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LAS VEGAS – Even if you do not believe in medical cannabis, be open to patients who ask you if it might benefit them, Kevin P. Hill, MD, advised.
“Being willing to talk to your patient about it is important,” said Dr. Hill, of the division of addiction psychiatry at Beth Israel Deaconess Medical Center, Boston, said at an annual psychopharmacology update held by the Nevada Psychiatric Association. “Because what will happen is, they’ll say, ‘Look. I need medical marijuana to treat my anxiety.’ Then you can say, ‘Well, I have treatments that work for anxiety that we haven’t tried.’ Maybe you can get them into treatment because of that conversation.”
In his opinion, the appropriate candidate for medical cannabis is someone with a debilitating condition who has failed multiple first- and second-line treatments. “,” he noted. “It’s not a good place to be, but now the question becomes: How do we give people what they want while addressing the risks? I think we need to do a better job of that. We can provide a service to patients and colleagues by being informed and thoughtful on the topic.”
Food and Drug Administration–approved cannabinoids to date are dronabinol (Marinol) and nabilone (Cesamet). These agents are approved for nausea and vomiting associated with chemotherapy and for appetite stimulation in wasting illnesses such as AIDS. “Your patients may come to you and say, ‘I think I need medical cannabis for condition X,’ ” said Dr. Hill, who authored the book “Marijuana: The Unbiased Truth About the World’s Most Popular Weed” (Center City, Minn.: Hazelden Publishing, 2015). “Maybe the cannabis plant can outperform the two approved agents that we have. I think we have to be open to that possibility. Maybe they offer some things that dronabinol and nabilone don’t.”
Medical indications for cannabis in various states include 53 conditions, he said, such as cancer, glaucoma, AIDS, hepatitis C, amyotrophic lateral sclerosis, Crohn’s disease, Parkinson’s disease, and multiple sclerosis. However, data suggest that most people with medical cannabis cards do not have one of those conditions. More than 50 trials of cannabinoids, including cannabis, have been conducted, “and we definitely need a lot more,” Dr. Hill continued. “About half of the studies show positive effects for chronic pain, neuropathic pain, and spasticity associated with MS.”
Resources Dr. Hill recommended for clinicians include a review that he published in JAMA (2015;313[24]:2474-83), and a review of cannabis and pain that he coauthored that was published in the journal Cannabis and Cannabinoid Research (2017;2[1]:96-104), and a free downloadable publication from he National Academies Press entitled “Health Effects of Cannabis and Cannabinoid Research: The Current State of Evidence and Recommendations for Research.” One passage from that document reads as follows: “Despite the extensive changes in policy at the state level and the rapid rise in the use of cannabis both for medical purposes and for recreational use, conclusive evidence regarding the short- and long-term health effects (harms and benefits) of cannabis use remains elusive. A lack of scientific research has resulted in a lack of information on the health implications of cannabis use, which is a significant public health concern for vulnerable populations such as pregnant women and adolescents. Unlike other substances whose use may confer risk, such as alcohol or tobacco, no accepted standards exist to help guide individuals as they make choices regarding the issues of if, when, where, and how to use cannabis safely and, in regard to therapeutic uses, effectively.”
Dr. Hill disclosed that he has received research grants from National Institute on Drug Abuse, the Brain and Behavior Research Foundation, the American Lung Association, the Greater Boston Council on Alcoholism, and the Peter G. Dodge Foundation. He also receives book royalties from Hazelden Publishing.
[email protected]
LAS VEGAS – Even if you do not believe in medical cannabis, be open to patients who ask you if it might benefit them, Kevin P. Hill, MD, advised.
“Being willing to talk to your patient about it is important,” said Dr. Hill, of the division of addiction psychiatry at Beth Israel Deaconess Medical Center, Boston, said at an annual psychopharmacology update held by the Nevada Psychiatric Association. “Because what will happen is, they’ll say, ‘Look. I need medical marijuana to treat my anxiety.’ Then you can say, ‘Well, I have treatments that work for anxiety that we haven’t tried.’ Maybe you can get them into treatment because of that conversation.”
In his opinion, the appropriate candidate for medical cannabis is someone with a debilitating condition who has failed multiple first- and second-line treatments. “,” he noted. “It’s not a good place to be, but now the question becomes: How do we give people what they want while addressing the risks? I think we need to do a better job of that. We can provide a service to patients and colleagues by being informed and thoughtful on the topic.”
Food and Drug Administration–approved cannabinoids to date are dronabinol (Marinol) and nabilone (Cesamet). These agents are approved for nausea and vomiting associated with chemotherapy and for appetite stimulation in wasting illnesses such as AIDS. “Your patients may come to you and say, ‘I think I need medical cannabis for condition X,’ ” said Dr. Hill, who authored the book “Marijuana: The Unbiased Truth About the World’s Most Popular Weed” (Center City, Minn.: Hazelden Publishing, 2015). “Maybe the cannabis plant can outperform the two approved agents that we have. I think we have to be open to that possibility. Maybe they offer some things that dronabinol and nabilone don’t.”
