While most Americans have embraced cannabis in medicine, the health care and insurance industries are struggling to do the same. Between stigma, a lack of access to medical literature and conflicting legislation, people are using medical marijuana in a system that's ill-equipped to handle it.
Doctors didn't learn about cannabis in medical school and it's not prescribed in the traditional manner they've grown accustomed to. It's readily available and comes in thousands of variations with different combinations of THC and CBD. On top of problems within the health care system, physicians and patients alike are caught between conflicting state and federal laws.
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Local experts discussed these issues in depth during a digital Q&A featuring NBC10 Boston Anchor Glenn Jones, Dr. Benjamin Caplan, CEO of CED Clinic, Dr. Mary Buss, director of outpatient palliative care at Tufts Medical Center and Dr. Uma Dhanabalan of Uplifting Health & Wellness.
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The biggest challenge doctors face when advising patients on cannabis use is a lack of information, according to Buss, a palliative care physician working at an academic medical center.
"I find that I'm often in the case of talking to patients trying to manage their symptoms and fielding questions about whether or not medical marijuana is a reasonable thing to offer them," Buss said. "And I don't have evidence that I wish I had in order to give them real counseling on this."
"That evidence is difficult to find, but it's not missing," countered Dr. Benjamin Caplan, a Boston-based primary care physician who said he curated the world's largest library of cannabis publications. Caplan is the founder of CED Clinic, a company that specializes in treating patients with medical marijuana.
"I think doctors are poorly equipped right now to deal with cannabis medicine," Caplan said. "Right now, there is 10 times more literature covering the molecules of cannabis than the common cold or Lyme disease. The problem is, it's very difficult to surface that literature, if you're not looking for it."
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Buss pointed to national surveys of oncologists, oncology trainees and palliative care trainees related to cannabis, which found that "people don't feel adequately trained in how to do this."
"I've actually made an effort to try and distill the evidence and I feel like every time I read through it, I'm still left with more questions than answers about how and when best to guide and recommend use of it," Buss said.
It's only over the last 100 years or so that cannabis hasn't been part of every medical discussion, according to Dhanabalan, who works in both conventional and holistic medicine. Yet modern-day doctors can't even agree that medical marijuana is harmless.
"Nobody in the whole world has ever died from a cannabis overdose. I mean, you have absolutely intoxication, but you can't die from it," Dhnabalan said. "We were told, 'Do no harm.' But Dr. Uma says, 'Safety first. Do no harm.'"
A similar dissonance exists in the way it's regulated. Medical marijuana is legal in 37 states and the District of Columbia. Yet cannabis is considered a Schedule I drug by the federal government, with no “currently accepted medical use in the United States.”
"I think curiosity is the cure," Caplan said. "As new medical grads are coming through and curious, as the adult population is curious, we are going to be driven to learn."
In the meantime, experts worry that patients suffer the consequences. Dhanabalan is concerned about people who get their state-issued medical marijuana license, but don't know how cannabis could interact with other drugs.
"My whole message has been, 'Please become an educated customer. Become an educated consumer,'" Dhanabalan said. "And this goes for health care providers. The whole health care system we belong to has its issues right now."
