Common questions about medical cannabis

Medical cannabis is currently legal in 37 states and, with 94% of Americans in favor of legal access to medical marijuana, it seems as if this treatment option is returning to the mainstream. Many people aren’t aware that cannabis was a popular treatment in this country in the late 1800s and early 1900s — commonly dispensed by doctors — and that the American Medical Association was one of the strongest voices testifying against prohibiting it in 1937.

I’ve been aware of the ability of medical cannabis to alleviate suffering since I watched my brother Danny use it during his unsuccessful battle with leukemia. Cannabis was the only thing that allowed him to keep down food during chemotherapy. Now, decades later, I am a physician who certifies patients that qualify for medical cannabis in Massachusetts. People often have questions about its safety and its proper use, and these are often the same considerations I have before certifying patients.

Is it safe?

As with nearly everything else about cannabis, how safe or dangerous it is remains hotly debated. As a primary care doctor, I have to ask myself: is cannabis safer than the alternatives I would be prescribing? For example, if I’m treating a patient for chronic pain, is cannabis safer than opiates? Medication risks must be balanced against the safety concerns of cannabis; the main ones are as follows:

• Its safety during pregnancy and breastfeeding has not been established.
• It can worsen, and even potentially cause, psychotic disorders.
• It can temporarily worsen short-term memory and cognitive functioning.
• It can have cardiac and lung effects, such as rapid heart rate and bronchitis.
• You can get addicted.
• There can be drug interactions, especially with CBD.
• It can cause or worsen anxiety at high dosages, even leading to panic attacks.
• Driving and the operation of heavy machinery is impaired.
• It can be especially dangerous for teenagers to use, as there is evidence that they are particularly susceptible to cognitive effects and addiction.

Cannabis should be used with extreme caution — if not avoided altogether — in patients with a history (or potentially a family history) of the problems listed above, such as psychosis, substance misuse, or cardiac arrythmias.

How can I consume cannabis?

People can consume cannabis in various ways: inhalation, placing a tincture under the tongue, ingesting edibles, or applying topical lotions. The advantages of consuming cannabis by inhalation, either by smoking or by vaporizing dried flower with a machine that heats it up, are rapid onset and easier titration of dosage. The disadvantages are that it can irritate the lungs, causing chronic bronchitis, and the therapeutic effect only lasts a few hours, so one has to redose frequently.

Many places simply do not allow cannabis combustion, such as in public housing. Edibles offer non-inhaled consumption and prolonged effects lasting up to 8 hours. However, dosing accurately is challenging, requiring a slow start.

A tincture, placed under the tongue for rapid absorption, acts between inhalation and edibles, taking about 30 minutes to kick in.

Topicals are just what they sound like: creams and lotions to rub on painful, inflamed, or itchy areas. There are very few safety concerns with topical preparations.

Will I get high?

In many instances, the answer is optional unless requiring a high dosage. Medical purposes often require significantly lower doses than recreational use. In regulated cannabis markets, patients have a wide array of strain options, unlike relying on whatever dealers had previously.

Today, individuals can opt for less sedating strains and those with lower THC levels, mitigating strong intoxicating effects. Medical cannabis patients develop tolerance to its psychoactive effects, experiencing less impairment compared to recreational users consuming higher doses less frequently. They still shouldn’t drive when using this medicine, but they do report being quite functional.

Is it legal?

Cannabis legality varies; while legalized for medical use in many states, it remains illegal elsewhere except for state-level permissions. Some states have gone partway and have legalized CBD only, or low-THC cannabis formulations. Remember, cannabis remains illegal federally, making it prohibited to fly with or transport across state borders, even between legalized states.

Employment implications arise even with a medical cannabis card as workplaces may conduct drug screenings, potentially posing risks. Hospitals, even in legal states, often prohibit cannabis due to federal funding concerns, potentially jeopardizing support for medical use.

I’m optimistic about societal progress on medical cannabis, envisioning relief for patients without stigma or legal issues, and unrestricted research opportunities. In this way, our knowledge of both the benefits and the harms of cannabis can continue to progress.

Conclusion

I often remind patients that common medications’ warning labels list potential side effects, some serious, emphasizing caution and awareness. No medication, including medical cannabis, is without drawbacks. Education and legal regulation can mitigate potential harms, ensuring safer usage. I advise starting with low doses to minimize harm, urging patients to “start low and go slow” for desired effects.

Also read our blog on Benefits (and Risks) of St. John’s Wort for Depression