kittryn Posted November 12, 2015 Share Posted November 12, 2015 anybody? I'm curious what our pa community's thoughts are (pro and con) on this as a treatment for serious illness. Link to comment Share on other sites More sharing options...
Hemmingway Posted November 12, 2015 Share Posted November 12, 2015 Given the way it is already abused in the states where it is legal I see mostly problems with little upside. Ironically I would support legalization but think the whole medical marijuana system is a fraud. Link to comment Share on other sites More sharing options...
BruceBanner Posted November 12, 2015 Share Posted November 12, 2015 ^Agreed. I have no ethical or medical issues with it's use for palliative reasons, but the MMJ system is a sham and mostly used by losers who want to grow extra plants quasi-legally for gray market sale, or just avoid paying high taxes on their weed. I personally don't think MJ should be in the realm of prescription medicine. Legalize its use and if people want to use it, they can use it. Don't come in to my office asking me to prescribe you weed. Link to comment Share on other sites More sharing options...
Administrator rev ronin Posted November 12, 2015 Administrator Share Posted November 12, 2015 I won't write for it. My SP will. Legal in Washington, so we don't dismiss chronic pain patients for using it. Link to comment Share on other sites More sharing options...
winterallsummer Posted November 12, 2015 Share Posted November 12, 2015 Not against legalization. However would not write for it personally outside of stage IV CA pts. Link to comment Share on other sites More sharing options...
Reality Check 2 Posted November 12, 2015 Share Posted November 12, 2015 I still go by the idea that my DEA is FEDERAL and the feds consider it illegal. So, I won't prescribe or endorse it. So, recreational - meh, not impressed. DUIs have gone up in Washington with pot impaired drivers and I am sick of seeing bongs in cars as I drive down the road. Legal - like alcohol - means do it in your home, not at work, not in the car and not endangering others and of age. Long term use damages the brain - there is evidence of that - as well as funky sperm etc. I have patients smoking 4-6 joints a day for "anxiety". I am pretty sure the pot is causing the anxiety because they are addicted. Yes, addicted - just like alcohol, meth, heroin, and even food. I have read many articles on the medical side and am just not convinced. Pot has become unbelievably more potent since Woodstock days and the variations and oils and all the types and flavors. Too many variables for me to be convinced of true medical benefit. Also, no real knowledge of how it mixes with any other meds - from BP meds to hydrocodone, ambien, benzos or anything else. And the govt isn't going to put any money into any studies - it will remain a Cat 1 restricted drug. A slippery slope that I am going to stay away from. My very old 2 cents..................... Link to comment Share on other sites More sharing options...
treejay Posted November 13, 2015 Share Posted November 13, 2015 I won't write for it. My SP will. Legal in Washington, so we don't dismiss chronic pain patients for using it. our practice in Washington has a policy that if a patient is being treated with narcotics for chronic pain, they can not also use marijuana. they can choose, one or the other, but not both. Link to comment Share on other sites More sharing options...
Administrator rev ronin Posted November 13, 2015 Administrator Share Posted November 13, 2015 our practice in Washington has a policy that if a patient is being treated with narcotics for chronic pain, they can not also use marijuana. they can choose, one or the other, but not both. My last practice was that way until legalization, and then they quietly started giving up on it, as patients came out of the woodwork saying they'd been smoking pot for years. Is there any evidence that in an environment where smoking pot is legal, not illicit, that it is associated with more negative outcomes for chronic opioid users? Link to comment Share on other sites More sharing options...
wilso2ar Posted November 13, 2015 Share Posted November 13, 2015 There is not any evidence stating that there are more negative outcomes, but there is also no evidence showing that it is safe to use in conjunction with opioids either. It will be interesting how this plays out as more and more states legalize marijuana. Link to comment Share on other sites More sharing options...
