Going to the doctor can be stressful. Whether it is for a routine exam or to see if something is wrong, the whole process can make you feel like cattle. Quality of care in America is highly variable and many times tied to income. Lack of public health insurance leaves patients vulnerable to economic hardship and access to the medication they need. This, along with the lack of credence given to the health issues of women and people of color by some health professionals has many looking outside of the healthcare system to address their needs. There are also risks with this approach as many claim to have alternative cures for illnesses with little to no science to back them up. Very little funding goes into the rigorous study of alternative medicine, and anecdotal evidence is widely shared as gospel.
Cannabis had been used as a medicine for thousands of years prior to its designation as a dangerous, illegal narcotic. Its medical benefits were widely rediscovered in the late 1980’s and used for appetite stimulation and combating nausea among those living with AIDS. In 1996, California became the first state to allow the use of medical cannabis with a doctor’s recommendation. But many doctors would not recommend cannabis. Some feared prosecution, and, in the early days, the Feds did try and prosecute doctors for recommending medical cannabis. In 2002, the case of Conant v. Walters challenged this, and the court ruled that the Feds could not seek to revoke a physician’s license simply for recommending medical cannabis to their patients. Some physicians, like Dr. Frank Lucido and Dr. David Bearman, were writing recommendations regardless of the threat, but others became more open to the idea after the court made that ruling. It wasn’t just the threat of legal action that kept doctors from being involved in medical cannabis. Its status as a Schedule I drug meant it technically had no medical use. Furthermore, the Endocannabinoid System (ECS) was only discovered in the late 1990’s, and most, if not all, medical schools did not include it, or the use of cannabis as medicine in their curricula. This resulted in an entire generation of practicing health professionals who were ill equipped to discuss cannabis as a medicine and in fact trained to believe that it isn’t one. Many who did support medical cannabis opened their own clinics or banded together to form medical cannabis based practices. However, the optics of medical cannabis recommendation clinics left them vulnerable to claims of malpractice and “drug peddling”. A divide was created between those in the mainstream medical world and those who recommended cannabis. And while there was some crossover, especially for physicians like Dr. Bonnie Goldstein, who work in pediatrics, the camps are still fairly well-defined.
It is important to understand this history and context when preparing to talk to your doctor about cannabis. First, unless you are seeing a specialist in a field where cannabis is fairly known and accepted, like oncology, it is unlikely that your regular doctor will write you a recommendation for cannabis unless that is already part of their practice. Some states, like New Jersey, require physicians to register with the state program before they can recommend. Other states do not require this, but if your doctor does not list cannabis as part of their practice specialities, it is unlikely they will write one. There are directories of medical cannabis providers hosted by organizations like the Society for Cannabis Clinicians.
The more likely question is: should I talk to my health professional about my cannabis use? The short answer is yes, with some caveats. Discrimination in the healthcare system is real and can compound the structural race and gender based discrimination that already exists. Women, and especially women of color, are more likely to have their concerns dismissed or misdiagnosed, and more likely to be viewed as combative or uncooperative for asserting their rights. If you already feel that your healthcare provider is making judgements about you based on who you are and that this is affecting your ability to get quality care, you should probably change healthcare providers. However, recognizing that this is not always possible due to insurance restrictions, take care in how much you divulge about behaviors that could add to this issue. If you feel comfortable with your healthcare provider, then I do recommend disclosing cannabis use for a few reasons.
3. It is part of your overall health and well-being. Many consumers use cannabis to relax. Some use it to help with sleep, others to treat pain. Over half of consumers use cannabis for both medical and recreational purposes, making it a key part of health and well-being for many. Just as you discuss your diet and exercise habits with your doctor, you should discuss other wellness related behaviors.
4. It is your medicine. If you are using cannabis specifically to treat a medical condition, you should list it with your other medications on intake forms (again, make this decision based on how comfortable you feel identifying yourself as a consumer). Knowing that you are using cannabis as a medicine will help your healthcare provider make more informed decisions about future treatments and medication.
I happen to live in a very cannabis friendly part of the world. When I disclose cannabis use to my surgeon or anesthesiologist or dermatologist, I am not afraid or judged. But, other places are different. Expect that, depending on where you live, you may get push back or even unkind words with your disclosure. The best thing to do in this situation is listen, nod, and move on. Remember the context, that your healthcare provider was likely not educated about the ECS, or the use of cannabis as medicine. They likely received messaging that it was dangerous, and that they should discourage use. And while some medical schools have begun to teach about the ECS and medical cannabis, it will be some time before there is broad adoption in the medical field.
