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Emergency Minute Episode 13 - Medical Marijuana Fact or Fiction

Writer's picture: drjparentedrjparente

Welcome back everyone, to another episode of Emergency Minutes. Want to take a moment to thank everyone who participated in episode twelve, which was Questions and Answers with an emergency medicine physician. That was a good time. So I appreciate everyone that was able to comment or ask those questions and then hopefully I address them for you in a slightly entertaining fashion but still get to the answers.


So appreciate that. Appreciate everyone participating in social media at DrJParente on just about any social media platform. Much love to you. It takes a village and to get this thing off the ground. Definitely going to need all of your help. So I do truly appreciate it. Much love to you.


All right, so recent polls would suggest that the topics for the next episode should be medical marijuana, which we're going to discuss today. And then also a discussion of interesting cases. So I'll probably be doing that one next for episode 14. Stay tuned. Selfish plug. All right, in all likelihood, the other option that I put out there for the poll last week was to do basically an inside story of COVID And also the other thing was weight loss fact or fiction.


So hear me out on this. So a couple of different things. Today we're going to talk about medical marijuana, fact or fiction because I think that there's an opportunity here to be using a medication that is not really in the mainstream or at least not legally at the surface and can really help a lot of people.


And so I'll go into that a little bit more detail as that is the entire point of the show today. However, interesting cases, I think people are just intrigued by that. With that one, I have to be a little bit careful because I have to make sure that I respect federal privacy laws and things like that.


So I have to be careful with what I say. But I promise you don't want to miss that episode. I'll be doing that one next. Now, as far as weight loss factor fiction, probably a lot of people don't realize that I had started a physician guided weight loss company many years ago that is still doing well today and treating patients.


As you probably know, there's a lot of new medications out there that are really helping a lot of people. It's really kind of cool to see and so we can get into that a little bit deeper. But I think one of the things I wanted to talk about with the weight loss factor.


Fiction is there's just a lot of misconception out there about weight loss. And the bad news is that everybody online, every single social media account is an expert. And it drives me crazy because not every single thing is the same for every person. And so we're going to get into that a little bit later.


But one of my favorite quotes, because it's absolutely wrong, is, I know what I need to do. Just need to do it in order to lose weight. And the problem is that people don't recognize that obesity is a disease, just like hypertension, just like diabetes. So, yeah, can you make adjustments to help your diabetes to help your high blood pressure?


Yes, you can. Can you just cure obesity by, quote, unquote, doing the right things? No, you can't. And so we're going to talk about that. We'll get into that. The other piece of that then, is obviously the inside story for COVID. Again, I like my job, sort of most days, I guess I'd like to keep it.


I'd rather not be fired. So I have to be very cautious. I obviously won't be using any hospital names. I won't be naming any specific employers or anything like that. It'll just be an inside look. I think you guys are going to be very interested and fascinated by what really happened at the hospital level, because to me, it was extremely interesting.


And what was even more interesting about it was how every hospital was completely different in their approach to how they were handling PPE, how they were handling nurses and people getting sick, and how all these things that took place before the initial wave of people that we thought were coming that never came.


And then what it did look like when these people eventually did come and society was shut down. And we can get into all of that. All right, well, that's a mouthful. So let's get back to the topic at hand here, which is medical marijuana fact or fiction? So the first question is how on earth did I get involved with this?


Well, first and foremost, I never touched marijuana in my life. Really wasn't my thing. I had plenty of other things that got me into trouble and I just didn't need to add any drugs. Whether you perceive this to be a drug or not, certainly wasn't going to help me get into medical school or good colleges.


So I just never really got into it. And I was one of those people that truly believed medical marijuana was just a way for people to get high. And now would be a good time to queue up to Cypress Hill. I want to get high. So high. Anyways, if you've ever been to a Cypress Hill concert, you know exactly what I'm talking about, because pretty much every single person in the audience is smoking marijuana.