kittryn Posted November 13, 2015 Author Share Posted November 13, 2015 I am finding that there are responsible cannabis providers, who conduct ongoing research and development, and take the "less is more" approach to cannabis as medicine. they are not "stoning out" their patients. they do not recommend smoking marijuana, but taking it by vaping or as tinctures, or even salves for more localized treatment. they are finding that cannabis is a safe, effective medicine for many serious illnesses, chronic pain, palliative care, anxiety, PTSD, and even treatment of addiction(s). further, used in conjunction with opioids - and bc cannabis potentiates opioids - cannabis allows for lower doses of opioids and longer times on those lower doses before the (inevitable) increase of opioid doses, which happens with the use of opioids when treating chronic pain. I am actually interviewing with a medical marijuana practice - one that is all the things I said above - and I have to say, I am completely sold, and very excited. I am so fed up with Big Pharma - which pumps out mountains of garbage that I can't even begin to keep up with, and which often have dangerous and terrible side effects - and with the insurance companies calling all the shots, and working us to death, that I have been ready to leave medicine altogether for quite some time. the alternative practice I am interviewing with does not take insurance, so I can spend as much time as I need/want with patients, and I will be prescribing a safe, effective medicine with many uses. my feelings on it are, why shouldn't we be exploring natural plant-based compounds for medical use(s)?" many very effective medicines are plant (or mold/fungus)-based - narcotics, digitalis, penicillin, ergotamine, etc...and with Big Pharma and insurance companies completely out of control and completely IN control, why wouldn't we want to consider alternative treatments for our patients? I shadowed the practice today and the patients are responsible, intelligent, working people who have many of the problems listed above, and for which I have routinely prescribed NSAIDs, narcotics, muscle-relaxers, etc and these patients are doing better on medical marijuana than they were on these other medicines, and with fewer side- and adverse effects. Link to comment Share on other sites More sharing options...
NLRP3 Posted November 13, 2015 Share Posted November 13, 2015 I think it is pretty telling that we don't prescribe whole plants of anything else. Marijuana is a dirty drug. There is no control over concentrations of THC and CBDs and tons of other chemicals that may or may not have an effect. I think that if CBDs are therapeutically beneficial they should be isolated and be prescribed in a therapeutic dose, not just willy nilly, depending on what strain you get at this or that dispensary. Futhermore for those that say that there is no evidence of harm, it is important to remember that absence of evidence is not evidence of absence. Link to comment Share on other sites More sharing options...
kittryn Posted November 14, 2015 Author Share Posted November 14, 2015 I think it is pretty telling that we don't prescribe whole plants of anything else. Marijuana is a dirty drug. There is no control over concentrations of THC and CBDs and tons of other chemicals that may or may not have an effect. I think that if CBDs are therapeutically beneficial they should be isolated and be prescribed in a therapeutic dose, not just willy nilly, depending on what strain you get at this or that dispensary. Futhermore for those that say that there is no evidence of harm, it is important to remember that absence of evidence is not evidence of absence. I wonder why they don't after all this time? I'm glad they haven't. one less thing for Big Pharma to get their grubby mitts on. Link to comment Share on other sites More sharing options...
Administrator rev ronin Posted November 14, 2015 Administrator Share Posted November 14, 2015 I'm glad they haven't. one less thing for Big Pharma to get their grubby mitts on. "Big Pharma" makes you sound like a conspiracy nut whack job who is going to start spouting off about Chemtrails and black helicopters. All using that phrase does is discredit you. Pharmaceutical companies are just like oil companies, banks, computer companies... oh, wait, they all have a common thread: they're COMPANIES. They all exist to make money for the shareholders, and customers are just a means to that end. Companies, in general, are amoral and will do anything to make a profit. Pharmaceutical companies are no worse or no better than any other companies: they're soulless behemoths of capitalism, not manifestations of intentional malevolence... although I admit, in certain circumstances it can be pretty hard to distinguish. If companies could make money killing babies and selling off the parts, they would, since nary a one has a moral compass. Yes, pharmaceutical companies have astroturf'ed for pain management, invented a new fountain of youth (by which they profit nicely...) every few years, and focused their R&D efforts on medicines that make ongoing profits, not ones that actually cure anything. But if you're envisioning a world where they're the only thing that's keeping the pure and holy magical weed of healing out of the hands of the masses, you're again shooting your credibility in the foot. Should pot be schedule 1? Of course not--not when cocaine is schedule 2, and there is plenty of evidence for appetite support in cancer patients. But let's not canonize it before we get to actually do randomized, double-blind, placebo controlled trials on it, shall we? That would be just as inappropriate as keeping it on schedule despite evidence that it doesn't belong there. Link to comment Share on other sites More sharing options...
