Doctors are discovering how medical cannabis can change patients’ lives.
With cannabis being medically or recreationally legal now in more states than it is still prohibited, doctors are confronting a new paradigm.
Though used for millennia in folk medicine across the globe, America is reevaluating its relationship to the plant and what it means for not only culture but medicine.
Cannabis is still federally illegal and not evaluated by the Food and Drug Administration, and doctors cannot prescribe it. They can only give recommendations and advise patients on its usage and dosages.
Dr. Steven Ross trained in emergency medicine and served in a military medical unit during Operation Enduring Freedom and Operation Iraqi Freedom before moving to Australia, where he worked as a public hospital emergency room director for eight years before moving back home to Oklahoma with his wife, Christine.
Steven Ross and Christine Ross, who is a registered nurse, were frustrated with some of the ways medical doctors were handling recommendations and opened MMDOKC as a specialized practice.
The Rosses also have spent time traveling across Asia and witnessed attitudes toward cannabis there.
“I found that it was accepted more as medicine in some of those cultures,” Steven Ross said. “We were in Vietnam and Sri Lanka and places like that, whereas here it’s just sort of becoming that here.”
After returning to Oklahoma, Ross attended an Oklahoma State Medical Association program on medical cannabis in October.
“I went to it more out of curiosity and sort of got the idea that, ‘Wow! This is pretty wide open,’” he said. “And add to that a few things — some issues with opiates in my family, the fact that medical marijuana had led to a 25 percent reduction in opiate death rates in states where it’s been passed — I thought, ‘Any doctor will be writing this,’ but it turns out a lot of doctors are very hamstrung from writing these recommendations because of the corporations and the other issues, and then I heard that there were doctors doing it not in the ways that I thought were the best, so we decided to open a clinic and do it right.”
Dr. Erick Kaufman was born and raised in Oklahoma and then moved to Arkansas, Oregon and Missouri before returning home and eventually retiring from OU Medical Center, the place where he began his career. He came out of his 2017 retirement to open Doctors of Cannabis. He estimated he had already seen more than 1,000 patients by the end of March.
“When the law passed, it was a big surprise to me — I think probably to a lot of people — and I had people asking me, with my background and research and education and patient care, ‘What [do you] think about this?’” Kaufman said. “And I really had to say, ‘I just don’t know anything about it’ because that’s where medical doctors were. And so I took a deep dive like I do with so many things because I wanted to be able to be part of the solution to help Oklahomans get responsible, clinical, medical use in a safe and effective way. And I wanted to really help develop the best programs that we could, to have doctors participate in research, to have ongoing education and really train doctors on how to be the best that they can for the patients that want to use it — not just to help them get certified, but actually help them through the process of using cannabis as medicine.
“So that required a lot of education on my part because I didn’t know anything about it,” Kaufman said. “The more I read and the more I learned and the more courses I took, the more I came to really see that we actually do have some evidence of how cannabis works, and I understood the nature of what the research was up until that point and the things that have limited the research.”
While he has seen a wide range of patients, Ross has had very few coming in for a recommendation without a legitimate medical need. Most of them are seeking to replace other medications with cannabis.
“A lot of people are getting off medications that were not really helping them and onto one that is helping them and it’s being used medically. I still hear, ‘They all just want to be stoners.’ No. The major question I’m asked is, ‘How do I use this but not be stoned all the time?’ It’s the exact opposite of, ‘Oh, they all just want to sit on the couch and play video games.’ That is not what I hear at all. It’s just not,” he said. “Most of them come in and go, ‘Oh yeah, you know, back in my 20s, we would get high from time to time, but I’m not interested in that now.’ But they’re still interested in it as a medicine because it helps more. The other thing I hear day after day is people that are on antidepressants, SSRIs, it ends up being the same thing: ‘I’m not myself when I’m on that’, or ‘I feel vague.’ ‘I feel like a zombie. I can’t do what I usually do. It’s just not me.’ And back when I was practicing regular medicine, I’d go, ‘Well, of course. You were depressed. Now you’re not. You’re not yourself. That’s great.’ But now I get it. Now they’re saying, ‘It took away my normal interactions and I didn’t feel like my normal self.’ And because cannabis acts at a completely different receptor system, it doesn’t seem to have that effect.”
While depression is behind a large number of patient complaints, it is not the top one Ross has seen.
“Anxiety and chronic pain are probably our top two by far,” he said. “Within that, obviously there’s many different types of anxiety. There’s social anxiety, there’s generalized anxiety disorders, and so all of those have different effects and needs. And same with chronic pain. … There’s different variations, but they all tend to get just a different type of relief than they do the other medicines. And I just think it is because it acts in a completely different way.”
“Everybody’s coming from a unique place, but there’s some unifying themes that we hear. And when we break down the real reason, it often comes down to pain, anxiety disorders and sleeping trouble or insomnia. Those are actually the top three unifying diagnoses that we see most commonly,” Kaufman said. “They don’t like the prescription drugs or the prescription drugs cause side effects and they’re expensive, and they’ve tried cannabis, and they know that it helps with their pain. So although they may see it in terms of arthritis, actually what they’re really looking for is some improvement in their pain so that they can function.”
