Prescribing Medical Marijuana

I work in neuro, and I just heard that in my state they are about to legalize CBD prescribing for Dravet Syndrome and Lennox-Gastaux Syndrome - those two diagnoses only. It also is apparently going to be a Schedule I drug. We actually don't have any pediatrics in our practice currently, so until they aporive it for something else, this won't apply to us, anyway. Not that I would be prescribing it, being that it's Schedule I. Funny, considering you can get it anywhere. I get asked about CBD almost daily. I have patients that use marijuana for seizures and MS. One of them bakes it into brownies. If they are smoking it, I always tell them to stop. If they are going to do it (which of course I can't recommend), they should at least make it a little safer and consume it. Smoking it is so bad for you, I could never recommend that. I'm not entirely sure I could recommend marijuana in general.

Here is one article that is a Meta analysis done on web MD:

https://www.webmd.com/pain-management/features/medical-marijuana-research-web

It's just so frustrating to see so many educated people who haven't read even one of the many, MANY MANY studies completed on marijuana. There are so many uses of marijuana and very little dangers, especially compared to the drugs we currently used.

A friend of mine recently took care of a 34 yr old previously normal patient. She had a critical incident and ended up on pressors which saved her life - but took every single one of her limbs. So, she is alive, but she can't walk, or hold her children. How many people would want to live like that. There are so many drugs we use WITH REGULARITY regardless of their side effects, then we cast such a harsh light on marijuana without the public being fully aware of the drugs we currently give them. We tell them marijuana is addictive then prescribe percocets. There is not a study YET that has shown ever a death due to marijuana alone, but we send people home on PO dilaudid, and we know what these things do!!! AZ recently passed a law preventing prescribers from sending people home on more than 90 mg of morphine po! How can a person prescribe 90 of morphine then claim marijuana is dangerous and addictive is beyond me!

It is so misleading to tell people not to use marijuana because they will get high then prescribe ambien for insomnia, when we all know the hallucinations that can lead to. So many people have killed love ones, or woken up in a grocery store on ambien and we still send people home on it! I just don't understand as a medical professionals, how we are doing what is best for our patients when we say these things. Look at the risks we are putting our patients in so that we can look like perfect prescribers in the eyes of the government. Here's some ativan, benadryl, percocet and ambien, but MARIJUANA is dangerous - cuz the government says so! LOL.

You definitely do not have to believe me, I'm only an RN, but there are BOOKS, STUDIES many many things that have been done in the name of research of marijuana. Do you think the same lawmakers who don't even see a need to clean flints water would legalize marijuana if they weren't presented with cold hard facts? Even if ALL of the politicians in the world were evil, then are all of the people? The people are stating marijuana has helped them, Sanjay Gupta did that special... are all these people kooks? There is a nursing association ACNA - American Cannabis Nursing Association, which is dedicated to further marijuana education from a nursing perspective. Look at any of these things. Even if you choose to throw every word out I have said, read the Web MD meta analysis above, go to the ACNA website, or just google marijuana studies and read for 5 or 10 minutes, and I guarantee you will see how beneficial this can be for your patients. This is not a simple fad. If you don't see how wonderful for your patients this can be, at the very least you can see logically how the side effects are similar or better than many of the side effects of medications we currently prescribe daily. Please consider this the next time you discuss this with your patients. I beg of you to be considerate of the latest studies regardless of what "big brother" says, for your patients.

15 hours ago, tiffanyselah said:

Here is one article that is a Meta analysis done on web MD:

https://www.webmd.com/pain-management/features/medical-marijuana-research-web 

It's just so frustrating to see so many educated people who haven't read even one of the many, MANY MANY studies completed on marijuana. There are so many uses of marijuana and very little dangers, especially compared to the drugs we currently used.

A friend of mine recently took care of a 34 yr old previously normal patient. She had a critical incident and ended up on pressors which saved her life - but took every single one of her limbs. So, she is alive, but she can't walk, or hold her children. How many people would want to live like that. There are so many drugs we use WITH REGULARITY regardless of their side effects, then we cast such a harsh light on marijuana without the public being fully aware of the drugs we currently give them. We tell them marijuana is addictive then prescribe percocets. There is not a study YET that has shown ever a death due to marijuana alone, but we send people home on PO dilaudid, and we know what these things do!!! AZ recently passed a law preventing prescribers from sending people home on more than 90 mg of morphine po! How can a person prescribe 90 of morphine then claim marijuana is dangerous and addictive is beyond me!

