This week I want to highlight two different articles that are both about the usage and effects of marijuana in the medical field. The first article outlines guidelines set by the state of California for recommending marijuana to patients, while the second discusses a medical syndrome known as Cannabinoid Hyperemesis. Below you’ll find these articles and my thoughts on their implications.
Disclaimer: The views and opinions expressed below are those of Mark Pew, Senior Vice President of Product Development and Marketing, and do not necessarily reflect the views of Preferred Medical.
California is one of the many states that has legalized medical marijuana, but what you may not know is that there are guidelines to why, how, and when a physician can recommend marijuana to their patients for medical purposes. This document outlines these guidelines and includes that the physician will not face investigation or disciplinary action if they choose to recommend medicinal marijuana to their patients if they deem it beneficial. The guidelines outlined in this document include patient evaluation, qualifying conditions and treatment agreement, just to name a few.
Just in case you didn’t think there were any medical guidelines on recommending medical cannabis, the Medical Board of California published theirs in October 2017 and updated last April (on the 20th – nice touch). It’s a jam-packed seven pages. They include info about the “physician-patient relationship” (there should be one), “patient evaluation” (should be comprehensive), “informed and shared decision making” (benefits AND risks), “treatment agreement” (should be written and revisited regularly), “qualifying conditions” (“there is a lack of evidence for the efficacy of cannabis in treating certain medical conditions”), and even “medical records” (“proper record keeping and maintenance should support the decision to recommend the use of cannabis for medical purposes”). But the most interesting part of the guidelines is on the last page—”Decision Tree.” It starts with non-pharma treatment and provides multiple ways of determining if #marijuana is appropriate. In other words, a balanced approach. It’s worthy of a read. There are some helpful insights here regardless of the state in which you reside. In fact, it might be worthwhile for other state medical boards to take a look. But from a different vantage point these guidelines can help patients in the selection process of a provider. Are they treating cannabis as medicine (with all of the standards of care that come along with those expectations) or trivially as though it were recreational? If it’s supposed to be medicine, treat it like medicine.
A common use of marijuana is to treat nausea and vomiting, but in the case of Cannabinoid Hyperemesis Syndrome the opposite effects take place, and actually induce severe bouts of both. This usually only happens to heavy users of the drug, and it is still unclear why it only affects some users and not others. It is thought to be caused by receptors in the brain no longer responding to the drug in the way it used to in the beginning of usage, and thus the opposite effects occur.
There is a lot still unknown about CHS, including prevalence, but it certainly would be considered a risk for long-term cannabis users. For those interested in more information, I found the following helpful resources:
- A really deep dive for clinicians and scientists as published in 2011 in the US National Library of Medicine
- A layperson’s description published by Cedars-Sinai
Whichever one you read, just note that if someone has “cyclic episodes of nausea and vomiting” and is a “daily long-term user of #marijuana” it may not be a coincidence.
To read everything on my mind this past week, please visit me on LinkedIn, at https://www.linkedin.com/pulse/marks-musings-january-7-mark-rxprofessor-pew/.
Until next week,