Cannabis stigma continues to impede patient care

“My grandchildren are appalled.”

So said the elderly patient I saw yesterday. This lovely woman came to our practice for the treatment of extreme pain. At 99-years of age, she has survived multiple cancers and their associated treatments. She is now suffering from debilitating, degenerative joint pain. She has tried over-the-counter medications and opioids and is simply desperate for relief. Yet her major concern is what her grandchildren will think. As we spoke, I shared with her some of the histories of cannabis in an attempt to alleviate her shame regarding the idea of using cannabis medicine.

To this day, there are many misconceptions associated with cannabis and its use. These ideas and stigma often prevent patients from seeking the symptomatic relief that can be afforded by the use of medical cannabis. The word “marijuana” comes from Mexico, but its exact origins remain unknown. The use of cannabis became illegal in 1937. For the prohibitionists, the “exotic-sounding” word emphasized the drug’s foreignness to white Americans and appealed to xenophobia and the fear that marijuana would lead to the interbreeding of people of different racial types.

The following are a few facts necessary to be aware of in order to appreciate the gravity of the rest of this piece:

Fact: Most medical cannabis users use significantly less cannabis than do recreational users. In fact, medical users of cannabis are, in general, not heavy users as they are seeking treatment for and relief from a symptom or an illness. Their physician helps them find the minimum dose that will be effective for their particular symptoms; They are not looking to get intoxicated.
Fact: In most States, People with medical cannabis cards are prohibited from purchasing firearms.
Fact: People who use legally obtained recreational cannabis are not prohibited from purchasing firearms.
Fact: Although it is true that those who are “under the influence” of some substances are prone to violence, the incidence among cannabis users is limited to heavy users along with the use of other substances.
Fact: There is no medical use for alcohol and, there is no medical alcohol card available.
Fact: People who use alcohol recreationally are able to purchase firearms.
Fact: Alcohol is one of the substances that can lead to violent behavior and is one of the substances often cited as a contributing factor to gun violence.

Why, then, did a patient seeking medical care yesterday tell me she was afraid to get a medical cannabis card for fear that she could not get a gun permit if she ever wanted one? Instead, she would prefer to go to the recreational cannabis market, where her purchases are anonymous, in order not to have cannabis listed on her record. Alcohol purchases are not on people’s records, yet alcohol is far more addictive and more often linked to violent behavior than is cannabis. Narcotics, too, are exceedingly more addictive and potentially lethal than is cannabis. Having a purchase for oxycodone on one’s record does not prohibit them from purchasing a firearm.

In a similar vein, I spoke with a physician last week. She is going through menopause and is having horrendous hot flashes. She asked a group of fellow female physicians if there was anything she could do, short of going on hormone replacement therapy, to get relief.

I suggested she use medical cannabis, which can be very effective for the treatment of hot flashes. She contacted me in private and said that the state in which she lives does not permit recreational cannabis purchases and that she was fearful of obtaining a medical cannabis card because of “what might happen” to her medical license.

I’ve heard this time and again from a number of physicians. It is important to note here that no physician has lost their license due to medical cannabis use. Some have, however, lost their DEA privileges for admitting they have used cannabis. These same physicians have no issue having stimulants, or muscle relaxants, or anxiolytics — all of which have a much higher potential for harm than does cannabis — on their records.

In fact, some employers continue to penalize employees, even those who are using medical cannabis under the care of a physician, when they test positive during urine drug tests (THC can be detected in the urine for up to 30 days after use at the last patient’s last use and does not necessarily mean that a patient is “under the influence” while at work). They may even lose their jobs.

It is disheartening to hear the frustration and sadness in a medical cannabis patient’s voice when they learn that they cannot take their medication across state lines for fear of being arrested.

Just yesterday, one such patient was in tears as he stated he never thought he could “feel normal” again until he started taking medical cannabis. He was planning a road trip with his daughter and had to choose between crossing into the neighboring state or taking his medication with him. Yet, people can travel with their alcohol (often sold in airports), guns, and narcotics.

The stigma that continues to be associated with cannabis is preventing patients from seeking medical care and, when they do, working within the medical system.

This is yet another compelling argument for the proper medicalization of cannabis (doctor’s visits, prescriptions, and patient follow-up). Until this is accomplished, patients who could benefit from proper medical care will either have to go without, self-medicate or get their advice from — as mentioned in a previous piece, “Practicing medicine without a license is illegal. Yet cannabis dispensaries are doing it” — a dispensary clerk, also known as a bud-tender. Having a medical card is an important part of medical care. Cannabis regulations should protect, not penalize, those who are seeking proper medical care.