It is so misleading to tell people not to use marijuana because they will get high then prescribe ambien for insomnia, when we all know the hallucinations that can lead to. So many people have killed love ones, or woken up in a grocery store on ambien and we still send people home on it! I just don't understand as a medical professionals, how we are doing what is best for our patients when we say these things. Look at the risks we are putting our patients in so that we can look like perfect prescribers in the eyes of the government. Here's some ativan, benadryl, percocet and ambien, but MARIJUANA is dangerous - cuz the government says so! LOL.

 You definitely do not have to believe me, I'm only an RN, but there are BOOKS, STUDIES many many things that have been done in the name of research of marijuana. Do you think the same lawmakers who don't even see a need to clean flints water would legalize marijuana if they weren't presented with cold hard facts? Even if ALL of the politicians in the world were evil, then are all of the people? The people are stating marijuana has helped them, Sanjay Gupta did that special... are all these people kooks? There is a nursing association ACNA - American Cannabis Nursing Association, which is dedicated to further marijuana education from a nursing perspective. Look at any of these things. Even if you choose to throw every word out I have said, read the Web MD meta analysis above, go to the ACNA website, or just google marijuana studies and read for 5 or 10 minutes, and I guarantee you will see how beneficial this can be for your patients. This is not a simple fad. If you don't see how wonderful for your patients this can be, at the very least you can see logically how the side effects are similar or better than many of the side effects of medications we currently prescribe daily. Please consider this the next time you discuss this with your patients. I beg of you to be considerate of the latest studies regardless of what "big brother" says, for your patients.

Here are the points that stick out and reinforce that there is still too much anecdote surrounding the issue.

"Few of these studies, though, followed a controlled clinical trial. This is considered the best type of trial because it compares a drug to another drug, or to a placebo (a "fake" treatment).

Also, most of the studies had fewer than 200 patients. So doubt continues about marijuana’s value and who it really can help, says J. Michael Bostwick, MD. He's a psychiatrist at the Mayo Clinic and author of a review of medical marijuana research."

The problem I have with legalization of its' recreational use means that companies will have even less incentive to actually study it in real evidence-based studies and this makes it even harder to recommend as a therapy (OTC or as a prescription). It will also minimize the likelihood the FDA actually motivates to start approving it for specific therapies. And this also increases risks of it having an interaction with other therapies we are using should patients decide to use it. I would suggest it will likely forever be labeled as a supplement that may or may not have medical value and people will always have to pay out of pocket for something that could in theory be of real medical value.

On 7/26/2018 at 7:46 AM, iriska_meller said:

You are correct, no one can "prescribe" but in my state an MD/NP/PA can get certified to "recommend" it. Essentially you certify that patient has one of the "approved" conditions with "approved" complications - state publishes a list - and patient takes that to a dispensary.

I agree, too much legal limbo, especially with current federal administration being quite anti-weed.

I'm wondering how you became certified to recommend it? I would love to be able to recommend it to my patients. Thanks.

In Florida where it was recently legalized for medical purposes I did my PMHNP "advanced assessment" class last Summer with a family practice MD licensed to recommend cannabis. He felt that the DEA had a "target" planted on him as they conducted frequent "audits" of his practice, and another provider (also licensed for medical cannabis) near him was shut down. I believe that there is evidence for efficacy certainly with seizure control, but also with chronic inflammation (especially the higher cbd strains).

On 6/5/2019 at 12:16 PM, myoglobin said:

In Florida where it was recently legalized for medical purposes I did my PMHNP "advanced assessment" class last Summer with a family practice MD licensed to recommend cannabis. He felt that the DEA had a "target" planted on him as they conducted frequent "audits" of his practice, and another provider (also licensed for medical cannabis) near him was shut down. I believe that there is evidence for efficacy certainly with seizure control, but also with chronic inflammation (especially the higher cbd strains).

I'm in California where it is definitely legal for medical purposes.

There is definitely evidence of medical cannabis efficacy.

On 4/23/2019 at 4:09 PM, tiffanyselah said:

Here is one article that is a Meta analysis done on web MD:

https://www.webmd.com/pain-management/features/medical-marijuana-research-web

It's just so frustrating to see so many educated people who haven't read even one of the many, MANY MANY studies completed on marijuana. There are so many uses of marijuana and very little dangers, especially compared to the drugs we currently used.

A friend of mine recently took care of a 34 yr old previously normal patient. She had a critical incident and ended up on pressors which saved her life - but took every single one of her limbs. So, she is alive, but she can't walk, or hold her children. How many people would want to live like that. There are so many drugs we use WITH REGULARITY regardless of their side effects, then we cast such a harsh light on marijuana without the public being fully aware of the drugs we currently give them. We tell them marijuana is addictive then prescribe percocets. There is not a study YET that has shown ever a death due to marijuana alone, but we send people home on PO dilaudid, and we know what these things do!!! AZ recently passed a law preventing prescribers from sending people home on more than 90 mg of morphine po! How can a person prescribe 90 of morphine then claim marijuana is dangerous and addictive is beyond me!

