Month: January 2020

An integrative medicine perspective on why patients turn to cannabis, the biggest medical cannabis myths, and how to talk to your doctor about cannabis as a treatment option

Medically reviewed by Katherine Golden, RN
Written by Denise Rustning

The Leaf411 cannabis nurse hotline partners with healthcare providers and cannabis industry members to expand our education outreach and increase awareness around the safe use of legal cannabis. We’re proud to periodically spotlight our supporters here.

David Gordon, MD, founder of 4Pillars Health & Wellness, was an early supporter of Leaf411, and serves as one of our Advisory Board members. Dr. Gordon, better known as “Dr. Dave,” is the creator of the 4×4 Lifestyle Plan, offering patients an alternative to conventional medical treatment. His approach addresses food, movement, relaxation, and community to help patients transform their lives.

At Leaf411, we take our ethos (kindness, professionalism and caller loyalty) very seriously. Dr. Dave fits in with our organization so perfectly, from his devotion to his profession to his loyalty to his patients. We are honored to have Dave be a member of our Advisory Board and give him this spotlight. 

Leaf 411 COO Jennifer Axcell recently sat down with Dr. Dave learn more about what brings patients to cannabis, the questions and misconceptions he hears most often, and what he wishes other providers knew when it comes to advising patients on how to use cannabis.

Q: When do people typically come to you? How many other treatment options have they tried beforehand?

People have definitely already tried a lot of other options. This is true not only with cannabis, but also with an integrative approach in general.

In the cannabis space specifically, far and away chronic pain is the most common thing that we see. These are people who are still in pain despite them getting opioids or other medications. They’re still in pain despite going to physical therapy. They’re still in pain despite having surgeries and injections. They’re still suffering.

They’re definitely also tired of the risk and side effects of some of the other therapies when it comes to chronic pain. Certainly opioids—we hear about that a lot. But the risks and side effects of less toxic pain medications are underappreciated, whether it’s the ibuprofen class of meds or even Tylenol for that matter.

The biggest thing for people with chronic pain is that they’re not getting better. They’re not trying to avoid medicine. They’re really just trying to get relief that they haven’t had with other things.

If opioids were allowing people with chronic pain to feel great and be pain-free with high quality of life, these people wouldn’t be searching out cannabis.

We also see patients for lot of other conditions that standard medicines don’t treat well, be it sleep, mood disorders, or psychological symptoms. These are things that our current meds don’t do a very good job with.

Q: Is there a certain type of person who’s more likely to come to you? Is it the senior group, because they have more chronic conditions? Younger people who might be more open to cannabis? Or does it run the gamut?

The people who come to me really run the gamut, but they fall into a few categories.

A lot of people have figured out through experience that cannabis works better for them than other things. They’ve done the research and they know it’s safe. This is the average healthy person who has pain from sports injuries. It’s also the waiter or waitress or auto mechanic who comes home exhausted with pain and stiffness from work. They just want something to help their pain, help them relax and get to sleep easier. They don’t want to take a bunch of ibuprofen and Benadryl to go to sleep. They find that with a little bit of cannabis, they can relax, their pain is gone, and they fall asleep easily. This population just uses a small amount of cannabis in the evening. They know it’s more effective and safer than a lot of alternatives.

There’s also a big group of patients who have been dealing with various issues for years, and who are just sick of all the side effects and drug interactions. They want safer options. They might have been told they can’t take a variety of medications, or they’ve had side effects. These patients are looking for something they haven’t tried before because they have low quality of life. This is typically the senior population.

There’s a third patient group, the chronic pain population. The chronic pain may be related to an injury from a car accident or disc injury, or it could be non-injury related. Some patients have central pain issues like fibromyalgia, irritable bowel, irritable bowel syndrome, chronic pelvic pain, these kind of nebulous pain syndromes. That’s where you get the patient who says, “I haven’t had a good day in 25 years no matter how many meds I’ve taken.”

Q: What are the top three questions about cannabis that you get from patients?

