With 10+ years counseling patients on the use of medical cannabis, here are 5 tips I wish I had known earlier in my career.

While society is increasingly embracing the potential of medical cannabis, significant confusion still surrounds its optimal use for specific diseases and conditions. This uncertainty is compounded by the varying degrees of emphasis placed on cannabis education within medical school curriculums—some institutions offer comprehensive courses, others barely touch on the subject, and still others continue to focus on cannabis solely as a drug of abuse.

For medical students entering this rapidly evolving field, gaining a nuanced understanding of medical cannabis is essential. This knowledge can empower future healthcare providers to make informed decisions, bridging the gap between conventional medical practices and innovative therapies. After more than 10 years of treating patients with cannabis, here are five critical insights I wish I knew when first recommending medical cannabis to my patients.

1. Cannabis is not necessarily an isolated treatment but more likely to be an adjunctive therapy.

Although cannabis alone can sometimes solely treat a medical condition or a symptom, cannabis should be seen as an addition to existing treatments rather than a standalone solution. In many cases, it is used in conjunction with other therapies to enhance overall patient outcomes.

For example, patients with chronic pain might find relief through a combination of cannabis, NSAIDs, physical therapy or other pain medications. The use of cannabis in these situations should be seen to decrease the number or doses of other medications thereby decreasing the likelihood of complications from side effects of polypharmacy. Likewise, palliative care patients might use cannabis alongside conventional medications to improve quality of life and pain.

Understanding the synergistic potential of cannabis can help future physicians develop more holistic and effective treatment plans

2. Cannabis dosing and administration can, and will most likely, be a moving target.

One of the most challenging aspects of medical cannabis is finding the right dose and method of administration for each patient. Contrary to popular belief this is usually directed by the condition(s) being treated.  Where conventional medications often come with standardized dosing guidelines, cannabis therapy requires a practitioner be more knowledgeable and specific about the available treatment options.  Factors such as a patient's metabolism, condition being treated, and even genetic makeup can influence the effectiveness and safety of cannabis use.

This variability necessitates a personalized treatment plan, often involving trial and adjustment, to achieve the best therapeutic outcomes. This is important because unlike conventional pharmaceuticals which have defined dosing protocols, providers need to be more involved in adjusting dosing and routes of administration based on efficacy and side effects.

3. Being high doesn’t equate to the medicine being effective.

It's crucial to distinguish between the psychoactive effects of cannabis and its medicinal benefits. The use of cannabis medically aims to relieve symptoms, not induce a "high." For example, I find that low doses of THC (1-3mg) can have the ability to relieve symptoms while at the same time are less likely to induce psychotropic effects and other unwanted side effects. I find it extremely valuable and highly recommend committing time educating patients about this. I ask them to pay special attention to their symptoms and not the head “high” they are experiencing when determining whether cannabis is effective and at which dose.

Even with these benefits, a challenging reality persists: the medically effective dose often coincides with experiencing noticeable psychotropic side effects. This highlights the critical importance of educating patients about these potential effects and the best strategies to manage them effectively.

4. Understand that cannabis is not a panacea and not for everyone.

Cannabis holds promise for various conditions but is rarely a universal remedy for serious conditions. Additionally, it's important to recognize that cannabis isn't suitable for everyone, just as no single pharmaceutical works for every patient with a particular illness. Factors such as age, comorbidities, and unique genetic makeups contribute to this variability.

Given the vast biodiversity among humans, expecting a single treatment to be effective for all or free from side effects is unrealistic. Individual responses to cannabis can vary greatly; some may experience side effects like dizziness, dry mouth, or cognitive impairments, while others may not find it effective at all.

In my practice approximately 2 of 10 patients find cannabis to be completely ineffective while a similar number of patients experience significant side effects which either limit their use or require them to adjust the timing of their dosing to avoid side effects. For example, some patients, despite wishing they could use cannabis during the day for their symptoms, they simply cannot take it except in the evenings due to the fatigue or cognitive impairments they experience from THC during the day.

Medical students should understand these limitations and conduct comprehensive assessments to evaluate cannabis suitability. Staying updated with the latest research is crucial for informed, evidence-based practice.

5. There are reasons why the medical industry has not been receptive to cannabis.

The slow acceptance of cannabis in mainstream medicine can be attributed to historical, regulatory, and scientific challenges. Historically, cannabis has been stigmatized for its recreational use and classified as a Schedule 1 controlled substance, hindering research and medical adoption. Regulatory hurdles, such as varying state and federal laws, further complicate its use. Additionally, the lack of large-scale clinical trials and standardized formulations contributes to skepticism within the medical community.

Furthermore, the broad applications of medical cannabis make it direct competitor with the pharmaceutical industry who are likely to continue supporting efforts highlighting the potential negative effects of cannabis. Understanding these barriers is essential for students who wish to advocate for or specialize in cannabis medicine.

In conclusion, as you navigate your medical education, remember that cannabis medicine can be a useful way to serve your patients but requires an open mind, critical thinking, and compassion. By integrating these insights into your practice, you'll be better equipped to harness the potential of medical cannabis responsibly and effectively.