket. People just don't realize this. Even things like opium, from poppy, grow everywhere throughout the US. It's also easy to raise in your own garden, as are cannabis and psilocybin. It's not even difficult to extract the morphine and codeine alkaloids from the residue on poppy seeds in the supermarket.

Coca, tobacco, peyote, psilocybin, opium, etc have been around forever and have been used responsibly by many cultures. It's not my fault western culture decided to isolate certain components and strengthen and abuse them. Same issue with sugar. Most sugar is extracted from beets. Isolate the simple carb and do away with the healthy parts. That's probably the worst drug out there causing the most morbidity.

You can't do away with illicit drugs. They're here and they aren't going anywhere and people are going to continue to use and abuse them no matter what laws are passed.

I don't doubt that negative consequences will increase in the early stages of the legalization of cannabis as use will increase. But, I predict that once it's no longer cool or a big deal to use anymore the usage rates will decrease.
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lot of tangents here, but i think the question is whether or not we should be prescribing marijuana-based products for pain.

if patients ask me, i say "go ahead, have fun", but won't prescribe it myself
 
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SSdoc33 said:
lot of tangents here, but i think the question is whether or not we should be prescribing marijuana-based products for pain.

if patients ask me, i say "go ahead, have fun", but won't prescribe it myself
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You choose, THC or controlled substances. Not both.
 
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SSdoc33 said:
lot of tangents here, but i think the question is whether or not we should be prescribing marijuana-based products for pain.

if patients ask me, i say "go ahead, have fun", but won't prescribe it myself
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Guilty as charged, which is customary for me.

In either case, I sometimes offer it. I don't like that I can't prescribe it and I can only certify it. I have little control over it as it's left to the pharmacist to dispense yet I'm responsible for it. I figure it's better they receive in from the pharm than on their own. It's legal here.

If it were left completely to me, I would probably make sure it was nearly all CBD and not THC but it's at the discretion of the pharmacist.
 
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lobelsteve said:
You choose, THC or controlled substances. Not both.
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Exactly. THC is used to wind down opioids in my practice.

Regarding the prior comments making fun of me, my feelings are hurt. I’m a minority and I consider your comments racist. Lol
 
Knowing all the risks associated with marijuana, I would never use it myself, and so why would I recommend it to a patient? At most I tell them they can try a topical CBD with little to no THC in it, but honestly I’ve not seen much success with it. The dispensaries are a racket, it’s exactly like tobacco companies back in the day.
 
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The topical CBDs cheat by mixing in arnica and menthol. Might as well use icy hot or generic equivalent.

My go to is : layer diclofenac gel, then lidocaine cream, then biofreeze. All OTC and cheap.
 
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Ferrismonk said:
Good quality studies of benefit with standardized doses of active ingredient in a dosage form that gives reliable reproducible pharmcokinetics?
Click to expand...
Correct…
Also the feds need to accept DPH consequences , including ; autoaccidents (increases 25% per dept of transportation Colorado) , schizophrenenia, addiction (10%), ER admissions due to toxicity, etc.
I feel the psychiatrist societies have let us down as well on many modern day issues in
lobelsteve said:
You choose, THC or controlled substances. Not both.
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Agreed. But it’s actually, choose : alcohol, benzo, marijuana, or opioids . They are all toxins. Choose your poison . I recommend vit D… 😆
 
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10KHertz said:
Correct…
Also the feds need to accept DPH consequences , including ; autoaccidents (increases 25% per dept of transportation Colorado) , schizophrenenia, addiction (10%), ER admissions due to toxicity, etc.
I feel the psychiatrist societies have let us down as well on many modern day issues in

Agreed. But it’s actually, choose : alcohol, benzo, marijuana, or opioids . They are all toxins. Choose your poison . I recommend vit D… 😆
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And there’s lots of advice out there saying I’m poisoning myself with at least 1000 units too much vitamin D every day.
 
bedrock said:
Weird I’ve never seen that. Just right next to Ben gay?
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Yep, plus lidocaine patches. The adhesive patch technology is not as good as the prescription ones but it will do in a pinch.

I also frequently recommend the thermacare heat patches as portable heating pads, especially when traveling on planes. Stays hot a good 4 hours.
 
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dipriMAN said:
Knowing all the risks associated with marijuana, I would never use it myself, and so why would I recommend it to a patient? At most I tell them they can try a topical CBD with little to no THC in it, but honestly I’ve not seen much success with it. The dispensaries are a racket, it’s exactly like tobacco companies back in the day.
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Never? I don't like absolutes. There's a time and place. Just because it's not for people like you or me doesn't mean I can always speak for others.