But it’s not just prescription drugs. Ross said many patients come to him to eliminate regular usage of many over-the-counter drugs, from analgesics like ibuprofen and acetaminophen to sleep aids and diphenhydramine, which is an antihistamine found in products like Benadryl.
There are also a fair number of people who have been using alcohol to get to sleep but complain about the quality of sleep they do get and are replacing it with cannabis, Ross said.
Other conditions include multiple sclerosis, cancer and nausea from chemotherapy, Crohn’s and autoimmune diseases. The medical literature is still limited on why cannabis works for those specific diseases and conditions, but physicians have a good idea of why it works.
“Nerve impulses go from nerve to nerve, and there’s a synapse with neurotransmitters that cross that and transfer it to the next nerve,” Ross said. “Cannabis acts as sort of a feedback mechanism to that first nerve. If you have your hand on the stove, you want to know you’re in pain. But if your hand was on the stove three years ago, you still don’t want the pain. But that’s what’s happening with chronic pain. And it’s a feedback kind of saying, ‘Hey, nerve! Chill; we don’t need all these signals right now.’ I think that’s why people get these effects, like, ‘Wow! This is completely different.’ Where other medications were usually trying to hit those signals as they happen, this is sort of a feedback. I really do feel this is a helpful medicine, and I do want it to be, but it’s not going to be mainstream medicine.”
Because of potential unstudied harms, Kaufman said he limits his practice to patients age 21 and older.
“Even though people that have achieved the age of 18 can get a physician recommendation, we start at age 21 because we’re concerned about young people whose brains haven’t fully developed having potential long-term side effects, delayed cognitive growth and the risk of psychosis,” he said. “Even though there’s no cause and effect, there’s a correlation between the two. And so there have been exceptions. We’re always happy to sit down with a younger person in their family and review their medical history and have an interview with him and share our concerns, but that doesn’t mean we will necessarily be recommending it.”
While Ross said cannabis is not perfectly safe, it is “very safe,” especially considering the other drugs patients are leaving behind.
“Xanax is the huge one,” he said. “Xanax and then SSRIs. Prozac, Celexa, those type. I have so many people [saying], ‘I want to get off Xanax.’ That’s what I hear. Or, ‘I used this to get off Xanax. Now I want to be legal’ is the other way I hear it. Which is amazing. Because Xanax, while it’s a prescription drug and, sure, it has its uses, it’s not ideal. I’ve always said I will debate with any pain specialist or psychiatrist the safety of marijuana versus opiates and benzodiazepines any day of the week. It’s easy. My medication does not hit the brain stem, so if they overdose, they fall asleep. What does yours do? Oh, they quit breathing.
“There are two high-quality articles that have been published in the standard medical journals that compare states that have medical marijuana programs to states that don’t, and they look at the number of opiate prescriptions written between the two states, and there’s a significant decline, about a 25 percent decline, in opiate prescriptions in those states that have laws compared to states that don’t. So in my personal experience, I see opiates as one of the main drugs that people want to get off of and substitute medical marijuana or medical cannabis. Also benzodiazepines or other sedatives. And, of course, the risk of death goes way up if you use those two drugs together because of the synergistic effect. And so we’re always happy to be in support of people who have chronic conditions that are using opiates or benzos because it’s well recognized in the medical literature that those are not the most appropriate and generally, their doctors are very supportive of them getting off too.”
While some objective medical research exists, much of what Ross has seen within his own field is inadequate or outright dismal.
“I’ve researched the medical literature, and the medical literature on this is horrible,” he said. “It’s so biased. In the proper journals, you can just see the bias in what’s written. It’s unfortunate. And so I hope the literature will evolve and actually look at it more scientifically because most of it ends up being sort of opinion papers with a little bit of science in it.”
Kaufman said the past few months have been a learning experience and he is helping shift the attitudes of his colleagues.
“I had a lunch with one of my old colleagues from the university, and he said, ‘Well, I can understand what you’re doing, but let me just ask you. How can you recommend something for which there’s no evidence that it’s helpful?’” he said. “And I said, ‘Well, first of all, we do know a lot about how the plant works. Clinical studies are difficult because of the federal law, not because people don’t understand how the endocannabinoid system works. And the only way we’re really going to get clinical research is by having doctors participate in helping patients to use it. And so I’m willing to take a lesson.’ But I said, ‘More importantly, how can you continue to write prescriptions for medicines which you know are dangerous, where there’s actually evidence of harm?’
“And that kind of opened his eyes. So I’m walking this fine line between what traditional medicine has always meant to me and to my colleagues — the science and art of medicine has been a mind-blowing experience for me my whole life — but I really enjoyed cutting-edge stuff, and to me, learning about how cannabis can be helpful and participating at the level that a medical doctor has experience with just meant a lot to me. So it’s actually kind of started as a passion project. And it still is a passion project.”