These days, one of the top patient questions is about the different chemicals in cannabis, specifically THC and CBD. What is CBD? What is THC? What’s the difference?

Another common question is how best to administer cannabis, whether you’re talking about inhaling or eating or topical. People always want to know what’s the best.

Also, for patients who are new to cannabis, their questions involve safety, side effects, and interactions with other medications.

Q: What are some of the biggest misconceptions you hear from people, when it comes to using cannabis for health purposes?

New users often assume that using cannabis means that they’re going to be so high that they can’t function. That’s far and away the biggest misconception. I might explain to them that we’re going to use certain cannabis compounds that don’t cause any intoxication. Even if we’re using THC, the one compound that can cause intoxication, we might be starting it at a dose that they’ll barely notice or not notice it at all.

Also, a lot of the cannabis propaganda that people have heard over time is just wrong. The perfect example is when someone asks, “Is cannabis going to cause me to lose my brain cells?” Or they are worried it will cause early-onset Alzheimer’s. No, actually, the science shows that cannabis is probably going to protect your brain. We know that both the cannabis THC and CBD compounds protect brain cells. And there’s good evidence suggesting that they may reduce the risk of dementia.

Another misconception I hear is that cannabis is super-addictive. People just assume it’s a highly dangerous, addictive drug like heroin or cocaine, based on the propaganda they’ve heard. I share the actual information that’s out there in the research showing this propaganda is not true.

People also tell me, “My doctor told me there’s no research. There’s no science showing cannabis works.” (Dr. Dave responds to this misconception below.) 

There are a lot of myths about cannabis—the list goes on. But those are some of the main ones that people come in with preconceptions about.

Q: At Leaf411, one way we’re answering that concern about research is with our online Leaf Library. How do you answer questions about research, beyond saying “trust me”? 

My response varies between patients based on how they learn and what they want to know. We have different levels of research. You know, we have research that’s done in the lab that shows how and why cannabis works. And then we have research in animals showing its benefit. We also have research in humans, but the research in humans often isn’t as robust as we have for other medications because of the restrictions.

But I also remind people that most of what happens in a regular conventional medical office is also not supported by gold standard research using large-scale double-blind trials. Most conventional providers’ practice is based observational studies or recommendations, the exact same kind of research we have for cannabis, as well.

Evidence-based medicine is not just picking one study and saying, “Here’s the evidence. This is what we do.” Evidence-based medicine is combining the best research and science we have with our patients’ experiences, and with physicians’ experiences. And using those three aspects to make decisions that are best for a given patient. That is true evidence-based medicine. 

Q: From the patient perspective, when is the best time for someone to talk to a cannabis physician?

I am a little biased, but I think early on is best. In a perfect world, everybody would get guidance, even people who are knowledgeable about cannabis.

When I see a patient who tells me they’ve used cannabis for 25 years, there’s still information that I can provide to really optimize their treatment.

When we’re talking about the person who is new to cannabis, I think early is best, ideally before they use it or within the first month. 

My biggest concern with a new cannabis patient is that they’ll have a negative experience early on due to the product they tried or using too much. 

It’s not dangerous but they felt uncomfortable. That creates a negative association. We know in all treatments, someone’s initial experiences play a huge role. We want to avoid negative experiences early on, because that makes future treatment more difficult.

I think all people need some education early on how to use appropriate dosing and appropriate products to minimize negative experiences. And a lot of that’s just starting really low. I don’t think the industry facilitates that in the way they package and label products, and I don’t think budtenders facilitate that. Most people working in dispensaries are cannabis users, and probably have higher tolerance than someone who is new to cannabis. They may not understand low dose concepts like building up the dose slowly.

I don’t think someone necessarily has to see a doctor, but they should get guidance on the concept of starting low. This could come from an educational resource like Leaf411. 

Obviously, seeing a cannabis doctor can increase the likelihood that the first thing the person tries will be effective. Talking to any knowledgeable healthcare provider makes it more likely that someone will find the most effective dose or product sooner. 

