By Allie Haroutunian
The National Pain Report recently spoke with cannabis doctors Dustin Sulak, DO (Doctor of Osteopathy) out of Falmouth, Maine and Michelle Sexton, ND (Naturopathic Doctor) out of San Diego, California.
Medical Cannabis Doctors and the Appointments
Despite what you may have heard, docs who prescribe marijuana for chronic pain (and other maladies) are just regular doctors who treat patients with a variety of ailments. What makes these doctors different is they happen to recommend cannabis to their patients.
Allie: “You are a doctor that recommends and has medical marijuana patients come to see you. I read that you were one of the top doctors, most popular, in Maine.”
Dr. Sulak: “I had to learn very quickly to serve this unmet need in my community. A lot of the learning I did at first — seeing hundreds and thousands of patients — was just around listening to what people were doing with cannabis and looking for patterns around what was working and what wasn’t working. Very quickly I found that it was helping a lot of people with such a wide variety of different conditions particularly chronic pain.”
“It [chronic pain] is very common in Maine…and everywhere, although I think we have more than our fair share of it up here due to things like Lyme Disease and Vitamin D deficiency. There’s a lot of pain everywhere, and I spend consistently about 70% or more of my practice treating chronic pain.”
“Cannabis is an incredible treatment especially considering how few effective treatments there are in the current medical arsenal — in the pharmaceutical, and surgical and even more conservative measures like physical therapy, and manipulation. They all have their place, and they all have something to offer but it’s very clear to patients and doctors alike that chronic pain is a big problem that we don’t have an effective solution for. So I saw it working well for that and other conditions. I like being on the frontline of a new type of treatment that has such a good safety profile.”
National Pain Report: “Do you find you have to be careful in any way beyond normal practicing procedures as a recommending doctor?”
Dr. Sexton: “Not really, I think if you’re just following standard practice guidelines for any way that you would treat any other patient…that you see the patent in person, that you perform a physical exam where it’s indicated, you get all of their relevant medical history including the history of the present illness, you get family history, you get a list of what drugs they’re on — supplements, you do a review of all their systems. I mean, this is how you treat any other patient, so it’s no different for cannabis. The only specific thing, you would probably have them sign an informed consent document, because it’s federally illegal and they need to understand that. And I think patients also need to understand that often there’s no quality control or quality assurance of these products so you know you can’t hold the physician responsible for the [medical cannabis] industry who’s not performing analyses like they should.”
National Pain Report: “Is it true that Physician members have to be physicians licensed, healthcare providers in good standing that can issue cannabis recommendations wherever they are?”
Dr. Sulak: “Yes, Definitely. Because there are many unknowns we have to be cautious. For example, we have evidence that cannabis can both improve and worsen liver fibrosis and hepatitis C. So we need to evaluate those cases carefully to make sure that we’re not doing harm. To go along with that example, it can help them with fatigue, joint pain, nausea, and abdominal discomfort that is caused by the hepatitis, but while doing that THC can be increasing scarring in the liver. Could be…it depends. We have some evidence that it does when there’s active inflammation. Same thing with mental health. Those are cases where we have to exercise a lot of caution. Cannabis when it’s used in the right way can be very helpful for PTSD, anxiety, bipolar, even schizophrenia and other forms of psychosis but it can also make those conditions worse if it’s used in the wrong way.”
National Pain Report: “I’m getting the sense that there are distinguishing factors between the “real” doctors — the medical doctors who are investigating cannabis — and [those doing it] as a side thing.”
Dr. Sexton: “Definitely. One of our practice guidelines is that you have a face-to-face visit with the person. And I can tell you from experience my own partner who has a cancer diagnosis went to get a recommendation and there was not even a doctor on the premises. There was no exam, there was no review of medical records. It was walking in and paying the fee and walking out given a piece of paper that said here’s your recommendation you can use cannabis in California. Keep in mind is that it’s rapidly changing.”
“There is a new demographic of patients that are interested so they want to see a bona fide doctor who is going to review their records, is going to examine them, give them a treatment plan and follow up with them on the cannabis, and continue to guide them.”
National Pain Report: “In your practice how do you safeguard against different interactions with medications, and different ailments that may not be helped by cannabis?”
Dr. Sexton: “Well, it’s in taking the complete medical history, and part of that is getting a list of any medications that they’re on, and then doing diligence to find out if there’s going to be a drug interaction via the metabolizing enzymes in the liver or not, or some other physiologic. So for instance, take an elderly patient on a blood pressure medication; cannabis will dilate the blood vessels and lower blood pressure. In that case they need to be educated that this is a potential side effect, that they could have a hypotensive effect; you tell them how to avoid it — you monitor their blood pressure medications, monitor their blood pressure. If they stay on cannabis they may be able to come off of the blood pressure medication.”
More from these interviews will be published in future blogs by the National Pain Report.