So I never touched the stuff, but I can't say that I wasn't impacted by a couple of contact buzzes in my day of doing a lot of concerts. Meanwhile, back at the ranch, all right, so I'm sitting in a pool in Fort Lauderdale and I'm minding my own business and I start talking to this random dude next to me.


My whole family's there, and he had on these sunglasses that I liked. And so we just started up conversation, very strange conversation, but nonetheless and he starts talking to me about medical marijuana. I'm like, Get out of here. I'm like, that's just a way for people to get high.


No way. And he's like, Man, I'm telling you, do your research. You will be blown away at some of the data that's out there for some of these conditions. So I'm like, no way. And then he starts talking to me about the financial aspects, and maybe there's some opportunity to make some money there.


So I'm like, okay. So now he's got my attention. I'm slightly intrigued. So I go down this rabbit hole of doing some research. What does it require? To be able to sort of recommend medical marijuana, like, what are the benefits and all this stuff. And so I went down this deep rabbit hole, and at the end of the day, yeah, it does, it can help people.


And it's just very interesting because obviously this isn't being put out there by Big Pharma, right? So I think there's an obvious path here where a lot of hurdles have been thrown up in front of these companies and these dispensaries and things like that, because it's not regulated yet.


We don't have the tax structures in place for this thing yet. We don't have the Philip Morris that can go out there and just pump out tobacco the way it did back in the day. We have multiple dispensaries. There's obviously different strains of the plant. There's different methods of administration.


And the other thing to consider is, guess what? It's federally illegal. Yeah, that's right. So this is considered a schedule One drug. Schedule one that's the same as heroin. So the federal government considers marijuana on the same level and same scope as heroin. That's absolutely insane. That that's still how it is.


So they passed it down to the states and basically said it's up to the state to determine its legality. Now, there are some states that are recreational. Colorado, Washington, Virginia, Vermont, New York are a few of them. And then there's some that are just medical only, like here in Ohio, Florida, New Hampshire.


And then there's some states that it's actually illegal. Like Idaho, Wyoming, Kansas, south Carolina. So all of these things are sort of determined at the state level. So what I'm saying, if you're from out of Ohio, may not make sense in your state, and I can speak to your state because I don't know what every single state's rules are.


But you may want to check online. I'm sure that stuff is not that hard to find. Now, what are some of the conditions for medical marijuana and what can it do to help? Well, in order to do that, you kind of have to understand how it works. And like we talked about before, there's different strains of the cannabis, right?


So there's different plants, there's different strains, then there's different ratios of the THC to CBD, and then, of course, the different methods to administer the medication. Now, the medication itself works on the endocannabinoid system, so it does kind of function like a natural muscle relaxer. So let's run through some things that it kind of can treat.


Chronic pain. So this is one of the most common, if not the most common reason that patients get prescribed to medical marijuana. Or in Ohio we call it recommended. This is typically with patients that have like, back pain, spinal disease, things like that. Now, you can say all day long, like, well, you shouldn't be using marijuana, know of all these other different reasons and insert your statement there of why you shouldn't be using it.


But let me ask you something. Is it better to take medical marijuana for pain control or would it be better for someone to be on Percocet for the rest of their lives and then also take. Doses of NSAIDs, non steroidal anti inflammatory drugs, because that's really the question that you have to ask yourself.


None of these things is perfect, right? And I tell my patients all the time, which, by the way, selfish plug, yes, I do recommend medical marijuana with another company called Green Medicine that we'll talk about later. But the reality is that I tell my patients all the time, look, this is not a cure for anything.


Some patients take Tylenol and their headache gets better. Some people, Tylenol doesn't work, so they look for another tool in the toolbox ibuprofen. Or maybe it's a leave. Or maybe they need to be on a prescription dose of their migraine medicine. This is the same thing. This is just another tool in the toolbox.


