Dr. David Casarett was well into his career as Chief of Palliative Care at Duke Health when a patient asked him about marijuana. Not for recreational use, but for medical purposes.
He was treating an older woman who was suffering from pancreatic cancer and she asked if medical marijuana might help ease her pain, nausea, and vomiting. Right then, Dr. Casarett, author of more than 100 journal articles, including in JAMA and The New England Journal of Medicine, realized he didn’t know the answer.
In fact, he knew very little about the medicinal benefits of marijuana. Medical school had not trained him to discuss remedies such as cannabis and cannabidiol with patients.
In the years to come, Dr. Casarett set about studying the risks and benefits of medical marijuana and non-psychoactive extracts such as CBD. Again, he made a realization:
“A lot of the patients I talked with who turned to medical marijuana for help weren’t turning to medical marijuana because…they thought it was a wonder drug. They turned to medical marijuana because it gave them control over their illness. It let them manage their health in a way that was productive and efficient and effective and comfortable.”
According to Dr. Casarett, medical marijuana empowers patients in ways traditional medicine does not. Patients can choose when to treat their symptoms and at what dose and frequency. Essentially, they are in control.
Dr. Casarett believes the medical community can learn a lot from those who use and prescribe medical marijuana by understanding what draws patients to cannabis products in the first place. Specifically, what is the medical marijuana community doing that mainstream medicine isn’t? And why is the element of control so central in treating chronic illness?
Dr. Casarett explains that medical marijuana, whether prescribed by a doctor or sought out in dispensaries, falls within the “patient-centric care” movement, where patients feel more involved in their treatment plan.
For example, dispensaries tend to engage more personally with patients by asking questions about who they are, where they work, their medical goals, their hopes, and their fears. This creates a human connection where patients feel that their interests are considered and understood.
There’s also a feeling of communal support in the medical marijuana field. Patients talk with each other in waiting rooms and share experiences, suggestions, and advice online. Similarly, dispensary employees have the ability to spend more time engaging with customers, answering questions, and explaining the nuances of each product.
While Dr. Casarett sees the move towards medical marijuana and patient-centric care as positive, he is not advocating that patients should dictate their management plans for serious chronic illnesses. Nor is he saying that patients should be able to decide the dosage and duration of prescribed medication such as painkillers.
Instead, he sees opportunity to learn and adopt patient-centric practices from the medical marijuana community and improve health services.
He offers the same words of caution to those who staunchly advocate for marijuana, warning against painting an exaggerated picture of medical marijuana’s curative properties. The fact remains that the marijuana industry is revenue-driven, just like any other business.
For example, misleading marketing claims can make medical marijuana seem like a wonder drug that can cure everything from a headache to cancer. While evidence does suggest THC can treat pain and nausea, marijuana products are not without potentially serious side effects. He is concerned that the enthusiasm around THC products creates an almost evangelical devotion among supporters, leading to an abundance of health claims without conclusive scientific evidence.
He also points out that there is no overarching authority regulating the medicinal marijuana industry and encourages patients to vet their sources thoroughly.
“If you turn to the Internet, almost by definition you’re turning to bad sources of information,” he says, adding, “It’s a wild west out there.”
There are some good sources online, but without an authoritative body regulating companies’ sourcing, marketing, and labeling, patients are left guessing where to find evidence-based information.
There is also some resistance within the medical community itself—something Dr. Casarett didn’t necessarily realize until he was presented with a question from a patient.
“I think most physicians really don’t want to have this conversation and view it as patients just looking for drugs,” he says. “And I think in some states where cannabis for recreational use is legal, that’s probably a legitimate concern.”
While new groups of doctors are starting to dedicate at least part of their practice to medical marijuana and CBD, it remains largely peripheral.
Still, the very real medical opportunities associated with cannabis and CBD continue to drive medical marijuana and the patient-centric movement. Dr. Casarett working to provide patients with evidence-based information that is accessible and transparent is a noble goal and something currently absent in the space.
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