Medical indications for cannabis in various states include 53 conditions, he said, such as cancer, glaucoma, AIDS, hepatitis C, amyotrophic lateral sclerosis, Crohn’s disease, Parkinson’s disease, and multiple sclerosis. However, data suggest that most people with medical cannabis cards do not have one of those conditions. More than 50 trials of cannabinoids, including cannabis, have been conducted, “and we definitely need a lot more,” Dr. Hill continued. “About half of the studies show positive effects for chronic pain, neuropathic pain, and spasticity associated with MS.”
Resources Dr. Hill recommended for clinicians include a review that he published in JAMA (2015;313[24]:2474-83), and a review of cannabis and pain that he coauthored that was published in the journal Cannabis and Cannabinoid Research (2017;2[1]:96-104), and a free downloadable publication from he National Academies Press entitled “Health Effects of Cannabis and Cannabinoid Research: The Current State of Evidence and Recommendations for Research.” One passage from that document reads as follows: “Despite the extensive changes in policy at the state level and the rapid rise in the use of cannabis both for medical purposes and for recreational use, conclusive evidence regarding the short- and long-term health effects (harms and benefits) of cannabis use remains elusive. A lack of scientific research has resulted in a lack of information on the health implications of cannabis use, which is a significant public health concern for vulnerable populations such as pregnant women and adolescents. Unlike other substances whose use may confer risk, such as alcohol or tobacco, no accepted standards exist to help guide individuals as they make choices regarding the issues of if, when, where, and how to use cannabis safely and, in regard to therapeutic uses, effectively.”
Dr. Hill disclosed that he has received research grants from National Institute on Drug Abuse, the Brain and Behavior Research Foundation, the American Lung Association, the Greater Boston Council on Alcoholism, and the Peter G. Dodge Foundation. He also receives book royalties from Hazelden Publishing.
[email protected]
LAS VEGAS – Even if you do not believe in medical cannabis, be open to patients who ask you if it might benefit them, Kevin P. Hill, MD, advised.
“Being willing to talk to your patient about it is important,” said Dr. Hill, of the division of addiction psychiatry at Beth Israel Deaconess Medical Center, Boston, said at an annual psychopharmacology update held by the Nevada Psychiatric Association. “Because what will happen is, they’ll say, ‘Look. I need medical marijuana to treat my anxiety.’ Then you can say, ‘Well, I have treatments that work for anxiety that we haven’t tried.’ Maybe you can get them into treatment because of that conversation.”
In his opinion, the appropriate candidate for medical cannabis is someone with a debilitating condition who has failed multiple first- and second-line treatments. “,” he noted. “It’s not a good place to be, but now the question becomes: How do we give people what they want while addressing the risks? I think we need to do a better job of that. We can provide a service to patients and colleagues by being informed and thoughtful on the topic.”
Food and Drug Administration–approved cannabinoids to date are dronabinol (Marinol) and nabilone (Cesamet). These agents are approved for nausea and vomiting associated with chemotherapy and for appetite stimulation in wasting illnesses such as AIDS. “Your patients may come to you and say, ‘I think I need medical cannabis for condition X,’ ” said Dr. Hill, who authored the book “Marijuana: The Unbiased Truth About the World’s Most Popular Weed” (Center City, Minn.: Hazelden Publishing, 2015). “Maybe the cannabis plant can outperform the two approved agents that we have. I think we have to be open to that possibility. Maybe they offer some things that dronabinol and nabilone don’t.”
Medical indications for cannabis in various states include 53 conditions, he said, such as cancer, glaucoma, AIDS, hepatitis C, amyotrophic lateral sclerosis, Crohn’s disease, Parkinson’s disease, and multiple sclerosis. However, data suggest that most people with medical cannabis cards do not have one of those conditions. More than 50 trials of cannabinoids, including cannabis, have been conducted, “and we definitely need a lot more,” Dr. Hill continued. “About half of the studies show positive effects for chronic pain, neuropathic pain, and spasticity associated with MS.”
Resources Dr. Hill recommended for clinicians include a review that he published in JAMA (2015;313[24]:2474-83), and a review of cannabis and pain that he coauthored that was published in the journal Cannabis and Cannabinoid Research (2017;2[1]:96-104), and a free downloadable publication from he National Academies Press entitled “Health Effects of Cannabis and Cannabinoid Research: The Current State of Evidence and Recommendations for Research.” One passage from that document reads as follows: “Despite the extensive changes in policy at the state level and the rapid rise in the use of cannabis both for medical purposes and for recreational use, conclusive evidence regarding the short- and long-term health effects (harms and benefits) of cannabis use remains elusive. A lack of scientific research has resulted in a lack of information on the health implications of cannabis use, which is a significant public health concern for vulnerable populations such as pregnant women and adolescents. Unlike other substances whose use may confer risk, such as alcohol or tobacco, no accepted standards exist to help guide individuals as they make choices regarding the issues of if, when, where, and how to use cannabis safely and, in regard to therapeutic uses, effectively.”
Dr. Hill disclosed that he has received research grants from National Institute on Drug Abuse, the Brain and Behavior Research Foundation, the American Lung Association, the Greater Boston Council on Alcoholism, and the Peter G. Dodge Foundation. He also receives book royalties from Hazelden Publishing.
[email protected]
REPORTING FROM NPA 2018