But I have seen it very helpful in patients with chronic pain. And I would much rather my patients be on medical marijuana than on an opiate the rest of their lives. All right, so if chronic pain is the most common, then what's the most rewarding? Well, by far and away, it's cancer patients.


This can help in at least four different ways. It can help alleviate pain, it can help stimulate an appetite, it can suppress nausea, and it can help these patients sleep. And I can tell you stories that would blow your mind. In fact, I had a patient recently here within the last couple of years that was undergoing treatment on chemotherapy, losing weight, had all of these things chronic pain, nausea, no appetite whatsoever, was losing weight and became what's called cachectic, meaning that they basically have muscle wasting.


And they've become so very unhealthily skinny in that regard that it becomes difficult to fight the cancer and to continue to receive treatment. And so this particular patient to this day will tell me, when I started on medical marijuana from you, Dr. Parente, you helped me beat this thing.


I got my appetite back. I started to eat more. My nausea was suppressed. I was sleeping better. My pain was controlled. And guess what? He actually did beat the cancer. Now, do I think that the THC cured the cancer? No, I'm not saying that. I'm just saying that it improved his symptoms enough that it gave him the opportunity to fight against it.


And he's doing very well to this day. And I think that's an awesome story. So my most rewarding patients to treat, by far and away are the cancer patients. All right, so another one besides cancer and chronic pain, migraine headaches. So there is some data out there that medical marijuana can decrease the frequency or at least the severity of migraine headaches.


Now, I do have patients that I've treated in the past that said, you know what? It just doesn't help me that much. So again, this is not a cure for anything, but it does help with pain and frequency in a lot of patients. And again, there are a lot of other medications out there preventative medications, abortive medications.


Meaning I have the headache. I'm trying to get rid of it. There's all kinds of things. And of course, I recommend you to have these conversations with your physician. And if you're still having these headaches, then go see a neurologist. And a lot of the neurologists are. Actually subspecializing in headaches now too, because it's such a debilitating condition and it's so poorly understood that these specialists actually are quite good at what they do.


And the problem is, a lot of the mainstream sort of hospital systems, Cleveland Clinic, university hospitals, those kinds of big hospital systems, mercy Health System, they've basically told their doctors to stay away from medical marijuana. And part of it is because it's federally illegal, part of it is that stigma that we're still trying to change.


But you get a neurologist in a room, they're going to agree with me that these can be very helpful in patients with chronic migraine headaches. Another thing would be seizures. I do have at least two or three patients that have had a dramatic drop in the frequency of seizures compared to what their baseline was prior to this.


Again, this is not to replace their antiepileptic medications or anything like that. So, again, talk with your neurologist, but it's definitely something that can help. Now, inflammatory bowel disease. So we talk about ulcerative colitis and Crohn's, and now just recently in Ohio, irritable bowel syndrome. So that gets back to that muscle relaxer property.


That can be beneficial for sort of the gut smooth muscle. We talked earlier about Cachexia. That's another condition that's approved in Ohio. Basically, muscle wasting becomes so cachectic, which means just back down to skin and bones. Know, you're able to get this medication that can have you back, know, crushing your Cheesy Poofs.


I joke about it, but yeah, another thing, glaucoma, PTSD. The data is kind of mixed on this. I do have patients that I treat with both Glaucoma and PTSD. I only have one Glaucoma patient, and she tells me every time I talk to her that her ophthalmologist was like, whoa, what did you do that dropped your pressure?


And then she was like, I started on medical marijuana. And he's like, no, that's nonsense. That's not what caused it. And she's like, yeah, but it's the lowest it's ever been since she started with me, so it is kind of funny. So we joke about that. Again, PTSD is one of those things.


I think it's either going to help you or it's going to be absolutely worthless. I've had patients on both sides of that. The data is kind of 50 50 on that. So I think it's worth a shot for PTSD. I do have some patients that have told me that this has dramatically improved their lives.


