Cannabis medicine transformed my patients’ lives

When I was doing my medical doctorate back in 2005, medical cannabis had already been legal in Canada as a prescription medication since 2001,yet I was never taught anything about the endocannabinoid system, let alone the fact that physicians were prescribing herbal cannabis in the country where I would soon practice. Despite its legality, medical cannabis was frowned upon and discouraged by the conservative physician licensing bodies. I later became an American Board sub specialist in Integrative Medicine yet even with this, the highest possible level of training in evidence-based natural medicine, cannabis sativa as a medicinal plant was barely mentioned.

But, I first discovered it through my patients in a small surgery practice in British Columbia where at least a third of my patient population were growing their own plants and using it for things like menstrual cramps, chronic pain, fatigue, palliation for cancer pain and to avoid needing high doses of opioids. Because of my openness to herbal medicine they began to tell me how they were using the plant and I was able to partner with them and learn from them and also advise them on harm reduction and possible drug/herb interactions. This was my initial introduction to the practical medicinal uses of the plant in a community who had been using it for many years already, without the help of conventional medicine doctors. Then in 2015 I had an accident that left me with permanent nerve damage in my left hand and I refused to take the pregabalin and painkillers recommended to me as a ‘long term’ pain management plan by multiple surgeons and well meaning physicians.

Instead, I focused on my mindfulness based stress reduction practice (MBSR) and my other mind/body tools I had learned to help manage the quite persistent burning pain but was still struggling with it when I attended our annual American Integrative Medicine (AIHM) Conference in San Diego. I met a colleague who was using medical cannabis with his patients and he introduced me to one of the legal vendors there who gave me a sample pot of topical cannabis balm to use on my hand for the week whilst in California.

At first I was quite sceptical but I dutifully applied it a few times a day and by the end of the week, my near constant nerve pain and the night pain keeping me awake had reduced by about 80%! This experience was the final push I needed to start adding medical cannabis to my practice and shortly after, I accepted the offer to join a colleague’s practice in a referral only cannabinoid medicine clinic as the integrative medicine consultant for difficult cases. I took all the cannabinoid medicine training available and read all the cannabis medicine research papers I could find. My herbal medicine knowledge really helped me to understand how to use the plant in its various forms and the art of finding the right strain, dose and application for each patient.

I also learned an immense amount from my patients who enthusiastically partnered with me on this journey, many of whom who had never tried cannabis. They were looking for a better way to manage their chronic pain and medical symptoms that had failed other medications or had them ended up on many drugs with serious side effects including high doses of opioids and benzodiazepines and they no longer wanted to take. I was also part of an incredible group of colleagues via an invitation-based list-serve (private communication physician forum) for cannabinoid medicine physicians and researchers across North America where we all shared cases, research and helped with difficult cases. I saw thousands of patients and the relief and positive results they experienced with medical cannabis for a variety of complex difficult to treat chronic symptoms was unlike anything I had ever prescribed.

Instead of becoming ‘lazy’ on cannabis as many would expect from pop culture notions of using the plant recreationally, I had countless patients return to employment after being on long term disability for many years. I had patients tell me that going on medical cannabis for opioid reduction and chronic pain saved their marriage, changed their ability to connect with their kids again and changed their families due to the improved quality of life. And this improved family and social life was an unexpected theme that popped up again and again in a large number of my patients. I had many patients with lifetime insomnia and on multiple different psychotropic prescription sleeping pills come off of these pills completely using a low dose of cannabis oil for their sleep. Patients often said to me they finally knew what it was like to sleep normally for the first time in their lives.

Some of the effects of the plant I cannot prove in a randomised placebo controlled study (yet!) such as my type 2 diabetic patient with metabolic syndrome who lost weight – was it because they were just in less pain and exercised more or are there some other metabolic effects of certain strains of cannabis? We suspect this may be the case but we need more research. I have many ‘case anecdotes’ for the dramatic results I saw repeatedly with conditions like anxiety, depression, chronic fatigue, fibromyalgia and PTSD. These are not formal studies yet the body of evidence for cannabis medicinal use in a wide variety of chronic symptoms is growing steadily. Along with these results, I also noted the change in relationship with patients from a somewhat adversarial one – ‘these pills don’t work why can’t you help me’ – to a true partnership using medicinal cannabis products and learning together which ones work best for the unique human being sitting in front of you.

It’s by no means a ‘cure all’ and that is important to state – but there is no other medication tool that I have found more useful for many chronic difficult to treat symptoms. In the fall of 2018 I relocated back to London to train UK physicians in cannabis medicine after the law change in November 2018 and I became a founding member of the Medical Cannabis Clinician Society with Prof Mike Barnes. The MCCS is a non profit group open to all UK clinicians interested in cannabis medicine and those who currently wish to prescribe it as a specialist physician to provide mentorship, education and community using an evidence-based framework and further research interest in the area of medical cannabis. Somehow, a previously illegal plant has become my life’s work in medicine and I couldn’t think of a more exciting time to be in medicine and be a part of this shift.