How to Ask Your Doctor about Trying Medical Marijuana for Pain
Do your research on CBD and THC and be honest about why you may want to try cannabis for pain.
Doctors and patients alike may feel unsure of how to approach the subject of medical marijuana, or cannabidiol (CBD), as part of a pain management strategy during a clinical visit. While many physicians believe that cannabis can offer a legitimate medical therapy, one-half of primary care physicians (PCPs) surveyed in a new study either were not ready to or did not want to answer questions from patients on this topic.
Given the current concerns about overprescribing of opioids and efforts at all levels to reduce the number of individuals who may misuse, abuse, or overdose from these drugs, 1 clinicians and patients are looking for other treatment options when it comes to managing chronic pain and related symptoms. In February 2019, the World Health Organization (WHO) proposed “rescheduling cannabis within international law to take account of the growing evidence for medical applications of the drug, reversing its position held for the past 60 years that cannabis should not be used in legitimate medical practice.” 2
Despite this move, many knowledge gaps remain around marijuana for medical use, including how the body’s endocannabinoid system works (that is, the group of compounds naturally synthesized by the body that activate the same receptors as delta-9-tetrahydrocannabinol, also known as THC, which has psychoactive properties). Other knowledge gaps include the actual benefit of cannabis on a range of conditions; the optimal dosing and delivery methods (there is no consensus to date on starting strains or doses so “low and slow” is often advised); and potential side effects, interactions, and toxicities, including long-term use of the substance.
The questions are urgent enough that the National Academies of Sciences, Engineering and Medicine (NAM) undertook a priority comprehensive review of recent medical literature on the health effects of cannabis and cannabinoids. 3 Its report focused on 11 areas, among them therapeutic effects, cancer incidence, cardio-metabolic risk, respiratory disease, injury and death, and problematic cannabis use. The committee identified and prioritized a number of gaps and barriers to research. Add to this the fact that most doctors simply are not taught about cannabinoids in medical schools (continuing education courses and professional certificates in this field are growing, but the subject is still missing from the basic clinical curriculum). In a survey, two-thirds of medical school deans reported that their graduates were not at all prepared to prescribe medical marijuana and one quarter reported that their graduates were not at all prepared to answer questions about medical marijuana. 4
So, how should patients go about raising the subject of medical marijuana use for pain management and related symptoms, such as anxiety or disturbed sleep? Below are a few recommendations. *
Being honest with your doctor about wanting to try opioid alternatives such as medical marijuana, or cannabis, may open new doors to relieving your chronic pain. (Source: 123RF)
Catch Up on Cannabis Research for Pain
Start by doing your homework. Become familiar with some of the evidence for using medical cannabis for pain management, particularly which types of pain appear to respond better to the substance. Also, develop a basic knowledge of the key components of cannabis (eg, THC and CBD) and how they may affect the body, as well as available forms in which medical marijuana, cannabis, and hemp (which is a different plant and contains 0 to 3% THC) may be available (see details in “Navigating Cannabis Options for Chronic Pain”). Organizations like Patients Out of Time and the Marijuana Patients Organization, and mobile apps such as LEAFLY, also offer good resources.
Once you’ve done some research, David Bearman, MD, recommends printing it out and showing to your physician to get the conversation started. Dr. Bearman specializes in pain management and has more than 50 years of experience in the substance abuse treatment and prevention field. He serves as vice president of quality assurance and credentials at the American Academy of Cannabinoid Medicine. Ask if medical marijuana may be an option for you. If your physician is unwilling or unable to discuss cannabis as a pain treatment option, Dr. Bearman advises asking for a referral to a local physician or clinic that is knowledgeable about treating patients with medical marijuana.
Share Your Personal Experience with Marijuana
In a recent PPM online poll, just over half of respondents said they had tried medical marijuana to alleviate chronic pain or related symptoms (See the full results).
Be up front about whether you’ve tried cannabis for pain already. Did it help? What form did you use and how much did you take? This transparency will only help your doctor understand your specific experience, but also evaluate the risks and harms of medical marijuana given your full health picture — including other pain medications, like opioids. (Read how one patient uses a journal for her medical marijuana use in treating fibromyalgia and related symptoms. And see what other types of natural plants may help with chronic pain).
Move Forward with Caution
Finally, be vigilant. The evidence around the safety and efficacy of THC and CBD is still being researched. Studies to date have associated marijuana use with increased risk of death from hypertension, higher rates of acute ischemic stroke, and respiratory issues when used long-term. Potential harms in patients with psychotic and mood disorders have been increasingly documented. There may also be a link between marijuana use and the development of a substance dependence or abuse disorder with other substances including, alcohol, tobacco, and illicit drugs. 5-9
*These tips do not represent official nor medical advice nor clinical recommendations. Learn which states have legalized medical marijuana and always speak with your doctor before trying any new cannabinoid product.