So I think it's worth a shot. If this is something that is debilitating to you, then why not give it a try and see if it can help you? There's all kinds of other conditions in Ohio. Hepatitis, HIV, ALS, CTE, fibromyalgia, hepatitis C, Huntington's, MS, Parkinson's, sickle cell, any sort of terminal illness, chronic pain, TBI, which is traumatic brain injury.


I'm not really sure how CTE got approved. CTE is sort of the buzzword for these patients. Well, basically football players that end up with numerous concussions and end up like committing suicide. Or you see these high profile suicides and things. This can only be diagnosed with a brain biopsy, so I'm not really sure how they chose this one because have to kill the patient and sample their brain before being able to say that they had CTE, but I digress.


All right, so moving on. How do you get medical marijuana? Well, again, that depends on the state level. So I'll walk you through the process in the state of Ohio, because that's where I practice medicine. Now, to put this in perspective, ohio has roughly 600 physicians that have the additional training in order to recommend medical marijuana.


Okay, so what does that mean? 600 in the entire state of Ohio? Okay, that seems like a lot. Yeah. So perspective here. Pennsylvania has like 16,000 physicians that have the ability to do this. So Ohio definitely a little bit behind, but hey, at least we do have the ability for medical marijuana, including 26 approved conditions.


Ohio also has roughly 56 dispensaries. There was a big push to get more and more, but then COVID hit and kind of seemed to derail everything. So I'm not sure if we'll see that pick back up or not. The bad news with only having 56 dispensaries, and I tell my patients all the time, look, dispensaries are just like any other store, only you can't get in without a medical card.


But every store is a little bit different. And what happens is when there's not that many stores, prices are high. So that's the bad news about the state of Ohio. A lot of patients that are being treated with medical marijuana actually go to Michigan or surrounding states to pay lower prices on the cannabis.


So how does this work? Well, in the state of Ohio, what happens is a physician has to make the diagnosis, and it cannot be me or the person who's recommending the medical marijuana because there'd be obviously a conflict of interest, right? If I was a family physician and I was just like, oh, you have chronic pain right there.


Boom, chronic pain. And then, oh, why don't you come back tomorrow and you can get your medical marijuana be you could see how that would turn into a slippery slope. Be a little bit disingenuous. So what has to happen in the state of Ohio out is that they have to be diagnosed by a clinician with an actual diagnosis of the 26 that we kind of referred to.


And if you want to look at them, there's a link online that I'll include with this podcast that has the qualifying conditions. So basically, once we then go in and establish that we're going to have an appointment and a doctor patient relationship, I'm able to then have staff kind of go in and look at the medical record to see, yes, you do have that condition.


So that's kind of step one is I just have to verify that someone else, not me, has diagnosed you with this chronic pain, cancer, seizure, whatever the qualifying condition is. So that's kind of step one. Step two then is that we have an appointment. Now in Ohio, you are, because of COVID one of the only good things that came out of COVID was for the sort of push of telemedicine.


So prior COVID, we had to meet face to face. And now with this, we're able to actually meet via telemedicine on the phone, know, video conferencing, and we have the appointment that way. And that's where I kind of talk to the patients, find out what their goals are, talk to them a little bit about their medical history.


What are they trying to do? Are you trying to get off opiates? I have plenty of patients that are now off opiates. Are you trying to get relief of symptoms from your inflammatory bowel disease? You have chronic knee pain and you're due for knee replacement surgery, and you're trying to postpone that as long as possible?


These are the conversations. That I have with patients every day. Then once we have that appointment, I kind of walk them through how that appointment works. Because in a normal functioning, traditional medicine, per se, you'd come see me. I would diagnose you with ear infection or whatever the diagnosis is, prescribe your Amoxicillin, and send you out on your way with the prescription that you would take to the pharmacy.


Well, this really isn't that much different. You have a telemedicine appointment with me. I talked to you about how this whole thing works. I make the recommendation and then I create an account for you and we basically create your medical card at the state level. And that's considered your recommendation.


