Over my thirty years practicing Internal Medicine, I have greatly changed my opinion regarding what I consider “excessive” use of medications. I now include Cannabis in my assessment as well. So, when patients ask me, when is “too much” Cannabis really too much? I respond that as with all drugs, too much is when the drug is controlling the patient.

It might not be apparent to the patient they are controlled by cannabis, but it becomes obvious to most people who know them. Those who know the patient can see the affects on the patient’s life – they can tell if the Cannabis is interfering with work, or an issue at home with kids or family or is causing responsibilities to be neglected.

If so, it is a problem that simply needs to be addressed. However, (and you might be surprised by this), the problem is NOT directly related to the amount of Cannabis being used. Consider this: just as with pharmaceuticals, everyone is very different in their response and sensitivity to drugs. The various strains of Cannabis have a similar effect: a lot for one person can be trivial to another.

If the patient is using Cannabis and is acting responsibly, then what better result could anyone hope for? If friends and family continue to believe cannabis is adversely affecting the patient when there is no evidence, I think a good look at personal biases against Cannabis are in order.

Allan I Frankel, MD

There is talk at the level of the City Planning Commission to advise the Los Angeles City Council to prevent the sale of Cannabis “Concentrates” at local Caregivers. This makes little sense.

“Concentrates”, are a preparation of either Cannabis Sativa or Cannabis Indica, that can be taken orally as a lozenge, capsule, extract, etc. In my opinion, the patients using Concentrates are very “legitimate” patients because if they were recreational users, they would not take cannabis in such an expensive and inefficient manner. That is one reason the City of LA should consider leaving things alone.

Another reason is medical. In my recent blog, “Liver Failure Patient”, I discussed the death of Timothy Garin as a result of being denied a liver transplant due to him being a medical marijuana user. Mulling over his case has me thinking that perhaps one medical issue ties the “Transplant” and “Concentrates” issues together.

I always encourage my patients to use Concentrates as they are able. Yet for those patients who cannot, such as my Cancer/HIV patients, I always advise them to microwave their Cannabis prior to smoking when their immune function is severely compromised.

This is very important because several Fungi, primarily Aspergillosis, do tend to grow in many plants. When inhaled by an immunocompromised patient, this can be potentially harmful, and hence the suggestions to either stick with Concentrates or “nuke” the medication.

Perhaps as the City of Los Angeles becomes more aware of these and other issues, they will open their thinking to respect Concentrates? Perhaps if the transplant teams knew a patient were using a concentrate and so not exposing their immune system, would they be more comfortable treating medical marijuana patients?

Allan I Frankel, MD