With recreational marijuana dispensaries becoming more common across the country, the benefits of medical marijuana could be neutralized. How can doctors and dispensaries make sure the benefits of medical marijuana are still felt in a post-legalization nation?
The legalization of recreational marijuana has become a hot button topic in politics, with 18 states and Washington, DC, legalizing1 the use of recreational marijuana as of 2021. New Jersey and Connecticut have both announced the opening of recreational marijuana dispensaries in 2022, with New Jersey dispensaries opening on April 21.2
With 37 states already legalizing medical3 marijuana, including the aforementioned 18, it stands to reason that the way that medical marijuana is prescribed and dispensed will change. With medical marijuana proving to be a valuable pain medication among other uses, how can doctors, dispensaries, and marijuana consumers help prevent the medical benefits from becoming less effective with increased recreational consumption?
Medical Marijuana: A Valuable Medical Industry
With both forms of marijuana becoming more common and accessible, it’s important to note the differences between them. Recreational marijuana is entirely made of tetrahydrocannabinol, or THC,4 a chemical compound that binds to receptors in the brain that control pain and mood among other feelings. Medical marijuana is usually made up of THC to ease symptoms of multiple sclerosis, nerve pain, Parkinson disease, and nausea among others. Cannibidiol, or CBD, is often taken for medical uses such as Crohn disease, anxiety, arthritis, diabetes, and insomnia among others. However, there is limited evidence that CBD is helpful in any of these areas.
“The main difference between medical and recreational use is the end desired result and how it is consumed,” said Gregory Carter, MD, MS, a doctor at Providence Medical Center in Spokane, Washington. “Medical users seek relief from a symptom and would typically use edibles…whereas recreational users often will smoke with the end result of getting high [or intoxication].”
Medical marijuana requires state registration before a prescription is written and can be used; approximately 5.55 million United States citizens were registered for medical marijuana use in 37 states as of 2021. With several states without legalization of any form of marijuana, the benefits of medical marijuana cannot be utilized for all United States residents.
Mitchell Prywes, MD, medical director at the Center for Pain Rehabilitation, said that marijuana doesn’t have the capability of mortality overdose the way that opiates do, which makes it an appealing medication to prescribe for pain.
He also said that the endocannabinoid6 system is an ancient regulatory system of the body found in mammals which synthesizes marijuana-like chemicals that activate receptors to maintain homeostasis in the body; medical marijuana similarly activates those receptors.
Although future research is needed, this relationship demonstrates how instrumental marijuana is and can be to treating numerous medical conditions. But with legal recreational marijuana on the rise, can the effectiveness of medical marijuana be reduced?
Recreational Marijuana a Potential Medical Disruptor?
Marijuana had limited legality in the United States prior to 2012, when Colorado and Washington became the first7 states to fully legalize marijuana. California was the first to legalize medical marijuana in 1996. The legalization of marijuana across the country has been rapid in the past decade, with 35 states following the lead of Colorado and Washington in 10 short years. South Dakota, New Jersey, Arizona, and Montana passed voter-backed laws to legalize recreational use as recently as 2020.
However, this recent boom in the recreational marijuana industry has hurt the medical marijuana industry, according to Jordan Tishler, MD, president and CEO of Inhale MD and founder of the Association of Cannabinoid Specialists.
“The industry wants to treat everyone as a recreational user and would like to marginalize physician care and oversight. This is all in an attempt to sell the most cannabis they can,” he said. “The result of their approach is larger sales, escalating tolerance, and eventually the likely development of cannabis use disorder.”
Tishler said that many recreational users develop symptoms that could be effectively treated by medical marijuana. However, their previous use of marijuana often leads to so much tolerance that medical marijuana is no longer effective, which he says is happening more often now that recreational marijuana is legal.
According to WebMD,8 a break from marijuana products for 3 weeks could help reset tolerance to the drug. However, in patients who take marijuana regularly for medical reasons, this may not be possible and can present problems.
Tishler also said that some dispensaries, both medical and recreational, are giving out medical advice that they are not qualified to give in order to sell more marijuana products. “What really upsets me is when I meet a patient who was cannabis naïve 6 to 12 months ago but now, via recreational self-medicating, has gotten themselves behind the eight ball,” he said.
Recreational marijuana legalization has proven to be a new roadblock in the effort to make medical marijuana a legitimate treatment for patients of all ages. Finding a way for both kinds of dispensaries to work together and coexist may be a vital to ensuring effective medical treatment.
Working Together: What Does It Entail?
How can medical and recreational dispensaries work together to make sure that all consumers of marijuana, on both a medical and recreational level, get what they need without over-consumption or eventual high tolerance coming into play?
Tishler suggests that marijuana should have a dispensing system that acts more like a pharmacy. “We need to be able to, and be required to, write an actual prescription and know that the dispensary will honor it as written,” he said.
In Connecticut,9 pharmacists will be available on site in hybrid and medical dispensaries once recreational dispensaries open later this year.
“We were one of the first states to create a pharmaceutical model, which means that the 4 producers in our state are set up like pharmaceutical companies and they have to meet very high quality standards,” said Prywes. “And similarly, all dispensaries are treated like pharmacies and required to have licensed, trained pharmacists.”
This step is one way in which states can make sure that a focus on the health and safety of their consumers is a top priority. However, this requirement isn’t found everywhere. Which emphasizes the importance of communication between marijuana users and physicians trained in the use of medical marijuana to ensure that the right choices on dosage and medication are made.
Prywes said, “It must start with a true doctor-patient relationship….Having a doctor-patient relationship means you’ve thoroughly evaluated the patient, you understand what they’ve had, what they haven’t had, what their experience has been….It’s not a rubber stamp.” He said that these open conversations can also potentially exclude medical marijuana for patients who have a history of drug or substance abuse.
Tishler also said open conversations between patients and doctors about marijuana use in a non-judgmental manner can help patients get properly assessed for potential medications, starting with doctors taking the initiative in medical marijuana.
“Front-line clinicians need to start suggesting cannabis to their patients proactively instead of reaching for more dangerous [such as opioids] or less effective [such as gabapentinoids] alternatives….We need to start volunteering so that our patients get the care they need,” he said.
He also said that clinicians referring to cannabinoid specialists, much in the same way that you would refer patients to a cardiologist or dermatologist, could help make sure that patients are getting the proper cannabinoid care.
The ease of access can make it easy to consume more recreational or medical marijuana than is beneficial, which is why proper guidance by health care professionals alone, initiated by both parties, can get patients the health care that they need while also preventing over usage or not getting the care that they may benefit from.