kittryn Posted November 14, 2015 Author Share Posted November 14, 2015 "Big Pharma" makes you sound like a conspiracy nut whack job who is going to start spouting off about Chemtrails and black helicopters. All using that phrase does is discredit you. Pharmaceutical companies are just like oil companies, banks, computer companies... oh, wait, they all have a common thread: they're COMPANIES. They all exist to make money for the shareholders, and customers are just a means to that end. Companies, in general, are amoral and will do anything to make a profit. Pharmaceutical companies are no worse or no better than any other companies: they're soulless behemoths of capitalism, not manifestations of intentional malevolence... although I admit, in certain circumstances it can be pretty hard to distinguish. If companies could make money killing babies and selling off the parts, they would, since nary a one has a moral compass. Yes, pharmaceutical companies have astroturf'ed for pain management, invented a new fountain of youth (by which they profit nicely...) every few years, and focused their R&D efforts on medicines that make ongoing profits, not ones that actually cure anything. But if you're envisioning a world where they're the only thing that's keeping the pure and holy magical weed of healing out of the hands of the masses, you're again shooting your credibility in the foot. Should pot be schedule 1? Of course not--not when cocaine is schedule 2, and there is plenty of evidence for appetite support in cancer patients. But let's not canonize it before we get to actually do randomized, double-blind, placebo controlled trials on it, shall we? That would be just as inappropriate as keeping it on schedule despite evidence that it doesn't belong there. you are blacking-and-whiting all over the place. you make yourself sound like a reactionary whack job yourself by cannonballing someone with a different point of view from yours. and...people run companies. at least, so far.... Link to comment Share on other sites More sharing options...
JohnnyM2 Posted November 14, 2015 Share Posted November 14, 2015 If companies could make money killing babies and selling off the parts, they would, since nary a one has a moral compass. An apt description of Planned Parenthood which already does that. Link to comment Share on other sites More sharing options...
loliz Posted November 14, 2015 Share Posted November 14, 2015 An apt description of Planned Parenthood which already does that. ^^^^^ wow. Apparently, you completely missed the part where PP gives sliding scale annual exams giving women access to preventive medicine and giving access to OCP and IUDs to avoid the very situation that you are abusing to make headlines of. Let's be grown ups. No one sets out with the goal of getting an abortion. Access to healthcare is essential for all people- including women. But this isn't what this conversation is about, so let's go back to the task at hand instead of throwing out one liners to distract from the actual issue. Link to comment Share on other sites More sharing options...
Reality Check 2 Posted November 14, 2015 Share Posted November 14, 2015 Kittryn Be careful. Not sure you will keep your DEA and medical integrity working for a pot practice. It IS federally illegal and not cleared for medical anywhere but California and Colorado - not 100% on that data. I don't think this can go anywhere good. There is no magic bullet, so to speak. Until patients take responsibility for everything non-pharma - including pot- that they have to do themselves - we will still be a society of miracle seeking, lawyer happy folks who think everything is someone else's fault. And when something bad happens with pot - and it will happen - the lawyers are going to have a field day! Cynical - yes, I am 25 yrs in - been there, done that, have a stack of t-shirts....... Link to comment Share on other sites More sharing options...
