A doctor discusses medical marijuana with a patient.

Marijuana: It's Not Your Father's Pot

Today's marijuana is much stronger than it once was. With medical and recreational marijuana legal in many states, are the patients you've recommended it to utilizing marijuana correctly?

Julie had been suffering from knee pain for a number of years. Concerned that she was getting addicted to the pain medications prescribed, Julie’s partner suggested finding an alternative. A family friend with a medical marijuana card offered Julie a couple of his edibles to try. She ate an entire edible and then went to bed. During the night, she awoke with a feeling of bugs crawling all over her skin – so, she ate another edible.

The intentions of her family friend were to alleviate her pain; however, Julie’s actions were not wise: She took the offered edibles that had not been recommended by her doctor, and in a dose she was unable to control.

A recent study presented at the American College of Emergency Physicians (ACEP) meeting revealed an increase in the number of ED visits in Michigan since the legalization of marijuana, visits presenting with symptoms of neuropsychiatric toxicity. 

With the use of marijuana becoming more mainstream (and marijuana becoming more potent than ever), it is imperative that patients are educated on the use and safekeeping of their recommended marijuana. While education on medically recommended marijuana might not solve all the concerns surrounding potential neuropsychiatric issues, at least it is a start. And, obviously, no one can control what might happen when patients divert their supply to friends.

Have and Document a Conversation with Your Patients

As a healthcare professional, it is important to at least have and document a conversation about marijuana. Ask your patients if they are utilizing marijuana, in what form and how often.  As the Federation of State Medical Board (FSMB) suggests [PDF], be aware of the basics:

A health care professional should document a written treatment plan that includes: 

  • Review of other measures attempted to ease the suffering caused by the terminal or debilitating medical condition that do not involve the recommendation of marijuana.
  • Advise about other options for managing the terminal or debilitating medical condition.
  • Determine that the patient with a terminal or debilitating medical condition may benefit from the recommendation of marijuana. 
  • Advise about the potential risks of the medical use of marijuana to include: 
    • The variability of quality and concentration of marijuana
    • The risk of cannabis use disorder
    • Exacerbation of psychotic disorders and adverse cognitive effects for children and young adults
    • Adverse events, exacerbation of psychotic disorder, adverse cognitive effects for children and young adults, and other risks, including falls or fractures
    • Use of marijuana during pregnancy or breast feeding
    • The need to safeguard all marijuana and marijuana-infused products from children and pets or domestic animals
    • Notify the patient that the marijuana is for the patient’s use only and the marijuana should not be donated or otherwise supplied to another individual.
    • The potential need for additional diagnostic evaluations or other planned treatments
    • The specific duration for the marijuana authorization for a period no longer than twelve months
    • A specific ongoing treatment plan as medically appropriate

More Resources

For more information on this topic, you may enjoy these resources: