August 10, 2022

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Few doctors in New Jersey use marijuana in their practice. Here’s why I occasionally do. | Opinion

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By Jill M. Giordano Farmer

I’ve never had a fascination or a particular interest in marijuana. But over the past few years my patients have come to me with questions and I made the decision to find answers. Could medical cannabis help with movement disorders? If so, how?

Many of my patients live with Parkinson’s. Others have Tourette’s syndrome, essential tremor, Huntington’s disease, and other life changing conditions. The medical interventions available vary from robust to nonexistent. And when there is little to offer, people can understand what is available.

Of all the conditions I treat, Parkinson’s disease has excellent medical and surgical interventions. But even with these established treatments, there is still a lack of relief. Many patients ask me about new options like cannabis. There’s nothing worse than having a wonderful visit to a patient – and then they ask you a question you can’t answer. I felt obliged to stay open and learn all I could about medical cannabis.

I’ve heard some professionals insist that cannabis shouldn’t even be considered medicine, and I remember thinking, “Well, why not?” In pharmacology, there’s a story of kismet with drugs and plants as well Recreational drugs that have been shown to be medically valuable.

I realized that I must explore all the ways that could alleviate the suffering of my patients. I am grateful that I participated as The Parkinson’s Alliance, a patient advocacy group, brought together Parkinson’s patients, movement disorder specialists, psychiatrists, researchers, and others concerned with cannabis and treatment strategies.

As doctors and scientists, we all want the gold standard of randomized, controlled clinical trials. The federal classification of cannabis as a List I drug – meaning there is no accepted medical use and high potential for abuse – hinders the research we need. Medical cannabis is now legal in many states, including New Jersey and Pennsylvania, and patients use it for the conditions I treat.

I understand why a doctor might refuse to work with patients using cannabis until the research is clear, but I would rather support and keep my patients interested in cannabis under my care. For me, cannabis is just another tool in my toolbox. I have open conversations with patients and I don’t propose cannabis right outside the door. I urge my patients to first try the established medical strategies that I can offer. If these strategies are not helpful or not well tolerated, we consider adding cannabis.

Most of the time, I find cannabis to help patients with non-motor symptoms, which are common in people with movement disorders like insomnia, anxiety, and pain. There is some research that shows the benefits of cannabis in these areas, so that makes me feel comfortable there. And the drugs commonly prescribed for Parkinson’s patients – benzodiazepines like Klonopin and Xanax for anxiety, and opioids like Percocet for pain – have their own side effects, especially in the elderly. One patient found that her pain decreased so much that she rarely needed the opioids she was taking.

There is isolated evidence of marijuana and tremors. Patients often tell me about videos on the internet of people who took a bite of marijuana brownie and suddenly their tremors went away. I urge my patients to take these examples with a grain of salt, and I would never suggest marijuana over established interventions. But I never belittle a patient’s decision to try marijuana or dampen their hopes. I want them to be open with me and share their experiences.

I am now sharing my own experience because I think too many doctors have shut the door on marijuana unnecessarily. In New Jersey as of July 2019, only 1,000 of the states were more than 30,000 doctors were Participation in state medicine Marijuana program. People with muscular dystrophy, multiple sclerosis, and other diseases are entitled to medical cannabis. I don’t want these patients to see doctors who focus most of their practice on prescribing marijuana. Instead, I urge doctors who are already treating these conditions to consider adding medical marijuana to their practice and be better informed. Only about 15% of my patients have tried medical marijuana and about 10% use it regularly.

Yes, we absolutely need more research. That’s why I’m on the Advisory Board Cannabis Education and Research Institute (CERI), which is committed to advancing unbiased medical research and credible information about medical cannabis. And I believe the federal government needs to change the classification of marijuana and open the door to quality research.

In the meantime, we have patients who are currently suffering and who may benefit from medical cannabis. As doctors, we have to be there for them.

Dr. Jill M. Giordano Farmer is a member of the Advisory Board of the Cannabis Education and Research Institute (CERI) and Director of the Parkinson Disease & Movement Disorder Program at the Global Neurosciences Institute. She is a neurologist and lives in New Jersey.

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