You then take that recommendation to get into the dispensaries, and then you start to basically buy whatever it is that you want to buy to try to help your condition. Now, most dispensaries should be reputable, should be having a pharmacist on board that is just like me. So I'm obviously board certified physician, but I have additional training in medical marijuana.


They should be a board certified pharmacist that also has additional training in medical marijuana as well. Because one of the things to consider is when I write for Amoxicillin, I write for the dose, frequency, concentration, et cetera. We haven't gotten that far with medical marijuana yet, so I'm not doing any of that stuff.


I'm just prescribing or recommending medical marijuana as a treatment. Now, as the patient can go to the dispensary and I always advise them to try to sit down with the pharmacist and say, look, what's best for my condition? Is it best for me to get this flour vape? Is this best for me to get edible tinctures, topical patches?


What's the best way for me to sort of administer this medication? What would be the most appropriate dose? What would be the best concentration of that THC to CBD? And then you have to think about things like vaping onset super fast, five to 15 minutes versus edibles has to go through that first pass metabolism, which is definitely going to slow down the absorption of the medication, and then therefore prolong the onset of the sort of effect of it, which would be about 45 minutes.


So these are the conversations that patients really should have with the pharmacist at the dispensary. But again, a lot of variability there that I have absolutely no control over. I do think over the years this will become more of a streamlined process, but without the involvement of big pharma.


It's kind of interesting how right now it's a little bit the wild, Wild West out there. All of this can be done through my company. If you live anywhere in the state of Ohio, it's called Green Medicine. So check us out@greenmedicinellc.com, or you can check us out on Facebook or Instagram at Greenmedicine as well.


So shout out to my staff over at Green Medicine. Much love to you. All right? So another question I get about medical marijuana all the time is my employer. Fill in the blank. Here's the problem. The problem is these HR departments are years behind when it comes to these kinds of things new treatments, et cetera.


And here's the kicker we know medical marijuana. Has this horrible stigma of potheads and people who are being lazy, and they're not trying to advance their career. And we really haven't been able to shift that paradigm and that stigma that a lot of these patients are very highly functioning, highly successful, and they're just dealing with chronic diseases and illnesses and disorders and disabilities that limit their livelihood and limit their ability to function at a high level or at least function and live life to the highest capacity possible.


And it's amazing to me that you could be a nurse. You could be prescribed percocet and valium as a painkiller and muscle relaxer. Let's say you threw out your back. You could take one of each of those pills. You could drive to the hospital, work your shift, and no one would bat an eye.


In fact, if you got drug tested that day, you would test positive for opiates, and you would test positive for benzodiazepines, basically positive for the Percocet and for the value. And rightfully so. It's in your system. You were prescribed those medications from a physician, and that's okay. I mean, so long as you're not impaired.


But if you were to get recommended medical marijuana, and then you took a P test and it was positive for THC oh, boy. Hold the phone. Shut it down. What are you doing? People are losing their jobs. It's incredible to me. It's absolutely incredible to me that these HR departments are just not even paying attention to this.


So it's unfortunate because I do think sometimes people have to make a choice. I do have one specific patient who's said to me multiple times, like, I don't want to lose my job, but I don't know that I could work my job without this medical marijuana. I mean, that's a conundrum, right?


And this person, she doesn't want to go on an opiate. She doesn't want to take some of these other medications that have much more harmful side effects. So I get it, and I make no promises. I don't work for the HR company. I'm not going to be in that room.


And if you have a medical recommendation, I would think that you would be okay. But that's up to the company. And it's really unfortunate that that's where we're at still in 2023. But we talk about safety. Medical marijuana is much safer than an opiate. Virtually no addictive properties whatsoever.


Less dependence, less tolerance, fewer side effects. If you're going to go on Percocet or Vicodin or Norco, things like that, that causes constipation, sedation, respiratory depression at higher levels. These are not great medicines at all. One things we always talk about is medications in the elderly. What's the safest thing to give an elderly person as far as pain control?