I just certified a Suboxone patient for it. The patient has been using it for 20 years to treat anxiety and depression. Nothing else has helped. The pt is concerned because cannabis from illicit sources is now commonly contaminated with fentanyl and the pt definitely does not want the exposure to it. The pt is trying to do the right thing and has been stable in Suboxone.

You can't buy it here, yet, only grow it and the patient doesn't know how to do that.

I think certifying this person was the right thing to do. Benefits far outweigh the risks. Just say no doesn't really work for this population nor does making this patient choose.

With that said they can't stay on bzd if they want Suboxone.
 
Pain Applicant1 said:
Never? I don't like absolutes. There's a time and place. Just because it's not for people like you or me doesn't mean I can always speak for others.

I just certified a Suboxone patient for it. The patient has been using it for 20 years to treat anxiety and depression. Nothing else has helped. The pt is concerned because cannabis from illicit sources is now commonly contaminated with fentanyl and the pt definitely does not want the exposure to it. The pt is trying to do the right thing and has been stable in Suboxone.

You can't buy it here, yet, only grow it and the patient doesn't know how to do that.

I think certifying this person was the right thing to do. Benefits far outweigh the risks. Just say no doesn't really work for this population nor does making this patient choose.

With that said they can't stay on bzd if they want Suboxone.
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I see marijuana much the same as alcohol, someone with substance abuse in remission shouldn’t be using either one.

I see lots of suboxone patients in benzodiazepines?
 
dipriMAN said:
I see marijuana much the same as alcohol, someone with substance abuse in remission shouldn’t be using either one.

I see lots of suboxone patients in benzodiazepines?
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If I don't certify this person the pt may still use illicitly or relapse. If I find thc or that the pt relapsed on a uds what would I do at that point? Do I discharge? What good would that do? I don't typically discharge for intermittent relapsing as that's what I'm trying to treat. If it happens often I'll refer them to a more involved treatment program since what I'm doing isn't working.

As for bzd, it's a mandatory regulation from the state to not prescribe them concomitantly, so I don't.
 
what you are implying is that the patient is the one driving care, not you.


what if he told you he was going to take kratom, or illicit soma, irrespective of your beliefs on these drugs?
 
Ducttape said:
what you are implying is that the patient is the one driving care, not you.


what if he told you he was going to take kratom, or illicit soma, irrespective of your beliefs on these drugs?
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Kratom-there's typically no need if they're on suboxone - usually one or the other. Soma -no, they can't take. I never prescribed it and it's rare these days around here.

The relationship between cannabis and opioid abuse is very up in the air at this point. My primary goal is to prevent opioid-related deaths and cannabis access MAY be associated with lower opioid-related mortality. I'm not sure but the paper in BMJ from 2021 is interesting and anecdotally several pts tell me they wouldn't have relapsed with opioids had cannabis been accessible to them. They were scared of a UDS showing THC for their probation. So they didn't use it. Unfortunately, they lost to the urge to abuse opioids.

My secondary goal with the suboxones is to see them back to work, in positive relationships, etc.

The pt does not drive what I do but neither do I. I don't dictate to them what we're going to do. We work together as a team on an individual basis.

I trust, to a degree, that they know their minds and bodies better than I do. They don't typically lie to me as there is no need. I'm not law enforcement and I'm here to help them. They typically tell me if they use cannabis, if they relapse, if they've been incarcerated, etc and I listen to what they have to say.

Sometimes the best treatment option comes down to the lesser of two evils.
 
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Pain Applicant1 said:
Kratom-there's typically no need if they're on suboxone - usually one or the other. Soma -no, they can't take. I never prescribed it and it's rare these days around here.

The relationship between cannabis and opioid abuse is very up in the air at this point. My primary goal is to prevent opioid-related deaths and cannabis access MAY be associated with lower opioid-related mortality. I'm not sure but the paper in BMJ from 2021 is interesting and anecdotally several pts tell me they wouldn't have relapsed with opioids had cannabis been accessible to them. They were scared of a UDS showing THC for their probation. So they didn't use it. Unfortunately, they lost to the urge to abuse opioids.

My secondary goal with the suboxones is to see them back to work, in positive relationships, etc.

The pt does not drive what I do but neither do I. I don't dictate to them what we're going to do. We work together as a team on an individual basis.

I trust, to a degree, that they know their minds and bodies better than I do. They don't typically lie to me as there is no need. I'm not law enforcement and I'm here to help them. They typically tell me if they use cannabis, if they relapse, if they've been incarcerated, etc and I listen to what they have to say.

