Dr. Frankel's Journal

HOW DO WE TRAIN MORE DOCTORS TO WORK WITH CANNABIS

August 30, 2018
Allan Frankel, MD

Although 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 cannabis medicine 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 and frankly that should not be their responsibility. How much real information do pharmacists give us? There are a few areas 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 messages with a bud tender. In addition, the vast majority of stores, if they have ANY quality medical cannabis, they 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.

Without physicians creating initial treatment plans and stores having LARGE number of products to select from and/or switch to if one is not effective.

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, explain what is better and what is worse. 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 your 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 knowing how to manage dosing and adjust doses
  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 career and who will replace them. About once monthly a patient asks me “What do I do if you die?” Odd question, but maybe NOT so odd if there are not a bunch of docs to replace my generation.

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 just ask for help from the current or future specialists for those where a basic treatment plan failed.

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, considering setting up some days seeing patients together.

I hired a doctor, Dr. Mark Kurzman 9 months ago. It is an ongoing learning process for all of us. Now, Dr. Kurzman answers some questions for me and helps me as often as I help him. It is possible. With some advised reading and a week or two of following us around the office, will give the physician a very good idea of how the dosing schemes work.

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