Well, tylenol number one. And then after that, probably medical marijuana, because, look, you can't give someone that's 90 years old, you can't give them a whole bunch of ibuprofen, a leave, those kinds of things. Increase your chance of heart attack, stroke, stomach ulcers, kidney failure. Those are all, like, very real things.


Those aren't like you're going to get a rash on your toe. These are bigger. Heels. So we say, okay, well, we can't give muscle relaxers. Muscle relaxers in the elderly have been shown to get them to be dizzy and fall, and that's how they break their hips and that's how they shorten their lives.


So it's interesting to see where this is going to go, but we're far away from where we need to be. All right? And I cannot possibly do this podcast without talking about one of my least favorite things in the world. Cyclic Vomiting Syndrome. Yes. Known as cannabis hyperemesis syndrome.


CHS. What is this? Well, this is a syndrome where a patient uses marijuana, typically not medical marijuana, but stuff on the streets. It's a lot stronger, much higher concentration of the THC, and basically makes these patients go bananas with vomiting. And in the Er, we call it 'scrommiting' because it's like scream vomiting.


It's a very violent reaction and definitely an anxiety component that is playing into it as well. But they scream vomit and you can literally see them coming back from the waiting room and you're like, that's hyperemesis syndrome that is sick. With vomiting syndrome, you can see it from a mile away.


And it's very frustrating because most patients believe. And like we just talked about, THC helps me with nausea. So, yes, to an extent, THC can help you with nausea, but really, it's the THC CBD ratio. And in fact, the CBD is really more impactful in keeping the nausea at bay.


And so a lot of patients just flat out don't believe us. And it's hilarious because I've had this conversation a thousand times, and they're like, no, that's not what it is. And I'm like, It is what it is. And we've checked your labs, your pancreas, your gallbladder, your kidneys.


Everything else is doing fine. We can kind of see this as a clinical diagnosis. You did test positive for THC, and I'm telling you, this is what it is. And the other problem is that they don't believe us, is because they say, well, I stopped smoking three days ago.


It doesn't matter. Doesn't matter. Studies have shown that you can have this four weeks, if not two months after the fact, that you actually do stop using marijuana. So that's where we talk about the importance of the CBD, THC, those ratios. It's very frustrating to take care of these patients in the emergency department.


They need a ton of medications. We're doing things like Haldol. We're doing things like capsacion creams on their chest to try to do it. We're trying all these different things. Obviously, the usual things. Zofran, fenergan, protonics fluids. It's very difficult. It's very taxing on the nurses, and it's very awful, even for the patient.


Obviously, they're just puking uncontrollably. It kind of reminds me of Goonies when Chunk is making all those puke noises. He's telling him from grade school, and he's like, I was in kindergarten, and he starts going crazy about all these puke, and he's like and everybody throwing up and barfing.


Anyways, that's kind of what it sounds like. So multiply it by 100 and that's. We call it scrominiting. Anyway, side note, medicine has all kinds of made up contractions. By the way, scream vomiting is scromiting. If you're suicidal but you're drunk, then you're 'drunkacidal.' So we have all kinds of fun things we could talk about.


Another podcast. All right, well, that's all I got this week. Again, I wanted to thank everyone for joining us here today for discussion on fact or fiction with medical marijuana. Big shout out to the staff over at Green Medicine. Truly appreciate all of you. If you guys are interested, be sure to check them out on social media and give us a call if you think you know somebody that would be potentially helped buy medical marijuana.


Join us next week. Probably going to do some discussion of interesting cases, so check back in for that. And remember to spread the love and share this with anyone that you think would want to know about this. The person who shares this the most can get a new set of steak knives or maybe a vape pen.


I'm not sure which. Or maybe just in a free appointment at Green Medicine. Until next time, peace, love, and happiness to everyone. Cheers, guys.

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