It's brisk business on a Wednesday morning at Magnolia Wellness center, a medical marijuana dispensary in downtown Oakland. Although it’s legal to smoke marijuana in California now for recreational purposes, medicinal cannabis isn’t going away anytime soon.
But have these patients ever talked to their regular doctor or nurse about medical marijuana?
“I always tell them that I use it,” says Bob, who didn’t want to give his last name. "They don’t really want to talk about that much."
“I just didn’t really feel comfortable talking to my doctor about it,” says Alex, who also didn’t want to use his last name because of the stigma marijuana use can carry. Still, he laments that “it’d be nice to hear about it from a professional doctor rather from your friends or your family."
It's a similar refrain from Barbara Jean Campbell, who says she uses cannabis for irritable bowel syndrome, gout and rheumatoid arthritis.
“I talked to one of the nurses, and I asked, ‘Why doesn’t the doctor respond when I say I smoke marijuana?’ He said, ‘Cause they don’t want to deal with it,’ ” Campbell says.
There is a growing body of data about marijuana’s medicinal benefits, and groups like the American Nurses Association acknowledge it can help with chronic pain, MS, anxiety and many other conditions. But because it’s still illegal under federal law, there aren’t a lot of places medical professionals can learn about it. And if you ask your regular doctor whether it will help your particular ailment, there’s a good chance they might not know.
High in the Hospital?
"Patients are ahead of most physicians on the issue," says Dr. Larry Bedard, who’s on the board of directors of the Marin Healthcare District, which oversees Marin General Hospital and other health care facilities in Marin County.
"I think physicians just feel overburdened and burnt out, and they haven’t taken the time, the effort and the money to go to a high-quality educational course in cannabis," he adds.
Dr. Bedard introduced a resolution this fall, which could lead to Marin General allowing patients to use medicinal cannabis inside the hospital.
“I’m not naive enough to believe that patients don’t get it here in the hospital. ... I think the evidence for benefits to these patients, particularly people with pain problems or opioid addiction, the evidence is pretty clear, but the vast majority of physicians know very little or next to nothing."
Learning About Cannabis
So how to address that lack of knowledge? The downtown public library in the East Bay town of Lafayette might not seem the most likely place, but in October about 30 nurses and pharmacists gathered there for a daylong Nurses Medical Cannabis Workshop.
Geriatric nurse Eloise Theisen tells the crowd she generally does not recommend edibles, "especially in somebody I consider to be cannabis naive, somebody who hasn’t used cannabis before. And that’s because they’re super unpredictable."
Theisen also describes some possible scenarios that could occur if people mix marijuana with various other prescription medications. She explained how tamoxifen, for example, may actually block the effect of cannabis.
This is really technical stuff. But that’s what’s needed, according to workshop attendee Aglaia Panos, president of the Marin County Pharmacy Association.
“I had a student who had to do some research on marijuana because she was an intern at a pharmacy and she asked the patient, ‘Are you on any other drugs?’ So she said, ‘Yes. ... I take pot.’ And she didn’t know how to respond to them,” says Panos.
"She had no idea what to tell the patient of any drug interactions that the person was on along with other drugs."
“Even in the non-legal states people are using cannabis for medical purposes, and legal or illegal, it works," says retired hospice nurse Alice O’Leary-Randall, who’s currently treasurer of the American Cannabis Nurses Association.
“They come to us nurses, we’re the front line. ... We spend more time with the patients than the doctors do. And they’re going to tell us what’s going on with their health, and they’re going to tell us what happened when they tried medical marijuana. And we need to be aware of drug interactions. We need to be aware of how cannabis affects all our physiological systems,” she tells the audience.
In the weeks since Californians legalized marijuana with Proposition 64, the doctors who issue medical marijuana cards are reportedly seeing an influx of new patients.
And if more people start trying cannabis as medicine, more workshops like these will be needed, so the health care industry can be prepared.