When considering medical cannabis, patients often have numerous questions for their physicians. These questions typically revolve around safety, efficacy, legal issues, and personal concerns. Here are some of the most common questions patients are likely to ask their physicians about medical cannabis:

What Conditions Can Medical Cannabis Treat?

One of the first questions patients often ask is about the specific conditions that medical cannabis can help treat. Patients want to know if their particular condition, such as chronic pain, anxiety, epilepsy, or multiple sclerosis, can be managed with cannabis.

Research suggests that medical cannabis may help with a variety of conditions, including chronic pain, nausea and vomiting (especially related to chemotherapy), multiple sclerosis spasticity, and certain types of epilepsy. It has also being studied for its potential to help with anxiety, PTSD (post-traumatic stress disorder), and sleep disorders.

How Does Medical Cannabis Work?

Patients frequently ask about how medical cannabis works in the body.  They are interested in understanding the role of cannabinoids like THC (tetrahydrocannabinol) and CBD (cannabidiol), and how these compounds interact with the body’s endocannabinoid system to provide relief.

For example, giving patients the image of CB1/2 receptors as small satellite dishes helps them understand that removing (downregulation) these receptors in response to excessive THC leaves the system without enough “dishes” to hear the normal endocannabinoid signal.  Hopefully this understanding leads to better adherence to their regimen and helps keep them safe.

What Are the Potential Benefits and Risks?

Understanding the potential benefits and risks is crucial for patients. They often ask about the therapeutic benefits of medical cannabis, such as pain relief, reduction in anxiety, or control of seizures. Equally important, they want to know about the possible side effects, which can include dizziness, dry mouth, impaired memory, and, in some cases, mental health issues like anxiety or paranoia.

Patients may also inquire about long-term effects and the risk of dependence or addiction.

Is Medical Cannabis Legal in My State?

Legal concerns are a major topic of discussion. Patients want to know if medical cannabis is legal in their state or country, what the specific laws and regulations are, and what steps they need to take to obtain it legally.

They may also ask about the legal protections in place for medical cannabis users and how to navigate any potential legal issues.

How Do I Get a Prescription for Medical Cannabis?

Patients often need guidance on how to obtain a prescription or medical cannabis card. They ask about the process, including whether they need a referral to a specialist, what kind of evaluation is required, and how to find a physician authorized to prescribe medical cannabis.

They may also be curious about the paperwork and any fees involved in obtaining a medical cannabis card.

What Form of Medical Cannabis Should I Use?

There are various forms of medical cannabis, and patients frequently ask which one would be best for their condition. They want to know the pros and cons of smoking, vaping, edibles, tinctures, oils, and topicals. Some of these routes are viable and others are not. 

For example, topicals, as they are available presently in the cannabis industry, do not have skin penetration.  Therefore they are not useable for local treatment of deep structures like osteoarthritis of the knee.  Similarly, tinctures can be used in place of oral ingestion, but do not actually provide oral-mucosal absorption as is often touted.  Because they are liquids, often an edible is a better choice due to more precise, discrete dosing. 

Further, route of administration is best dictated not by patient preference, but by rate and duration of onset.  Inhalation is rapid onset and relatively short duration, best for acute or episodic problems like a Migraine headache.  Oral ingestion takes longer to start but due to first-pass transformation in the liver, works longer and is better for chronic problems like back or knee pain. 

Inhalation encompasses smoking, vaping, or vaporizing flower.  Neither smoking nor vaping is safe and should not form the basis of a medical regimen.  Vaporized flower is safe and useable, but requires instruction for the patient, like a Metered Dose Inhaler, in order for patients to use it correctly and effectively. 

How Do I Determine the Right Dosage?

Dosing can be complicated, so patients usually seek advice on how to find the right dosage. They may ask how to start, how to adjust the dose, and what to do if they experience side effects. They also want to know how long it might take to feel the effects and how to balance efficacy with potential side effects.

While dosing recommendations are beyond the scope of this article, it is important to consider that the simple “start low and go slow” mantra oft repeated in cannabis circles is both inarguable and also too simplistic.  What is low and what is slow?  Patients will need an actual starting dose, guidelines for self-titration, and end-points to signal time to check in with the clinician. 

For example, one might give the advice to start at 5mg orally at dinner time and advance to 7.5mg or 10mg after a period of time (for example, 1 week) based on effectiveness.  If the limit of 10mg is reached, the patient should have been instructed to contact their clinician for further instructions. 

Can I Use Medical Cannabis with My Current Medications?

Patients taking other medications need to know about possible interactions with medical cannabis. They ask whether cannabis will interfere with their current prescriptions, over-the-counter medications, or supplements.

This is particularly important for those taking medications for chronic conditions like diabetes, heart disease, or mental health disorders.

Are There Any Activities I Should Avoid While Using Medical Cannabis?

Safety concerns are paramount, and patients often ask about activities they should avoid while using medical cannabis. This includes driving, operating heavy machinery, and any other activities that require full cognitive function and motor skills (bungee jumping, street bike riding, competition sports). They want to understand how long they should wait after using cannabis before it is safe to engage in these activities.

How Will Medical Cannabis Affect My Daily Life?

Patients are curious about how medical cannabis might impact their daily routines. They ask whether it will affect their work, social interactions, or overall lifestyle. Concerns about stigma and privacy also come up, as patients want to know how to handle potential judgment or misunderstanding from employers, colleagues, and family members.

What Should I Look for in a Medical Cannabis Product?

With many products available, patients often seek advice on what to look for in a quality medical cannabis product. They want to know about reputable brands, how to read labels, and what to consider regarding THC and CBD concentrations.

Given the lack of federal oversight, particularly of hemp-derived cannabinoids that are now freely available in gas stations and online, patients should be instructed to avoid all of these potentially dangerous and/or contaminated products and purchase only state-legal products that have been adequately tested.

Can I Develop a Tolerance or Dependence?

Patients frequently ask about the potential for developing a tolerance to medical cannabis, meaning they might need higher doses over time to achieve the same effects. They also want to know about the risk of dependence and how to use cannabis responsibly to minimize these risks.

Sticking to their regimen of low THC dose should protect most patients from the risks of tolerance and dependence. 

How Often Should I Follow Up with My Physician?

Finally, patients ask about follow-up care. They want to know how often they should check in with their physician to discuss their progress, any side effects, and whether any adjustments to their treatment plan are necessary. Regular follow-ups are important to ensure the treatment is effective and to make any necessary changes.

By answering these questions, practitioners can help their patients make informed decisions about using medical cannabis to get safe and effective treatment.