How to Ask Your Doctor about Trying Medical Marijuana for Pain
Do your research on CBD and THC and be honest about why you may want to try cannabis for pain.
Doctors and patients alike may feel unsure of how to approach the subject of medical marijuana, or cannabidiol (CBD), as part of a pain management strategy during a clinical visit. While many physicians believe that cannabis can offer a legitimate medical therapy, one-half of primary care physicians (PCPs) surveyed in a new study either were not ready to or did not want to answer questions from patients on this topic.
Given the current concerns about overprescribing of opioids and efforts at all levels to reduce the number of individuals who may misuse, abuse, or overdose from these drugs, 1 clinicians and patients are looking for other treatment options when it comes to managing chronic pain and related symptoms. In February 2019, the World Health Organization (WHO) proposed “rescheduling cannabis within international law to take account of the growing evidence for medical applications of the drug, reversing its position held for the past 60 years that cannabis should not be used in legitimate medical practice.” 2
Despite this move, many knowledge gaps remain around marijuana for medical use, including how the body’s endocannabinoid system works (that is, the group of compounds naturally synthesized by the body that activate the same receptors as delta-9-tetrahydrocannabinol, also known as THC, which has psychoactive properties). Other knowledge gaps include the actual benefit of cannabis on a range of conditions; the optimal dosing and delivery methods (there is no consensus to date on starting strains or doses so “low and slow” is often advised); and potential side effects, interactions, and toxicities, including long-term use of the substance.
The questions are urgent enough that the National Academies of Sciences, Engineering and Medicine (NAM) undertook a priority comprehensive review of recent medical literature on the health effects of cannabis and cannabinoids. 3 Its report focused on 11 areas, among them therapeutic effects, cancer incidence, cardio-metabolic risk, respiratory disease, injury and death, and problematic cannabis use. The committee identified and prioritized a number of gaps and barriers to research. Add to this the fact that most doctors simply are not taught about cannabinoids in medical schools (continuing education courses and professional certificates in this field are growing, but the subject is still missing from the basic clinical curriculum). In a survey, two-thirds of medical school deans reported that their graduates were not at all prepared to prescribe medical marijuana and one quarter reported that their graduates were not at all prepared to answer questions about medical marijuana. 4
So, how should patients go about raising the subject of medical marijuana use for pain management and related symptoms, such as anxiety or disturbed sleep? Below are a few recommendations. *
Being honest with your doctor about wanting to try opioid alternatives such as medical marijuana, or cannabis, may open new doors to relieving your chronic pain. (Source: 123RF)
Catch Up on Cannabis Research for Pain
Start by doing your homework. Become familiar with some of the evidence for using medical cannabis for pain management, particularly which types of pain appear to respond better to the substance. Also, develop a basic knowledge of the key components of cannabis (eg, THC and CBD) and how they may affect the body, as well as available forms in which medical marijuana, cannabis, and hemp (which is a different plant and contains 0 to 3% THC) may be available (see details in “Navigating Cannabis Options for Chronic Pain”). Organizations like Patients Out of Time and the Marijuana Patients Organization, and mobile apps such as LEAFLY, also offer good resources.
Once you’ve done some research, David Bearman, MD, recommends printing it out and showing to your physician to get the conversation started. Dr. Bearman specializes in pain management and has more than 50 years of experience in the substance abuse treatment and prevention field. He serves as vice president of quality assurance and credentials at the American Academy of Cannabinoid Medicine. Ask if medical marijuana may be an option for you. If your physician is unwilling or unable to discuss cannabis as a pain treatment option, Dr. Bearman advises asking for a referral to a local physician or clinic that is knowledgeable about treating patients with medical marijuana.
Share Your Personal Experience with Marijuana
In a recent PPM online poll, just over half of respondents said they had tried medical marijuana to alleviate chronic pain or related symptoms (See the full results).
Be up front about whether you’ve tried cannabis for pain already. Did it help? What form did you use and how much did you take? This transparency will only help your doctor understand your specific experience, but also evaluate the risks and harms of medical marijuana given your full health picture — including other pain medications, like opioids. (Read how one patient uses a journal for her medical marijuana use in treating fibromyalgia and related symptoms. And see what other types of natural plants may help with chronic pain).
Move Forward with Caution
Finally, be vigilant. The evidence around the safety and efficacy of THC and CBD is still being researched. Studies to date have associated marijuana use with increased risk of death from hypertension, higher rates of acute ischemic stroke, and respiratory issues when used long-term. Potential harms in patients with psychotic and mood disorders have been increasingly documented. There may also be a link between marijuana use and the development of a substance dependence or abuse disorder with other substances including, alcohol, tobacco, and illicit drugs. 5-9
*These tips do not represent official nor medical advice nor clinical recommendations. Learn which states have legalized medical marijuana and always speak with your doctor before trying any new cannabinoid product.
Doctors and patients alike may be hesitant to discuss medical marijuana, or cannabidiol (CBD), as part of a strategy for relieving chronic pain. Here's how to get the conversation started.