Sometimes the best treatment option comes down to the lesser of two evils.
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you're being inconsistent in your reasoning. you say you might as well give them MJ otherwise they'll get it illicitly off the street however you won't let them have soma. What if I say you might as well b/c they'll just get it off the street. In fact we could say this with all drugs at which point you'd be a libertarian which maybe you are. However this is erroneous logic

And there is data showing cumulative and synergistic negative effects from concomitant opioid and MJ use on both reaction times, judgement, cognition, recall and decision making. This is far from a safe and beneficial combo. I think it is the infrequent and rare patient who uses one to abstain from the other
 
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clubdeac said:
you're being inconsistent in your reasoning. you say you might as well give them MJ otherwise they'll get it illicitly off the street however you won't let them have soma. What if I say you might as well b/c they'll just get it off the street. In fact we could say this with all drugs at which point you'd be a libertarian which maybe you are. However this is erroneous logic

And there is data showing cumulative and synergistic negative effects from concomitant opioid and MJ use on both reaction times, judgement, cognition, recall and decision making. This is far from a safe and beneficial combo. I think it is the infrequent and rare patient who uses one to abstain from the other
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..except state regulations are against concomitant use suboxone/opioids and bzd, soma, and tramadol as they see a correlation with an increased risk of overdose deaths. They haven't mentioned cannabis yet. I don't think combining cannabis and opioids is a good thing for nearly all people but in this case, I think it's appropriate. As I mentioned, my primary goal is to prevent overdose deaths from opioids and there's some literature that shows cannabis may have an association with that.

If the mandatory regs change and include cannabis then I'll no longer allow it.

Everything is inconsistent with cannabis and drugs these days. CBD legal, THC illegal by federal law yet legal by state law. Actually only legal if greater than 0.3 percent but can still show positive on a UDS. Can't sell it here but can only grow it. Can't have more than an ounce outside of your house but there's no law on how much you can have inside your home. If you walk a few miles across the state line you can now buy it, but not really as it needs to gifted, but you can buy it across the other border of the state line. Regardless of all of the conflicting laws, those who want to use it still use it and LEOs aren't sure what they're supposed to enforce, etc.........and on and on and on....

That's why I try to treat all pts as individuals as a blanket policy can be detrimental on the individual level.
 
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Pain Applicant1 said:
..except state regulations are against concomitant use suboxone/opioids and bzd, soma, and tramadol as they see a correlation with an increased risk of overdose deaths. They haven't mentioned cannabis yet. I don't think combining cannabis and opioids is a good thing for nearly all people but in this case, I think it's appropriate. As I mentioned, my primary goal is to prevent overdose deaths from opioids and there's some literature that shows cannabis may have an association with that.

If the mandatory regs change and include cannabis then I'll no longer allow it.

Everything is inconsistent with cannabis and drugs these days. CBD legal, THC illegal by federal law yet legal by state law. Actually only legal if greater than 0.3 percent but can still show positive on a UDS. Can't sell it here but can only grow it. Can't have more than an ounce outside of your house but there's no law on how much you can have inside your home. If you walk a few miles across the state line you can now buy it, but not really as it needs to gifted, but you can buy it across the other border of the state line. Regardless of all of the conflicting laws, those who want to use it still use it and LEOs aren't sure what they're supposed to enforce, etc.........and on and on and on....

That's why I try to treat all pts as individuals as a blanket policy can be detrimental on the individual level.
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Agree if your doing suboxone for OUD then the risk benefit is far different than someone taking opioids for chronic pain. I might be more lenient with marijuana use.

Just curious, how did you certify the patient, for anxiety? Do you have to put a specific ICD? Any concern that it’s outside your specialty?
 
dipriMAN said:
Agree if your doing suboxone for OUD then the risk benefit is far different than someone taking opioids for chronic pain. I might be more lenient with marijuana use.

Just curious, how did you certify the patient, for anxiety? Do you have to put a specific ICD? Any concern that it’s outside your specialty?
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I don't have to give a specific diagnosis on the certification form and in the chart I document the things I've mentioned above. I'm hoping in the event that something bad goes down and I get audited I'll be okay as long as I always put the pt first. If I always do what I honestly feel is in the best interest of the pt then no one can hold anything against me. I don't know if this is the right approach or not but I feel that it is.

This pt is a medicaid pt so I'm definitely not seeing this person to improve my bank account.

Speaking of Medicaid, how's this for a slap in the face. $22 reimbursement for a TPI.

I don't typically see medicaids outside of suboxone but if a suboxone pt asks for pain management I'll usually evaluate and treat them accordingly.
 
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kakalinasewald said:
I think marijuana helps people dealing with anxiety and other diseases. For example, this helps people who have cancer.
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Define helps. For medicine we want ro see standardized scoring for pain, anxiety, nausea, appetite, disability compared to placebo.
 
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