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Special circumstances
Some patient-care
situations deserve special mention, as they present unusual complexities or
problems.
Should a patient's
medical cannabis use be questioned, some presentations or diagnoses are
particularly likely to be challenged by school, probation or law enforcement
authorities.
Psychiatric Patients
Psychiatric diagnoses,
particularly if unstable, are likely to raise this kind of "red flag." In such cases, it is important to have a good history of the efficacy of
cannabis for the patient. Approval of the therapist is desirable; next best is a
significant other who can attest to the patient's condition being improved by medical cannabis use.
Minors
The recommendation of
medical cannabis use to minors is an area of controversy. As in all of medicine,
one must make a risk/benefit assessment.
The developmental needs
of adolescents and children suggest that cannabis use should be discouraged,
unless, as would be true in a person of any age, the medical benefit obtained
outweighs the risk. Recommendations
for medical cannabis for minors should be issued conservatively, and evidence of
effectiveness should be well-documented, as should be parental consent.
Elders and/or naïve users
Many elders have never
been exposed to a social environment in which cannabis is used recreationally.
For these patients, as well as for any naïve or first-time user, the
psychological effects may be disturbing. The extensive report on medical
cannabis prepared by the National Academy of Sciences Institute of Medicine in
1999 suggests that "for some patients-particularly older patients with no
previous marijuana experience-the psychological effects are disturbing (p. 4)."
In the years following
the legalization of cannabis for medical use, only a small fraction of patients
seeking physician approval have been cannabis-naive. At least 90 percent
of those seeking approval from CCRMG-affiliated physicians already know that,
for them, the benefits outweigh any adverse effects. More naive patients can be
expected to inquire about cannabis as a treatment option as favorable research
results from Europe are reported in the literature.
How will the naive patient learn to use
cannabis?
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An additional question in
relation to the inexperienced user is that of how the patient will learn to use
cannabis.
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Who is available to teach the patient?
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Will an informed,
experienced user be available when the patient first tries medical cannabis?
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In what form will the
patient ingest cannabis?
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Does he or she understand
the concept of titration of the dose?
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Is there a protected
environment available to the patient for his or her initial and subsequent use?
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How should the patient be
counseled about the possibility of unwanted effects?
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What precautions or
preparation should the patient be advised to use?
PRIOR ARTICLE: Issue of
Confidentiality CONTINUE:
Conclusions
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| Input to the Medical Board
of California by year: |
| 2004 |
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May 7,
2004 -- Transcript |
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Various question raised to the MBC. Comments on MBC positions. |
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| 2003 |
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May 8, 2003 |
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Defining standards of care, complaint initiation and
responsibility |
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