By Dr Janelle Trees, BSC (HONS), MBBS (HONS), FRACGP
Have you seen a doctor who doesn’t want to know about medical marijuana? I’ve met a couple. One of them said, ‘But it’s not easy, you know, you have to fill in special forms,’ when discussing a dying patient who may have benefited greatly from medicinal cannabis. He wasn’t familiar with the forms and didn’t have the time or energy to find out how to access the cannabis-based medicines. Some doctors resist learning about something new. It’s understandable. There’s a lot to keep up with as a doctor. But most of us are led to learn by our patients’ needs. Formal training in marijuana-based medicines only recently began in Australia. Some of us are doing our own research.
Medical marijuana works with cannabinoid receptors which are part of every body. The endocannabinoid system is a system of lipids, transporters and receptors said by some researchers to be as significant as the nervous system. We’re only beginning to learn about it. Doctors are on a steep learning curve now to find out about the endocannabinoid system and cannabis-based medicines.
Some doctors who work with cannabis-based medicines are starting to talk about cannabinoid deficiency syndrome, which sounds like a stoner’s joke. But understanding this system looks likely to give us insight into illnesses and symptoms that we presently have limited capacity to treat and few solutions to try for a cure. This knowledge may give us the keys to be able to help some of our longest-suffering patients, like those with Irritable Bowel Syndrome, Fibromyalgia or chronic Migraine.
When I trained as a scientist and doctor, through the ‘nineties and into the early new century, doctors and scientists were just beginning to understand some of the problems arising from misuse (mainly overuse) of recreational marijuana.
In Australia then, outstanding people (some of them doctors) worked towards removing stigma and improving access to treatment of mental illness. The roots of addictive behaviour were explored in new depth by psychologists who considered intergenerational trauma, co-dependency and the effects of different chemicals on the brain’s chemistry. Cannabis as a good thing featured in none of this.
Then the new century saw the emergence of so-called synthetic marijuana, which seems to me to be a collection of systematically synthesised chemicals that make people feel like they want to die and never do drugs again.
Alongside the dangerous chemical mixes of illegal synthetic cannabinoids, the generally benign side-effect profile of natural cannabis was distorted by people who overindulged the way that humans can misuse anything that gives them pleasure. Plants were selected and grown to maximise the intoxicating, ‘stoney’ effects of the herb. Other aspects of the plant—many potentially healing cannabinoids—were almost literally driven underground.
In this context, it’s worth recalling that healthy people don’t often come to see us, sick people do. It’s why so many of my colleagues don’t seem to be able to acknowledge the health-giving pleasures of eating steak or chocolate. Or sleeping in. We have a professional bias that exaggerates the potential badness in butter.
This kind of knowledge base—marijuana is nothing but bad—and behaviour—you have to drill ‘health’ into people’s heads—by my colleagues, can make patients uncomfortable talking about a subject that their doctor may be a bit irrational about. A subject like medical marijuana.
As a patient you should be able to talk to your doctor about anything. What’s the worst that can happen? Even if your doctor is ignorant and dismissive when you ask about medicinal cannabis, he or she is unlikely to be so shocked and disgusted that they won’t continue the therapeutic relationship with you. Doctors get asked all sorts of things they consider unscientific every day.
Sometimes I’ve found myself huffing and puffing a bit about an idea that a patient suggested—as medical school trains us to do— then doing a little research to follow up after hours. More than once I’ve had to apologise to a patient who knew something I didn’t. It’s the nature of the job.
So, be direct and ask. Don’t be too put off if your doctor doesn’t know much about marijuana-based medicines yet. It’s a rapidly evolving field of scientific knowledge. If you think you might benefit from marijuana-based medicine, give your doctor a chance to do some research, find out about the possible benefits of the medicine for you and fill out some forms. A referral to an Australian Medical Marijuana Clinic might be the beginning of something good for you.