It is so misleading to tell people not to use marijuana because they will get high then prescribe ambien for insomnia, when we all know the hallucinations that can lead to. So many people have killed love ones, or woken up in a grocery store on ambien and we still send people home on it! I just don't understand as a medical professionals, how we are doing what is best for our patients when we say these things. Look at the risks we are putting our patients in so that we can look like perfect prescribers in the eyes of the government. Here's some ativan, benadryl, percocet and ambien, but MARIJUANA is dangerous - cuz the government says so! LOL.

You definitely do not have to believe me, I'm only an RN, but there are BOOKS, STUDIES many many things that have been done in the name of research of marijuana. Do you think the same lawmakers who don't even see a need to clean flints water would legalize marijuana if they weren't presented with cold hard facts? Even if ALL of the politicians in the world were evil, then are all of the people? The people are stating marijuana has helped them, Sanjay Gupta did that special... are all these people kooks? There is a nursing association ACNA - American Cannabis Nursing Association, which is dedicated to further marijuana education from a nursing perspective. Look at any of these things. Even if you choose to throw every word out I have said, read the Web MD meta analysis above, go to the ACNA website, or just google marijuana studies and read for 5 or 10 minutes, and I guarantee you will see how beneficial this can be for your patients. This is not a simple fad. If you don't see how wonderful for your patients this can be, at the very least you can see logically how the side effects are similar or better than many of the side effects of medications we currently prescribe daily. Please consider this the next time you discuss this with your patients. I beg of you to be considerate of the latest studies regardless of what "big brother" says, for your patients.

I LOVE THIS. I see so many nurses on here low-key shaming other nurses who advocate for marijuana, but are okay with ALL the other pharmaceuticals that have some serious side effects. Because "tHe GoVeRnMeNt SaYs ItS iLleGaL". There's been so many studies, so many people saying it helps them, so much evidence of it helping people. It's 2019, people. Marijuana is becoming legalized; get over it.

3 minutes ago, stephxbee said:

I LOVE THIS. I see so many nurses on here low-key shaming other nurses who advocate for marijuana, but are okay with ALL the other pharmaceuticals that have some serious side effects. Because "tHe GoVeRnMeNt SaYs ItS iLleGaL". There's been so many studies, so many people saying it helps them, so much evidence of it helping people. It's 2019, people. Marijuana is becoming legalized; get over it.

That meta analysis wasn't exactly Earth shattering as I mentioned earlier. And I don't think anyone here is low key shaming anything. We're being practical in our practice of medicine. I don't recommend it to anyone any more than I recommend a supplement from gnc. I can't vouch for the efficacy of the dose, the recommended dose for an ailment, or even have a somewhat verified parameter of ailments to recommend it for. I tell most people if they're gonna take it, not to smoke because as a good clinician, I discourage patients doing things that can lead to COPD, something all forms of smoke inhalation can lead to. It also still isn't legalized in most states. So most people shouldn't be blanket told to "get over it".

On 7/11/2019 at 8:42 PM, stephxbee said:

I LOVE THIS. I see so many nurses on here low-key shaming other nurses who advocate for marijuana, but are okay with ALL the other pharmaceuticals that have some serious side effects. Because "tHe GoVeRnMeNt SaYs ItS iLleGaL". There's been so many studies, so many people saying it helps them, so much evidence of it helping people. It's 2019, people. Marijuana is becoming legalized; get over it.

Agreed! I often advocate for people to at least do some research for themselves before deciding that the "Devil's Weed" is some sort of evil entity that exists to erode the morals of this "great country", particularly if they ask me their opinion. I've done so as a bedside nurse, as well as in my role as a primary care provider. Clearly there are some situations in which I won't suggest it, but by letting common sense guide the conversation (and knowing a little of the history and effects of weed), that can be managed.

One of the only reasons it's still federally illegal is because of some BS back in the earlier part of last century that involved Mexicans and African Americans, and then again when Reagan started waging War on Drugs, which (unsurprisingly) affected minorities in greater numbers. What a crock.

Don't believe anything the government tells you...they aren't always right or looking out for the people's best interest. Think and investigate for yourself. That's the only way we grow and learn.

In AZ, only MD/DO/ND can issue medical marijuana cards. Chiropractors used to be able to issue cards as well.