Doctors and patients alike may be hesitant to discuss medical marijuana, or cannabidiol (CBD), as part of a strategy for relieving chronic pain. Here's how to get the conversation started.
How to Talk to Your Physician About Medical Cannabis: 10 Points to Guide You
Living with chronic pain is challenging, especially when opioids may be less available. If you are wondering about other pain relief options—including medical cannabis—here’s a guide discussing alternatives with your doctor.
There are many ways to start a conversation with your doctor If you feel awkward bringing up the topic of medical marijuana. If you suffer from a chronic medical condition and have not found adequate relief from pain and other symptoms using traditional medicines, you may be thinking about trying medical cannabis (also commonly referred to as medical marijuana) as part of your treatment strategy.
A growing number of states (currently 31 plus the District of Columbia) have approved cannabis use for medicinal purposes to treat a host of serious and chronic medical needs from nerve pain to nausea and anxiety. (Note: the conditions which qualify for its use vary from state to state.) According to proponents, medical cannabis can relieve pain, reduce inflammation, lessen nausea/improve appetite, control epileptic seizures and more. Also of note, in a Fall 2018 PPM online patient poll, about half of respondents said they had tried medical marijuana to help alleviate their pain or pain-related symptoms.
If you have a medical condition that qualifies for medical cannabis use in your state, you can start by talking to your primary care physician about the options, benefits, and risks of using it therapeutically for your specific situation, says David Bearman, MD, a physician with 40 years of experience in the substance abuse field and author of the recent book, Drugs Are NOT the Devil’s Tools: How Greed and Discrimination Led to a Dysfunctional Drug Policy and How It Can Be Fixed.
10 Key Considerations
Before broaching the subject, It is helpful to know the basics about medical cannabis and some of the issues and concerns involved in its usage. Here are some points to help guide your conversation with your physician:
#1. Not all medical cannabis is the same.
Photo courtesy Robin R. Buckallew, hosted by the USDA-NRCS PLANTS Database Medical cannabis comes from the Cannabis sativa plant, and there are hundreds of different strains out there. “Cannabinoids are the molecules in the cannabis plant matter that have a medical value and perform certain actions in the body,” explains Sharmilla K Patil, MD, CAS, FDM, who serves as the CMO of Divine Balance Medical Group and CEO of Greentech Laboratories, Inc.
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Two of the best-known types of cannabinoids contained in most strains are THC (delta 9 tetrahydrocannabinol) and CBD (the name for cannabidiol). THC causes the psychoactive effect that people typically associate with cannabis use; CBD offers many therapeutic applications without the psychoactive properties.
Most people use a strain that contains a mixture of both compounds. Experts say low doses of THC can be effective for treating anxiety, attention deficit disorder (ADD) and post traumatic stress disorder (PTSD). Higher doses are typically required for pain relief.
#2. Medical cannabis can be used to treat a variety of conditions.
“Some of the more frequent reasons for cannabinoid medicine specialists [or other physicians] to recommend cannabis is to treat pain and to treat anxiety,” Dr. Bearman says. “Other common conditions that cannabis can address include [but aren’t limited to] migraines, epilepsy, ADD/ADHD, PTSD, depression, Crohn’s disease, nausea, appetite stimulant, Parkinson’s Disease, multiple sclerosis, fibromyalgia, complex regional pain syndrome (CRPS), rheumatoid arthritis, lupus, and autism.” (Keep in mind that the conditions cannabis is approved to treat will depend on the state in which you live.) Your doctor may be able to discuss your condition and explain how medical cannabis can be used to address your symptoms.
Some people are not good candidates for this form of treatment. Your practitioner should be able to tell you if this is true for you. As with any medication, pregnant women should consult a doctor before use and those with schizophrenia should use cannabis only under the supervision of a psychiatrist.
In addition, Dr. Bearman points out that the US Food and Drug Administration (FDA) offers a warning for users of Marinol (prescription synthetic THC) and other psychoactive drugs, which is not to drive, operate heavy equipment or engage in dangerous activity until the substance’s affects are evaluated in them. Something to keep in mind when using medical cannabis as well.
#3. Medical cannabis comes in several forms.
Dr. Bearman suggests you ask your physician to recommend the best ratio of THC to CBD to look for in a marijuana strain, as well as to offer a suggested dosage and route of administration. Medical cannabis can be taken in a variety of forms, including being smoked, vaporized, sublingually (under the tongue), ingested, and used topically. When you visit a dispensary with your doctor’s recommendation, if the staff there is experienced and well-informed, they can also help guide you to identify the best option for the type of results you are seeking. Some patients prefer to grow their own cannabis. You can also talk to your doctor about going this route, too.
#4. Side effects are usually minor but do exist.