kittryn Posted November 14, 2015 Author Share Posted November 14, 2015 Kittryn Be careful. Not sure you will keep your DEA and medical integrity working for a pot practice. It IS federally illegal and not cleared for medical anywhere but California and Colorado - not 100% on that data. I don't think this can go anywhere good. There is no magic bullet, so to speak. Until patients take responsibility for everything non-pharma - including pot- that they have to do themselves - we will still be a society of miracle seeking, lawyer happy folks who think everything is someone else's fault. And when something bad happens with pot - and it will happen - the lawyers are going to have a field day! Cynical - yes, I am 25 yrs in - been there, done that, have a stack of t-shirts....... I won't be prescribing it (PAs cannot, just like we cannot prescribe suboxone). I will be evaluating patients for their qualifying conditions and other elements to see if they are good candidates for this alternative therapy. the doc writes the certificates. I know it's a fine (and maybe meaningless) distinction overall, but my DEA reg is technically protected in that regard. I hear what you are saying about my credibility as a provider possibly being affected...maybe, maybe not; and I have thought about that, too. the first litmus test was when I asked my references (HIGHLY respected and accomplished docs) for a recommendation - and they had no problem giving me a strong recommendation, and actually wanted to know more about the practice and responsible use of marijuana for qualifying conditions. further, I am completely disillusioned with medicine and how we are now forced to practice (bc of insurance companies' quota requirements, RVUs, etc), and have been pretty much planning to leave medicine altogether bc I just can't work the way medicine now demands. I like to spend time with my patients and find best solutions to their illnesses and injuries. if medical marijuana helps, and I can spend as much time with these patients as I like (again - no insurance restrictions on amount of time spent with patients), I feel I have nothing to lose. at age 57, I would like to find a relaxed, humane, and creative practice of medicine to work in until I retire. taking this job seems like a reasonable path, given those factors, to me. I think many here are having the same knee-jerk reaction here that I had - and also had about methadone - before I became educated about the responsible approaches to treating conditions with these medicines. there are responsible providers, and conservative treatment plans, with cannabis. I don't see why I should close my mind to treatments which may be helpful to my patients. apart from the DEA's position on medical marijuana, states are taking their own positions. here is an interesting list of the qualifying medical conditions for medical marijuana by state. check it out! https://www.leafly.com/news/health/qualifying-conditions-for-medical-marijuana-by-state Link to comment Share on other sites More sharing options...
dholmb Posted November 14, 2015 Share Posted November 14, 2015 I can’t help but think the uproar about marijuana being used as a medication is less about it being more dangerous than common prescription drugs, but how it is viewed in society. Overall, I think that people overestimate the negative effects of marijuana, and underestimate the negative effects of other prescription drugs. It’s okay if someone has chronic pain and takes narcotics (opiates, aka heroin), but not if they find relief through marijuana. That being said, we need more research to determine its benefits and risks like any other treatment. Link to comment Share on other sites More sharing options...
Guest JMPA Posted November 14, 2015 Share Posted November 14, 2015 ^^^^^ wow. Apparently, you completely missed the part where PP gives sliding scale annual exams giving women access to preventive medicine and giving access to OCP and IUDs to avoid the very situation that you are abusing to make headlines of. Let's be grown ups. No one sets out with the goal of getting an abortion. Access to healthcare is essential for all people- including women. But this isn't what this conversation is about, so let's go back to the task at hand instead of throwing out one liners to distract from the actual issue. so PP that mutilates and sells infant body parts for profit is ok because it gives free annual exams? selling human body parts is illegal and immoral. if you feel that it is acceptable than that reflects your own condemnation. Link to comment Share on other sites More sharing options...
Guest JMPA Posted November 14, 2015 Share Posted November 14, 2015 it's morbid how the same medical professionals whom are so anti vitamin are so pro mmj. mixed up world? i think so. i will never prescribe this federally illegal poison Link to comment Share on other sites More sharing options...
