Medical Cannabis
FEATURE
Article #5
Jeffrey Tucker
DC, DACRB
I was recently asked, “What advice would you have for doctors wanting to broach the cannabis subject with an ailing patient (family member, mother, father, aunt, uncle) who grew up in that era of “cannabis makes you stupid,” “it’s the evil weed,” or “just say no”? Some patients won’t even consider it because of the stigma. They associate it with dopers and pushers. I let them know I don’t want them to get “stoned.” I often share the personal story of my household growing up with a druggie brother and my fears about drugs (and abuse). I often say, “You know, I’m not sending you on a psychedelic trip, and you’re not going to wind up sitting along the freeway entrance with a sign reading ‘need money. ’ That’s not going to happen. This is safe and worth a try. Let’s try it in baby steps. Let’s see if you feel better. Something good could happen.” Mothers have been treating their children for epilepsy and other chronic conditions with cannabis. It had to take strength and confidence to take what has been considered an “illegal drug” and give it to their children, possibly risking their safety.
Following is how I introduce it to my patients. “Many of my other patients find that this works and are not experiencing side effects, so this is what I suggest you try. This could work. It’s not going to hurt you; you could feel better. Let’s see if it works for you too.”
Over the years, many patients helped educate me about cannabis. For example, Allan is a 60-year-old obese man with COPD and a history of smoking cigarettes who contracted the swine flu in 2011. He is on oxygen and has to carry a tank everywhere, but he claims he has an easier time breathing after a “hit” of cannabis. With COPD, he has trouble pumping air, but the cannabis relaxes him, and he does not exert as much energy to breathe. He says, “I relax, and that helps me breathe better.” I put him on a weight loss program because he has excess fat related to his inability to move around because of COPD and being sedentary. So far, he’s lost 43 pounds, and 34 pounds of that were pounds of fat! He is moving easier and now can go up and down his stairs at home several times a day when before he could barely go up and down once a day. He still has a way to go, but the weight loss has him feeling significantly better and he’s able to be more functional. Cannabis and weight loss—what a concept!
With the Winter Olympics recently ending, the role of cannabis in sports medicine has come up. Some athletes use it for post-workout pain, muscle recovery, a better cool
" There is actually a cannabis industry-sponsored Olympicsstyle games called the 420 Games."
down, or during workouts for improved focus. Is cannabis a performance-enhancing drug? In 2018, the World AntiDoping Agency (WADA) removed cannabidiol (CBD) from its list of banned substances. However, THC and other cannabinoids in marijuana are still “prohibited in competition.” When cannabis first enters the cells, it opens up the blood vessels and it’s able to tap into glycogen stores as an energy source. It also opens up the alveoli in the lungs, so you’re getting more air in, and the more air in, the more oxygen you have and maybe the faster you can go. It’s also an anti-inflammatory that allows for faster repair. If cannabis takes away or diminishes postexercise soreness or pain, that would help recovery, and your ability to focus for the next 24 to 48 hours would be improved. If you’re not monitoring sore muscles or joints, I think you can be less distracted and able to play full out, and that gives you confidence.
There is actually a cannabis industry-sponsored Olympics-style games called the 420 Games. They advocate that cannabis can be a positive and helpful part of a productive, athletic person’s lifestyle. From the 420 Games’ website:
“We strive to teach those who have been misled about cannabis in a positive and respectful manner so people can make educated decisions about the use of cannabis. The 420 Games is against underage use of cannabis. We do not endorse the illegal or irresponsible use of marijuana... Our events are NOT ‘smoke ins.’ If you choose to use marijuana before, during, or after our events, please make sure to do so discreetly, legally, and respectfully. All of us are responsible people who want to change the outlook on cannabis use. Therefore it is important we all act in a manner that breeds respect.”
A typical question chiropractors often ask is, “Do insurance companies cover medical marijuana use?” The current answer is no, but at the beginning of 2017, a New Jersey judge made a landmark ruling involving a workers’ compensation case. A lumber worker testified about his legal use of medical marijuana to treat neuropathic pain in one of his hands. The judge ruled workers’ compensation would have to cover the cost of his medical marijuana. I recently heard that SNC Claims Systems put a workers’ comp program together for chronic and opioid-dependent patients. It’s rolling out in New Mexico, Nevada, California, Arizona, and Utah. The insurance company pays for it for people with chronic pain, and apparently, it’s working well. Imagine all of the attorneys, corporate heads, and departments that decision had to go through!
Is medical cannabis cheaper than opioids? Yes! OxyContin could cost on average $450 a month for 30 pills. The price for opioid treatment may vary based on a number of factors. Recent preliminary cost estimates from the U.S. Department of Defense for treatment in a certified opioid treatment program (OTP) provide a reasonable basis for comparison. Methadone treatment, including medication, and integrated psychosocial and medical support services (assumes daily visits) costs $126 per week or $6,552 per year. Buprenorphine for a stable patient provided in a certified OTP, including medication and twice-weekly visits, costs $115 per week or $5,980 per year. Naltrexone provided in an OTP, including drug, drug administration, and related services, costs$l,176.50per month or $ 14,112 per year. To put these costs into context, it is useful to compare them with the costs of other conditions. According to the Agency for Healthcare Research and Quality, annual expenditures for individuals who received health care are $3,560 for those with diabetes mellitus and $5,624 for kidney disease. The California average cost of an ounce of quality market cannabis is roughly $250. I don’t really know how to calculate this, but a heavy smoker who purchases $300-per-ounce cannabis and uses half an ounce monthly would expect to pay $1,800 annually for his or her medication.
If you are losing sleep over this whole cannabis thing, well maybe it’s time to try it. Insomnia is a common issue among people today and several factors contribute to sleep issues, such as stress, diet, chronic pain, asthma, or nasal/
sinus issues. Sleeping pills come with unwanted side effects and can compromise overall health. A natural and low-cost alternative remedy is cannabidiol (CBD). CBD works with the body’s endocannabinoid system, which is accountable for all of the homeostatic functions of the body. CBD regulates balance and homeostasis in the human body. Additionally, CBD is an anti-anxiolytic, which fights off anxiety, a huge influence on horrible sleep patterns. REM sleep plays a major role in keeping up with health because during REM your blood flows and diverts to your muscles, giving time and space for your brain to take a break. Without consistent REM sleep, your brain is not getting the rest that it needs. From my experience with many patients, I feel safe saying that CBD tinctures are successful in helping patients regulate REM sleep.
References:
1. U.S. Department of Defense, Office of the Secretary. TRICARE: Mental Health and Substance Use Disorder Treatment. Federal Register, https://www.federalregister.gov/ documents/2016/09/02/2016-21125/tricare-mental-healthand-substance-use-disorder-treatment. Published September 2, 2016.
2. Agency for Healthcare Research and Quality. Mean Expenses per Person with Care for Selected Conditions by Type of Service: United States, 2014. Medical Expenditure Panel Survey Household Component Data. 2016. https://meps.ahni. gov/mepsweb/survey comp household, jsp. Accessed May 11, 2017.
3. https: www.projectcbd. org/sleep-disorders
Jeffrey Tucker, DC, DACRB, practices in West Los Angeles, CA. He is the President of the AC A Rehab Council (CCPTR.org). Dr. Tucker's website is www. DrJeffreyTucker.com