“While cannabis does have a few side effects, they are generally dose related and occur more frequently in novice users, and in most cases nonmedical recreational consumers,” Dr. Bearman points out. “These side effects include paranoia, panic attacks, and dysphoria [a feeling of deep uneasiness or dissatisfaction]. Therefore, the best advice with medical cannabis is to “start low and go slow,” he stresses.
#5. You don’t need a prescription for medical cannabis but you do need a physician’s recommendation.
If you are an appropriate candidate for medical cannabis treatment, your physician can provide a medical cannabis recommendation that can be used in your state. Since medical cannabis is classified as a Schedule 1 drug, doctors don’t formally prescribe it; they recommend usage. A physician’s recommendation is needed to purchase the substance at a medical marijuana dispensary.
You may also want to use the recommendation to apply for a formal medical marijuana card, which enables you to be a registered medical cannabis user in your state. (Note: The card is an optional step in many states, but be sure to find out the laws where you live.) Dr. Bearman points out that the benefit of having a medical cannabis card is to offer protection in the event you need to prove to law enforcement that you are using it for a valid medical reason. Law enforcement may ignore the doctor’s letter (the courts will recognize it, however) but the card is an official state document and can help you avoid unnecessary hassle.
#6. Cannabis use laws vary by state.
To learn the medical cannabis laws in your state, several online resources are available. Sites such as the National Organization for the Reform of Marijuana Laws (NORML), the Marijuana Policy Project, and the United Patient’s Group provide information about regulations in each state. You can also call your state legislators for more information about local regulations.
It’s also important to understand that medical marijuana is prohibited under federal law but in states with controlled medical cannabis laws, patients with physician’s recommendations don’t generally need to be concerned about this. In 2014, Congress budgeted no money to enforce the federal anti-marijuana law (the Controlled Substances Act of 1970) in states where cannabis is legal. The US Drug Enforcement Agency (DEA) points out that the laws are meant to protect against drug rings and aren’t meant to target individual people using cannabis for approved therapeutic reasons.
“No patient should be worried. The states that have medical marijuana usually have amendments that protect patients and physicians from federal laws,” stresses Philip S. Kim, MD, CEO and founder of the Center for Interventional Pain Spine, LLC, in Newark, Delaware.
Dr. Kim also points out that for people in states that don’t have medical cannabis laws, they can ask their doctor about dronabinol, a synthetic THC and the generic form of Marinol, which is FDA approved and available nationwide.The National Institute on Drug Abuse (NIDA) website reports that medications containing THC that are approved by the FDA can help with nausea control, improved pain, reduced inflammation and improvements in muscle control issues.
#7. There’s more than one way to start the conversation with your doctor about using cannabis therapeutically.
If you’re unsure how to bring up the subject of using medical cannabis with your doctor, Dr. Bearman has a few possible openings. Try talking about someone else you know (“a friend”) who is using medical cannabis effectively; mentioning a book on the subject that you have recently read or a documentary or news show you’ve watched or asking about research you’ve discovered on the Internet. “Any of these tactics can kick off a conversation with your doctor,” he says.
#8. Not all doctors are up on the latest research on medical cannabis.
You shouldn’t assume that your doctor is well versed in the current medical cannabis literature. One way to find out his level of knowledge is to inquire if he or she has attended any continuing education programs or workshops about cannabis recently. Dr. Bearman says that you shouldn’t be surprised if the answer is, “no.”
“Most physicians have not even been taught about the endocannabinoid system [the neurotransmitter system that cannabis affects for results], let alone the medicinal value of cannabis [the plant matter] and cannabinoids [the molecules]. Even physicians who make cannabis recommendations may be unfamiliar with its value, dosing, and/or strain in treating a less common condition that may respond favorably to cannabis,” Dr. Bearman explains. So, be sure to do your homework and understand the options and issues involved in using medical cannabis.
#9. If your physician doesn’t recommend cannabis for you, you can still find a doctor who specializes in this treatment.
If your condition qualifies you to use medical cannabis in your state and you don’t have any contraindications that make usage risky, but your primary care physician isn’t comfortable making a cannabis recommendation, ask him or her for a referral to another clinician. Medical cannabis practitioners can also be tracked down online through resources such as the Medicinal Marijuana Association.
#10. Medical cannabis use can negatively impact your career and finances.
While the majority of states have some type of medical cannabis law in place to make it accessible for patients who qualify, there are still some important implications that people should think about before they decide to use it. For instance, regular usage could impact life insurance premiums and could also put you at risk on the job in some circumstances if your employer performs drug testing and is not willing to recognize the medical benefits of this drug. (Dr. Bearman notes that the use of synthetic THC [dronabinol] will be reported as a negative test result, so this could be worth considering.)
Your best bet is to ask your doctor about the benefits and risks associated with any options you are considering so you can determine what makes the most sense for your specific symptoms and circumstances.
If you're considering trying medical cannabis for pain relief, here's how to speak with your doctor about getting a recommendation for the substance that is currently legal in 28 states.