University Of Pennsylvania: Doctor's Convincing Case For Medical Marijuana

Jacob Redmond

Well-Known Member
Dr. David Casarett works at the University of Pennsylvania's Perleman School of Medicine and has become an unlikely, national voice on medical marijuana.

As the director of Hospice and Palliative Care, Casarett was, at first, a skeptic regarding cannabis as a medical therapy. Then he decided to write a book on the topic and his perspective changed.

In Stoned: A Doctor's Case for Medical Marijuana he documents a journey through the scientific literature and around the country to explore the subject.

The book has brought Casarett a lot of attention, including appearances on National Public Radio and other syndicated outlets.

He also joined in the hot debate around legalizing medical cannabis in Pennsylvania testifying before a joint information gathering hearing by the Pennsylvania House Health and Judiciary Committees in March. This week he agreed to an interview with Philly420.

Casarett rides his bike to work and speaks in a soft but determined manner, honed from years of tending to terminal patients and those in tremendous pain. His own research is a fascinating view on how a medical professional views the modern world of cannabis. He agrees that criminal laws need to change to allow medical access but also recommends a careful, hands-on approach by the health care community when administering the therapy.

What do you think the role of doctors should be when medical marijuana is legal?

I'd like to see doctors step up and take a role in counseling patients about marijuana's potential benefits, and also risks. To do that, though, and to do it well, physicians will need training. There's not much in the medical school curriculum now, and what's there is largely about its risks.

Do you think nurses have an important role in administering cannabis therapy?

Patients deserve education about medical marijuana, how to use it, and its risks and potential benefits. In other areas of medicine, nurses have taken on a significant role in patient education, and I think this could happen with medical marijuana, too. A well-trained nurse, who has the medical background and training to provide education, could be very helpful to patients, particularly those who are thinking about using medical marijuana for the first time.

New Jersey's medical marijuana program requires doctors to register with the state before they can recommend the therapy - do you think that is a good approach or should all physicians have the ability to recommend?

I think all physicians should be able to recommend, assuming they're physicians in good standing and have an active license to practice medicine. So I'm not sure I understand the rationale behind asking physicians to register. Instead, I'd focus on what those physicians are required to do. For instance, I'm worried about those clinics where patients can get a recommendation after a 3-minute Skype call with a physician in another state. That's not medicine. So I'd think about requirements that the patient meet the physician in person, take a history, review the patient's medications, and perform a physical exam. If we're going to treat marijuana as a medicine, then it should be recommended just as other medications are.

Some states have passed medical cannabis laws that do not allow smoking, Pennsylvania is considering the same - what do you think of that approach?

It makes no sense to me. There are no proven long-term risks of smoking marijuana (either cancer or emphysema). And smoking is one of the fastest, most efficient ways to deliver the active ingredients of marijuana. It's not for everyone, and other methods (edibles, tinctures, vaporizers) are also useful. But to prohibit smoking doesn't make sense.

You have spent a career in hospice and palliative care in a state that does not have medical marijuana; is it common for pain and/or terminal patients to utilize underground marijuana?

I'm not sure. However, I have noticed that lately when patients ask me if medical marijuana might help them, if I say that it might, many will tell me that they're already using it. That is, they were just testing me to see if I'd support them. And I'm pretty sure that for every patient who admits to me that they're using medical marijuana, there are probably dozens more who don't.

Right now medical cannabis is not allowed in hospital settings; should that change? How could that operate?

Legally, I'm not sure. But technically? It should be simple. Marijuana is available as edibles and tinctures, which could be administered by a hospital pharmacy like other medications. Smoking wouldn't be possible, obviously. But use of a vaporizer might.

Within the general, professional medical community is there more excitement or trepidation when it comes to cannabis therapy?

In general, I'm hearing more trepidation than excitement right now. Many physicians are worried that they'll be inundated with patient requests for medical marijuana recommendations for common conditions like chronic back pain.

In the book you describe your own experience with medical cannabis; what were some of the pros/cons of that? Would you utilize it again?

I told that story to illustrate what happens if you use very potent marijuana and if you don't have much prior experience with it. (I hadn't used marijuana for years). I was pretty paranoid, and had visual and auditory hallucinations. Not fun. But it didn't have to be that way. If I had had access to a marijuana dispensary, I could have gotten marijuana that was low in THC. I could have avoided most of those effects, and probably would have gotten the same pain relief, without all the weirdness.

Cannabis with a high concentration of CBD and low THC has made a lot of headlines in the last two years; some states have passed law only allowing for CBD....in your research what did you find out about THC? Is it important for cannabis therapy and do you think THC and the euphoric effect are being unduly demonized?

THC probably has some therapeutic effects, too. And it may be that for some conditions, like nausea and pain, you need both. THC has certainly been demonized because it causes that 'high' feeling. But dispensaries and growers have contributed to that, too, by promoting strains that are really high in THC.

You discuss the possibility of cannabis dependence and withdrawal; what are those factors and how do they compare to other narcotics used for pain and palliative care?

I was surprised to learn that marijuana dependence and addiction are real. So is marijuana withdrawal. However, it seems to me that the effects of dependence and withdrawal aren't usually as severe or as life-altering as they are for other drugs, like opioids, including heroin. That doesn't mean we can ignore those risks, though.

A patient you focus on in the book lives with PTSD. Some states allow for PTSD as a qualifying condition for medical cannabis; Pennsylvania is considering having that condition on the list. How could cannabis help with PTSD and does your research indicate that cannabis is beneficial for these patients?

Isn't it strange that marijuana 'works' for PTSD in California but not in Colorado? The truth, as near as I can tell, is that there haven't been any good randomized controlled trials of marijuana in the treatment of PTSD. So it may work, but we don't know yet. I do know that lots of people are using for that reason. They say it's the only thing that helps them. And maybe they're right. But we urgently need studies that will tell us whether, when, and how to use it for PTSD.

You traveled cross the country to research your book; there is a patchwork of state laws for medical marijuana...is that enough or do you think federal reform is needed?

"Patchwork" is probably a charitable term. The differences are huge, and of course in many states medical marijuana is still illegal. I do think the federal government needs to rethink its position, partly so that access doesn't depend so much on where a patient lives. But revisions to the federal position would also make research easier. And if there's one thing that I think everyone agrees on, it's that we need more and better research into medical marijuana's risks and benefits.

What kinds of patients should be most cautious about utilizing cannabis therapy?

We really don't know. There have been lots of studies of the risks of recreational marijuana, but not about medical marijuana. That's an important difference, because medical marijuana users are often different than recreational users. They use in different amounts, in different ways, and in different settings. So we need research into the risks of medical marijuana use.

15804.jpg


News Moderator: Jacob Redmond 420 MAGAZINE ®
Full Article: Philly420: UPenn doctor's convincing case for medical marijuana
Author: Chris Goldstein
Contact: Chris@freedomisgreen.com
Photo Credit: Flickr/Coleen Whitfield
Website: Philadelphia local news, sports, jobs, cars, homes - Philly.com
 
Back
Top Bottom