In Minnesota, we have established the most rigorous and “medical†law to date. There is no smoking in the program, and we do not classify our medicine by cheeky strain names. We also do not keep plants in jars. All medicine is created using a pharmaceutical process and is independently tested following state mandates. Licensed pharmacists who are trained experts at cannabinoid dosing are responsible for determining the best combination of medical cannabis types and forms, as well as dose amount. Pharmacists can coordinate with doctors to keep everyone on the same page.
A prominent problem patients face is that most doctors are not even aware of the state program’s details (or even that it exists at all). Many doctors do not see cannabis as truly medical, and they still believe that “medical†is just a code word for legalization. Few know that cannabinoid preparations were the second most prescribed pharmaceutical in the late 1800s, or that the American Medical Association (AMA) advocated for keeping cannabis a medicine just 80 years ago.
5 tips of Advice from Gary Starr
As knowledge is power, we consulted our Chief Medical Officer, Gary Starr MD, to compile a list of advice and resources to educate and empower you in preparing to have this crucial conversation with your doctor.
- “Your doctor is likely not aware of the benefits of medical cannabis. Medical school and residency have not included medical cannabis in the curriculum. Your doctor’s viewpoint is more likely influenced by decades of political rhetoric. Once you find a doctor you trust, ask him or her to objectively and compassionately learn about how medical cannabis is an option for you and may improve your quality of life. You’ll need to guide them towards the educational resources they may be unaware of (see the list provided below).
- Be scientific. Know your data, your disease process and the way that medical cannabis has been used to treat it, and the research studies that support your point (don’t be afraid to bring them with you.) Patients with the most success in managing their complex diseases and symptoms tend to be scientific about their disorders, even if they use alternative medical therapies too.
- Most doctors speak in terms of data. There are many doctors who do not believe there is any data to support the use of medical cannabis. That is because, as explained above, they often don’t know that this data exists. They learned to say “there’s no data†from someone who learned the same words the same way before them. It’s likely going to be up to you to introduce your doctor to the data (see #4).
- Gently educate; raise the medical cannabis topic after you have developed a good flow to your conversation. Be kind and personable. Doctors often do not react well to patients “telling them†how to practice medicine. This may seem unfair when they do not know anything about medical cannabis, but it is your health and wellbeing, so it is up to you to use good communication strategies that work. Many doctors will be willing to listen to your data and take an interest in learning more if you present it to them in the right way.
- Stick to your point. No matter how kind you are, your doctor is still only able to give you 10-15 minutes of time before their next patient. Tell a story. Do not just list all of your symptoms. Talk about your illness and how you’ve attempted to treat it. Discuss how this has made you feel. Remember, you are a patient who needs care, not a customer expecting to get the item you came to buy.
- Discuss your goals. Consider using other local patient success stories to illustrate your points, but be clear and prepared to discuss how and why you feel medical cannabis is appropriate for you specifically. In Minnesota, the state’s registry data has recently been published, showing a majority of patients realizing benefit with medical cannabis treatment. Bring this data and other supporting studies and summaries with you to give to your doctor.
- REFRAIN from using recreational cannabis terms to argue your point. AVOID using data from sources on the web that focus on plant strains or different ways of experimenting with cannabis dosing. Unless your doctor is already supportive of this, it is very likely that this will decrease your credibility. Most doctors are not impressed with uncontrolled, federally persecuted, smoked plant matter as a medicine. Do not try to get them to speak that language.
- If you can, highlight how one of your goals with medical cannabis is to decrease the use of other medications which cause worse side effects and are not working well for you, such as opiates for treating chronic pain. One thing many doctors are afraid of is “drug seekingâ€. If you discuss your desire to decrease opiate or other controlled medication use, it greatly diminishes the fear of “drug seekingâ€. This will get their attention.
- Know the law in your state backwards and forwards. Bring printed material to walk your doctor through the process (see below). Many doctors are afraid of the topic and do not realize they are not writing any prescriptions. They may be unaware–in Minnesota specifically–that another licensed medical professional (pharmacist) is educated in dosing cannabinoid based medicines along with your other medications.
- Bring a friend or family member to your appointment. He or she can be your advocate. Whoever you bring should have the same knowledge (see above) as you so he or she can help you keep the discussion focused and on track.
- Know the facts about medical cannabis safety, addiction risks, and limitations. Acknowledging these points in your discussion may increase your credibility on the topic. Doctors are often suspicious of anything that has “no bad sideâ€, so being honest and knowledgeable about a treatment’s negative aspects will help them hear you and at the same time probably teach them something.
- If your doctor continues to object to the discussion, or is against certifying you for medical cannabis use, you may be prepared for some “say-it-like-it-is†arguments. Try to avoid using these unless it seems like a little extra nudge is needed. For example:
- “If I was dying…†Your doctor is your best advocate for helping you heal with compassion. If they would certify you if you were “dyingâ€, why are they holding back as you try to live? Where is the line? How close to dying is “okâ€? Many doctors will not have thought through this and it will make them begin to consider it.
- “Would you refer me to…â€. There are a lot of things some doctors do not believe in personally, but they would not prevent you from trying. If your doctor had to refer you to an acupuncture therapist before you could see them, would they refuse? …even if they didn’t understand how acupuncture therapy works? In general, most doctors would not refuse this even they did not know anything about acupuncture. Why actively refuse to certify you as eligible to use medical cannabis, then? Any response to this question either highlights their moral objection (which is not sound medical practice), their lack of knowledge (back to the top), or their fear of legal risk (lack of knowledge).
I encourage you to use some of the following resources to prepare yourself.
Be well,
Gary Starr, MD & Chief Medical Officer at LeafLine Labs
Resources:
State Law Resources
http://www.health.state.mn.us/topics/cannabis/rulemaking/index.html
Patient Checklist
Minnesota Office of Medical Cannabis Data
http://www.health.state.mn.us/topics/cannabis/about/stats.html