JohnnyM2 Posted November 14, 2015 Share Posted November 14, 2015 ^^^^^ wow. Apparently, you completely missed the part where PP gives sliding scale annual exams giving women access to preventive medicine and giving access to OCP and IUDs to avoid the very situation that you are abusing to make headlines of. Let's be grown ups. No one sets out with the goal of getting an abortion. Access to healthcare is essential for all people- including women. But this isn't what this conversation is about, so let's go back to the task at hand instead of throwing out one liners to distract from the actual issue. No, actually I didn't miss that at all, and doing something that is illegal and immoral doesn't make offering a few useful services ok. The sale of fetal body parts tells us what kind of organization they really are. When you admonish "let's be grown ups" and let's get back to the task at hand", you are ineffectively and transparently attempting to change the subject yourself. BTW what you set out to do doesn't really matter, its what you end up doing that matters. If you want to get back to the original subject, I will add that if the federal government wants to legalize marijuana or a derivative as a prescription drug, that's one thing. The current use of the term "medical marijuana" is a sham commonly used to give people pseudo legal access to an otherwise illegal substance. I would rather not go down that rabbit hole. Link to comment Share on other sites More sharing options...
kittryn Posted November 14, 2015 Author Share Posted November 14, 2015 No, actually I didn't miss that at all, and doing something that is illegal and immoral doesn't make offering a few useful services ok. The sale of fetal body parts tells us what kind of organization they really are. When you admonish "let's be grown ups" and let's get back to the task at hand", you are ineffectively and transparently attempting to change the subject yourself. BTW what you set out to do doesn't really matter, its what you end up doing that matters. If you want to get back to the original subject, I will add that if the federal government wants to legalize marijuana or a derivative as a prescription drug, that's one thing. The current use of the term "medical marijuana" is a sham commonly used to give people pseudo legal access to an otherwise illegal substance. I would rather not go down that rabbit hole. well, the actual topic at hand is medical marijuana, lol, and your comment, "the current use of the term "medical marijuana" is a sham commonly used to give people pseudo legal access to an otherwise illegal substance" is actually just your opinion. have you ever read the literature? it sounds like you just want to spout off and hit anyone over the head with a hammer who thinks differently than you do. oh well! I prefer to keep an open mind, and have already benefitted immensely from doing so. Link to comment Share on other sites More sharing options...
Guest Paula Posted November 14, 2015 Share Posted November 14, 2015 The majority of the states have chronic or severe pain on the list. My guess is that will be the majority of patients you will see and need to evaluate. How will you decide the pain is chronic and severe? Does the practice require the past medical records of the patients, including surgery notes, pain clinic notes, primary care notes, psychiatric notes, specialty notes etc. before you see the patient? That in itself will take lots of time to sort out the patients and you will spend plenty of time with the patient discussing their results. Does the clinic review disability documents to review why a patient is medically disabled? Do you verify? If this method is used you will probably see 4 patients a day while you call for records, wait for faxes, etc., etc., etc. Are you paid on production? Are the physicians who write the certification paid on production or volume? Do patients pay cash? Link to comment Share on other sites More sharing options...
JohnnyM2 Posted November 14, 2015 Share Posted November 14, 2015 well, the actual topic at hand is medical marijuana, lol, and your comment, "the current use of the term "medical marijuana" is a sham commonly used to give people pseudo legal access to an otherwise illegal substance" is actually just your own (uninformed) opinion. I'll bet you've never even read up on it. it sounds like you just want to spout off and hit anyone over the head with a hammer who thinks differently than you do. oh well! I prefer to keep an open mind, and have already benefitted immensely from doing so. Bully for you. But you bet wrong so you lose. Do you always discount the opinions of those who disagree with you? With regards to the hammer, case of mistaken identity. I didn't touch you. I swear. Be careful though, a fall from such a high horse can really hurt. Sent from my SM-G900V using Tapatalk Link to comment Share on other sites More sharing options...
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