Physicians Dosing Cannabis Medicine - How do we train more?

Cannabis now comes in two flavors, Medical and Recreational. There is no doubt that recreational cannabis will survive forever.

At the same time, in many states medical cannabis has pretty much disappeared. Why? Because they had no real medical cannabis to begin with.

Most dispensaries, whether medical or recreational, have many, many recreational and “stony” products, but have very, very few dosed, consistent medical extracts, capsules,etc. The bud tenders may know some about the recreational end, but they rarely have any useful dosing information and frankly that should not be their responsibility.

How much real information do pharmacists give us? There are a few areas in which they are great, but they know very little about which products might be best for a particular patient. If we are dealing with “medical” cannabis and sick patients, making poor choices will not kill you, but you can be miserable and if not, how do you do follow up visits or messaging with a bud tender. In addition, the vast majority of stores, if they have ANY quality medical cannabis, have very few quality CBD products. Hemp CBD is everywhere and not very effective and the folks in the stores have no way of handling this. It is sometimes difficult for me to know what type of products are being sold. Often, the best way for me to evaluate an oil, is to smell it; if it smells like cannabis, it is a great start!

We need more physicians who are creating detailed treatment plans for their patients. We also need stores carrying a large number of dosed and consistent medicines that are "whole plant". This allows much more flexibility for the physician and patient. In addition, if one product is not exactly right, there should be a SIMILAR one to choose from as well as a variety of different oils/tinctures/extracts.

Clearly, for sick patients, working with a physician knowledgeable in medicine and dosed cannabis medicine, is a great help. If one extract is not helpful, check back with your doctor, agree upon a change and then the patient checks back again.

If your physician knows what is happening and knows what you are taking AND has been trained in cannabis dosing, there is an excellent chance they will give you reasonable advise. If it helps some, check back and make an adjustment. I have been dosing my patients for 7 years. If a patient is comfortable with casual use to take care of their issues, they do not need a doctor.

How do we solve this? The laws are a problem but they are far from the biggest issue.

There are two related and serious issues:

  1. very few physicians know how to manage dosing
  2. very few patients even know that cannabis can be taken just like standard medicines

How do we train physicians? This is the real issue. Without a LOT more physicians feeling comfortable with dosing, the very few will just finish their careers. Who will replace them. 

Other than giving many lectures, one of the best ways I have found to train new cannabis physicians, is for them to stay in the consult room with me seeing all my patients. A day is just a taste, but a week or two and the doctor should be able to deal with initial dosing and more.

I really love teaching physicians and over time I would love to do more of this. So, if you are a doctor with some interest but do not know where to start, consider setting up some days seeing patients together.

Are you a physician out there thinking about this? If yes, start with a couple of hours with us. If it makes sense to you, consider spending some more time. Bringing this back to the doctors practice will result in the standardization of education and therapy

Author
Allan Frankel, MD

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