How to Talk to Your Doctor About Cannabis Use
Jun 27th 2019
Have you had a bad experience disclosing cannabis use to a doctor? Did a doctor's attitude toward cannabis impact the quality of care you received? You're not alone.
Unfortunately, a prevailing stigma, lack of exposure to current marijuana research, and confusion about the legality of discussing cannabis with patients are still barriers within the medical community that keep doctors from treating their cannabis-using patients accurately and fairly.
One thing medical and non-medical cannabis users have in common with the rest of the world is that all need access to medical care. So what is a cannabis user to do?
To answer this question, Weedmaps News spoke with two experts on the subject. Dr. Bonni Goldstein is a Medical Director of Canna-Centers, a medical marijuana evaluation service in Lawndale, California, and a medical adviser to Weedmaps. Ted Chan is the CEO of CareDash, a fast-growing healthcare review website.
Both Goldstein and Chan have consulted with thousands of patients, many of whom report a variety of poor experiences disclosing cannabis use to doctors. Based on their respective years of research, and field experience in the subject, here are some key words of advice to keep in mind when talking to your doctor about weed.
Be Transparent (and Prepare for a Negative Response)
The first thing both adult users and medical cannabis patients should realize when disclosing to a physician is that they're likely to be met with either prejudice, ignorance, or both.
Goldstein has seen thousands of medical cannabis patients, many of whom have reported frustrating conversations with their doctors about using cannabis as medicine.
“Unfortunately, most doctors know nothing about cannabis as medicine or about the endocannabinoid system (ECS). There is no formal education about these topics in the majority of medical school or residency programs.” Goldstein said. “Only about 9% of medical schools even mention cannabis as medicine in their curriculum. And the reality is that we as doctors are taught that cannabis is a drug of abuse.”
Goldstein added that those who disclose non-medical cannabis use to doctors are likely to be lectured or even diagnosed with cannabis use disorder, a clinical impairment of control over cannabis use despite harmful or adverse effects.
Even with these systemic biases within the medical community, it's ultimately better to err on the side of full disclosure with a physician.
For all of marijuana's potentially therapeutic properties, there are risks involved in mixing it with other medications. Drug.com lists 612 drugs that interact with cannabis, 129 of which have major interactions.Recent findings suggest that cannabis users need more than twice the usual amount of anesthesia before undergoing endoscopic surgery. It's also possible to be allergic to cannabis, and experience symptoms typical of other food, skin, or airborne allergies. The more your doctors know, the better chance they have of giving you proper care.
That's why Chan recommends being completely transparent about your patterns of cannabis use. “If you use a little, say that,” Chan said. “If it's daily, recreational, or to manage a specific symptom, don't be afraid to say it.”
According to Chan, full transparency is not only a way to increase your chances of getting the medical care you need, but also a quicker route to finding out the doctor's attitude toward cannabis. Just be prepared to find out you know more than your doctor about cannabis and how it affects your body.
Be Proactive in Gauging Your Doctor's Reaction
Since most doctors you're likely to encounter either know nothing or have a professional bias against cannabis, it's important to be proactive and gauge how your doctor responds when you disclose cannabis use.
As CEO of CareDash, Chan has read thousands of reviews of doctors made by their patients, and talks to many patients personally. He considers patient advocacy a central role at CareDash. There's no shortage of reviews on the site describing incidents where a patient was either misdiagnosed or denied the care they needed based on physicians' bias against cannabis as a drug of abuse.
“We have 160,000 reviews on the site, and I'd say about 100 involve negative experiences around marijuana impacting patient experience,” Chan said.
In states where medical cannabis is legal, CareDash reviewers have described incidents where doctors seem convinced that the patient is trying to scam them for a medical marijuana recommendation. Reviewers often express surprise that their physician seemed to have no working knowledge of medical cannabis research.
A New York patient reported seeing a neurologist who immediately dismissed her for “seeking medical marijuana” after the woman expressed a desire to use cannabidiol (CBD) oil for her foot neuropathy instead of a pharmaceutical prescription. A patient in Nebraska who went to an emergency room with the flu reported being misdiagnosed as having a rare disease the doctor claimed was from smoking too much marijuana. According to the patient, the visit was during flu season, and the doctor refused to test the patient for the flu, and made the diagnosis only after the patient had disclosed cannabis use to the nurse.
If your doctor has an overtly negative reaction when you tell them you use cannabis, Chan recommends seeking a second opinion.
You may also encounter a physician who seems reluctant to even address the subject of cannabis use when you disclose. According to Goldstein, most physicians don't know they are free to discuss medical cannabis with their patients. Many think that because it is federally illegal, they can get in trouble for speaking to patients about it.
“In 2002, the 9th U.S. Circuit Court of Appeals held that the federal government could not punish or threaten to punish a doctor for telling a patient that his or her use of medical marijuana use is proper,” Goldstein noted. “The relationship between physician and patient is special and protected, so physicians have free speech as long as they tell the truth about the science. No physician has been punished federally due to this protection.”
Ask Your Doctor How They Feel About Cannabis
If you find an appropriate time to do so, Goldstein recommends that medical patients ask their doctor how they feel about cannabis as medicine.
“I tell patients who are nervous about bringing up medical cannabis use with their physician to first ask 'What do you think about the use of medical cannabis for ... (Insert ailment)?' This way you are not sharing info that you may not be ready to share and you are feeling out the physician's attitude toward cannabis.”
If You Have a Good Relationship with Your Doctor, Consider Sharing Medical Information
If you find your physician negative or dismissing of medical cannabis, Dr. Goldstein recommends following up via email or in person with a scientific article or two about medical cannabis for the ailment in question, or about the ECS.
“Everyone says there is not enough research [about medical cannabis] and this is true, but there is lots of research on medical cannabis for the more common ailments. And it can be accessed easily on the internet through Google Scholar or PubMed,” Goldstein said. “Giving your physicians published research in a non-threatening way is a good way to start the conversation.”
According to Chan, an overwhelming majority of doctors are quite averse to accepting medical research from patients. So if you're going to try sharing cannabis information with your doctor, it might be best to wait until you've established an amicable relationship with them. Both Chan and Goldstein highly recommend elevating the conversation with technical and scientific terms (saying “cannabis” instead of “weed,” for example). If you're a medical cannabis patient, refer to cannabis as medicine and emphasize how it helps you.
Don't Be Afraid to Switch Doctors
According to Chan, there's a growing pool of weed-friendly doctors who understand the science and respect medical and responsible adult use of cannabis. Though they may still be few and far between, Chan says their ranks are growing, and cannabis users should seek them out when possible.
“Patients have a choice. It is their right to have a primary care physician who is understanding and supportive of their lifestyle choices,” Chan said. “It is in the interest of both the doctor and the patient to be aligned.
“I view it as more of a dating situation. As you might be on a date that doesn't work out,” Chan continued, “be friendly, but don't be afraid to shop around the next time you need a checkup and find a physician who is more aligned with your choice to use marijuana.”
If one is available in your area, Goldstein recommends seeing a cannabis specialist in addition to your doctor visits. “If you are asking your physician for medical cannabis advice, you will likely be disappointed as, again, most don't know anything. Seeing a cannabis specialist is likely going to be much more beneficial if you are looking for specific advice about cannabinoids, product, and dosing.”