It’s common for medical conferences to take place in a golf course clubhouse. What’s uncommon is the conference starting with a bus trip down the road to an industrial cannabis grow operation.
Integrating Cannabis With Patient Care was a medical conference put on by Terra Ascend Health Network. It focused on showing doctors and health-care professionals how to integrate cannabis with patient care. The tour of a licensed growing facility was an attempt to show doctors where the plant comes from and how strict the standards are.
Medical Professionals Learn How to Grow Marijuana
The bus pulled up to a blank brick facade, surrounded by a tall fence tipped with barbed wire. Two growers appeared from a door with three security cameras hanging above it. When the door opened, the smell of marijuana poured out. As soon as the group moved into the building, they all put on shoe covers, then full body suits, hair nets and gloves.
“It’s just like the lab!” one doctor joked.
The tour itself was a step-by-step guide of how most licensed producers (LPs) grow marijuana in Canada. First, a room with mother plants—the plants growers clone to grow more flower. Then, a long room with four rows of growing, flowering marijuana plants. There were four rows, and each row produces about 16 kilograms of marijuana every few weeks.
Then, the group went to another sealed-off room where dried and cured marijuana was placed in clear bags, ready to be shipped out. There were about 25 bags in the room, each with around six kilograms of cannabis inside.
The doctors and health-care professionals listened intently to the grower. While almost everyone on the tour was either a doctor or someone who worked in a related profession, the tour focused solely on the botany of marijuana and how precisely the marijuana is cared for. Everything from the PH level of the soil to the temperature of the room was closely monitored with heavy machinery.
Doctors Get a Crash Course in Cannabis
Once the group was back at the clubhouse, Dr. Caroline Landolt a prominent rheumatologist for 25 years who has been studying and consulting about marijuana and cannabinoids for the past three years, led a crash course in cannabis. Her presentation was an overview of the entire plant, but focused on showing concrete evidence of marijuana’s benefits and how health-care professionals use it in practice.
While Dr. Landolt covered basic information for anybody familiar with cannabis, she used clinical language. People familiar with the endocannabinoid system (ECS)—the system in the human body that interacts with cannabis—may also be familiar with the two most active receptors in the brain: CB1 and CB2. Dr. Landolt took it several steps further, by explaining that these are homologous G-protein coupled receptors.
Many doctors don’t actually know that much about cannabis, and misconceptions persist even in the medical community. “We’re doctors, but we’re still people,” Dr. Landolt said. “We all carry around some old ideas with us.”
Evidence That Marijuana Works
For evidence of marijuana's effectiveness, Dr. Landolt turned to a meta-analysis of several hundred cannabis studies. The breakdown of these studies shows that cannabis has proven effects when it comes to:
- Pain
- Nausea/vomiting
- Sleep
- Anorexia
- Spasticity
These are the symptoms that cannabis is proven to help. However, Dr. Landolt acknowledged there is promising research currently being done, and that there are anecdotal stories about many other possible benefits. “These are the symptoms I focus on when prescribing cannabis,” she said.
Even though much of the evidence Dr. Landolt produced was solid, she still issued caveats. Cannabis is tricky to dose, and many of the studies didn’t control how people consumed it. There was also variability in strains that are hard to predict and account for. It’s also possible that some patients react to other cannabinoids in cannabis. Cannabidiol (CBD) and tetrahydrocannabinol (THC) are the most prominent chemicals, but other, much less studied cannabinoids still affect the body.
Dr. Landolt then discussed a template she and her team have put together for treating different ailments with cannabis. This included recommended dosing of CBD, THC and other guidelines. “CBD is where much of the medical seems to lie,” she said. When Dr. Landolt starts treating a patient with cannabis, the first step is always a low dose of CBD. She’ll up the dosage or add THC as the patient's needs call for it.
A big part of using cannabis in a medical practice, according to Dr. Landolt, is managing patient expectations. “A lot of false information exists on the internet,” she said. “People think cannabis is an answer to their prayers. It’s not.”
Some Doctors Still Have Questions About Cannabis
Dr. Landolt finished the presentation with an open invitation for questions. The question period was dominated by only a few of the most skeptical and curious doctors. Dr. Landolt answered the questions in the same clinical, factual terms that carried the rest of the presentation.
“If CBD is where the benefits come from, why do we prescribe THC at all?” One doctor asked.
“CBD does have side effects,” Dr. Landolt said. “So if a person takes CBD, but feels out of it, THC can help there.” Dr Landolt also pointed out that THC helps more with sleep, and a few other ailments more than CBD does.
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One doctor asked why all of his patients hate synthetic THC drugs like Marinol, but love to smoke or eat marijuana. Dr. Landolt took the opportunity to remind the room that there are many cannabinoids that act when people ingest marijuana. We just don’t understand them well. “It can’t all be just THC,” she said.
A running theme throughout the whole presentation was the lack of hard scientific evidence about marijuana. There’s more information now than ever before, but it’s still sparse; the legality of marijuana still makes it difficult to study.
Medical Professionals Are Coming Around on Marijuana
Despite the informational hole, the more doctors learn, the more they’re open to the possibility of integrating cannabis in their practice. Even though the hard evidence for the effectiveness of marijuana is still lacking, the trend is clear. “I get referrals now from doctors I never thought would be open to it. So, it’s changing,” Dr. Landolt said.
Photo credit: Luis Melendez
