I got an email from a patient the other day that, frankly, is all too common these days. He wrote to ask my advice because he’s no longer sleeping. He’s been a life-long insomniac and came to me years ago for this problem. After the usual medication adjustment period, he was able to achieve 6-7 hours sleep per night fairly, but not always, consistently. He described this progress as being “miraculous” and “beyond his wildest dreams”. In addition to being overjoyed, his life which had been a shambles started to right itself. His ongoing depression, while not cured, got better and he was better able to make progress in his business and maintain deeper personal relationships.
Concentrates are Not Miracle Solutions
He had been stable this way and on the same, safe regimen for several years. Until he emailed me. Now he’s reporting it’s all gone sideways. The longer story, as it turns out, is that in his quest for the next miracle to fully fix his sleep and depression, a “friend” who runs a cannabis dispensary recommended that he try using RSO (Rick Simpson Oil – a highly concentrated extract of cannabis). This worked “wonderfully” for about 2 weeks. He reported getting even better sleep – up to 9 hours.
However, now he notes no sleep at all for a week coupled with morning grogginess and loss of focus. He reached out to me for advice on what to do now. I’ll tell you what I told him: go back to the regimen that was safe and was working. It’ll take up to several weeks to undo the effects of the concentrate but over time the old regimen will start to work just fine once again. On the other hand, those next few weeks are going to be rough, and there was no need to get into this position in the first place.
Listen to Your Doctor, Not Your Budtender
Ultimately, this story illustrates two unfortunate realities that are beyond my comprehension.
The first is that the cannabis industry is not your friend. Even the most well-meaning people, some of whom might even be actual friends, are likely to trip you up. The cannabis industry, perhaps like most industries, is greedy and immoral, and will tell you anything to make increasing sales. They will downplay risk, overstate benefit, and cajole you into buying more and different products than you need. They aren’t stupid either. They know that the more you buy the more you’ll use, and the more you use the more you’ll use. It’s all about sales – not your health or safety.
Furthermore, nobody in the cannabis industry has the expertise or the dispassion to be giving medical advice. Not only do they lack the intense medical training needed to provide actual medical care, but again, their job is to sell product which is a goal that’s at odds with giving unbiased medical advice.
Not only have physicians studied for 7-12 years after college but, contrary to popular conspiracy theories, we don’t make money when we prescribe medications. In fact, that would be not only immoral but illegal.
So, the second unfortunate reality, is that despite knowing this, people will for some reason listen to the advice of exactly the people they know they shouldn’t. While the greed of the industry disturbs me, it’s the bizarre decision-making of human beings that truly baffles me.
Sure, if you didn’t have access to medical care I could understand doing your best to take care of yourself. It’s also unbelievably difficult to sort fact from fiction these days, and especially so in the cannabis field. A not-so-recent-anymore study once showed to only 3% of cannabis information available on the web was accurate and came from credible sources.
Nonetheless, people do have access to cannabis care, through me if they are (or want to be) my patient, or through other well-trained clinicians who they can access by referral from the Association of Cannabinoid Specialists.
Avoid Concentrates
I never recommend patients use concentrates. In fact, they are on my “Avoid” page in the packet of information that I cover with all of my patients and send to them for their review after our visit. Concentrates make fine ingredients in other products like edibles, but are too potent, sticky, and immeasurable to be useful or safe for direct human consumption.
What happened to my patient was entirely predictable and why these products are on that Avoid page. What I still can’t fathom is why he listened to his friend’s advice over mine, or why, if he didn’t recall my advice, he didn’t check in with me to verify his friend’s advice? It’s not as though he, and all of my patients, didn’t have my direct email address.
Would you really monkey around with your heart medication? Would you take your buddy’s advice or would you contact your doctor?
Medications Need Limitations
Because of all this greed, upselling, and frankly people’s willingness to fall for it, I’ve been writing my recommendations with a limit on how much the dispensary can sell a patient. I wouldn’t (couldn’t) write a prescription for Percocet without stating how many tablets are to be sold. Why would I give limitless access to cannabis? I can hear the cannabis advocates saying, “but cannabis is safer than opioids” and I would agree, but respectfully point out that safer is not the same as safe, and we know that dependence and addiction, among other problems, do occur with cannabis.
Like any physician who prescribes opioids or benzodiazepines can tell you, I catch quite a bit of flak from some of my patients for instituting this limitation. Unfortunately, given the negligent prescribers out there, and very lax recreational laws, patients can ultimately simply go find their excessive amounts elsewhere. The consequences of over-prescribing opioids has been made abundantly clear (perhaps excessively) and providers’ requirement to check prescription monitoring services has led to a decrease in “doctor shopping” to get inappropriate amounts of pills. Here in Massachusetts one of our better ideas has been that cannabinoid providers can view both the purchases of patients and the prior prescriptions by clinicians. Yet after patients have jumped ship over the limitation, I’ve never had a single inquiry from the receiving clinician as to why the limit was in place or the use history of the patient.
The System Needs to Improve for Patients
It’s well past time to improve this system for the benefit and safety of patients. We all have a role to play. Clinicians must be more specific about the appropriate regimen and follow closely to ensure adherence. To the extent that limitation on sales is an available tool, it should be routinely used. Boards of Licensure need to establish and enforce standards of care to ensure that practitioners are behaving ethically and in the interest of patients.
Lawmakers need to acknowledge that cannabis is not simply safe, and that promoting the greedy industry is not the appropriate first priority. They need to enact regulation that helps clinicians look after their patients. A good first step might be to ask physicians what that should look like, and not surprisingly, the Association of Cannabinoid Specialists has documents to explain what’s needed.
Most of all, patients, please start taking cannabinoid medicine seriously. Please don’t dabble with your healthcare, regardless of what the industry tells you. Listen to your physicians, reach out to them when you have questions or get advice that differs from what they’ve told you. We can only be your advisors, but it’s harmful to you and frustrating to us when you fall into the traps set by the industry. Just reach out.
Consult with a Qualified Massachusetts Medical Marijuana Expert Today
Those considering using THC, CBD, or any type of medicine found in cannabis to help manage their condition should consider speaking to a trained medical expert who is knowledgeable about using cannabis therapeutically.
Massachusetts medical marijuana doctor Jordan Tishler, M.D. sits on the faculty of Harvard Medical School and has years of experience helping patients treat pain and other ailments using cannabis. He and the team at inhaleMD stand ready to assist patients in determining whether medical marijuana is right for them.
For more information, or to set up a virtual consultation with the team at inhaleMD, call us at (617) 477-8886 today.