Q: How do you guide patients to talk to their primary care doctor, knowing that there is resistance and lack of knowledge among some providers?

I recommend that patients start by sharing their personal feelings and goals.

Don’t just say, “I’m using cannabis, deal with it.”

Instead, maybe say, “Hey, I’ve been really struggling with this. You know that we’ve tried many things and I haven’t been getting optimal results. I’ve tried this new thing. It’s really helping me. I’d really like to stick with this because I’m feeling better.”

If the doctor hears the patient articulate that they’re doing well and they’re achieving their goals, but they’re not willing to support that—I mean, I usually tell patients that’s the time you need to think about getting a new doctor.

If a doctor doesn’t know something and says, “Okay, I’d love to learn more. How can I support you?” that’s okay. They don’t need to be a cannabis expert. 

I wish that every doctor understood the low dose concept. If a patient said, “I want to try cannabis,” the doctor’s response would be, “I don’t know anything. But all I know is that you start with one or two milligrams and go up every few days.” If every doctor just knew that, that would be outstanding.

Q: Many people in the cannabis space have a story. What’s yours?

My story is not so much a personal story. For me, it’s really just seeing what worked with patients and what didn’t work.

I always wanted to be a doctor and enjoyed the sciences, and started on a pretty straight path going to medical school. I had no exposure to integrative medicine or anything beyond standard medicine throughout my training.

I started my own practice right out of residency, a general internal medicine, primary care practice. Paying attention to patients and how they were doing, I realized what I was taught didn’t work very well. I was doling out medicines left and right, and yet people were not getting better. Even if their numbers got better, I would see them keep coming in with side effects and new issues.

Within the first year or two of practice, I decided that I needed better tools. I started learning more about nutrition and root causes of health issues, and expanded into integrative practice where I had a bigger toolbox. I partnered with patients, spending more time with them to find out what their triggers were. Then, I incorporated new tools, using other practitioners, chiropractors, psychologists, physical therapists, and acupuncturists. I also taught myself more about nutrition and incorporated that piece as well. Patients really got better using those modalities.

Once cannabis was legalized in Colorado, I immediately had patients coming to me and saying, “Oh, I’ve already been using cannabis for my pain,” or “I’ve been using cannabis for sleep,” or for other conditions. Patients asked, “Will you authorize my medical card?” These were patients I knew and trusted, and so I signed off on that.

After hearing similar stories from many patients, I thought I should try to learn about cannabis beyond just signing off on it. When I looked into things, I was blown away by how much information was already out there about the endocannabinoid system and cannabis. At the time, there were a few decades of research showing what cannabis does, why it works, and how people were benefiting from it.

I saw this firsthand in my practice, as well. When patients were struggling, I looked at using cannabis as a bridge to help them get better so we could implement other dietary and lifestyle measures. Cannabis was just one part of my toolbox.

My story has really been focused on what’s best for the patient. That’s what led me to general integrative medicine, and to cannabis specifically.

This interview has been edited for length and clarity.

For More Information

You can learn more about Dr. Dave and 4Pillars Health & Wellness here. Dr. Dave provides in-person, phone, and video consults for people seeking guidance and education on cannabis as well as other integrative health practices to improve overall health. He also offers office appointments for Colorado residents seeking a medical marijuana card.

The Leaf411 cannabis nurse hotline is proud to have supporters like Dr. Dave. Our nurse team depends on our medical advisors to take our callers to the next level of care that is outside our scope of practice and Dr. Dave can do just that. He takes in-person, phone, and video consultations from all over the country. We are proud to list his practice as a resource for our callers.

We recognize that not everyone may have the resources to visit a cannabis doctor. That’s a big reason why we set up our hotline as a free service available to anyone, anywhere, regardless of their insurance coverage or ability to pay.

Do you have questions about using cannabis for a health concern?

Would you like to learn more about the low dose concept?

Call 844-LEAF411 (844-532-3411) for answers from our cannabis-trained registered nurses.