By Dr. Allan Frankel, MD
With the current information age, it is very easy to find dosing information for any drug online. It is pretty easy to find most of these drugs online without prescriptions. Yet, “people” who are “patients”, generally don’t practice their own medicine on themselves very often.
Why do people generally prefer to have a physician’s opinion before taking medicines? I believe most patients believe there is more information available that presumably the physician will know. I believe most patients are not certain of what dose of what medicine to take even after reading whatever they can find. I am not saying patients should not read about their diseases. I think it is essential and essential to help educate your physician. I had a UCLA professor that once told me, “…when in doubt……ASK THE PATIENT!”. It was funny but not meant as a joke. I do it all the time. People in general like to share their opinions and the person with the disease does have some critical information and opinions.
In addition to information obtained from a physician, ideally, in a healthy medical environment, the physician and patient are true partners. Of course the patient’s health is the health discussed, but every physician can learn from every patient every visit.
After much ado, here is the point of this blog. I get emails and comments at GreenBridge Medical every day asking a “dose” of cannabis for their disease. I just cannot do this. I really can’t. I spend one hour with every new patient. Frequently, not until the last 15 minutes of the visit do I come up with the dosing and administration plan. In addition to a number of facts that I gather during the visit, I have time to get to know the patient.
– Is this a patient who has used cannabis?
– Did it help their symptoms?
– Did it worsen their symptoms?
– Do we have any information on their using cannabis orally?
– If yes, what was their reaction?
– If the reaction was bad, does not mean that oral CBD won’t be great?
– I need to know the patient’s other medications.
– I need to review any potential drug interactions. Medications metabolized in the liver compete cannabinoid metabolism.
– Do we expect a serious interaction?
– Should we decrease the expected CBD dose?
– Should we decrease the other drugs?
– When should there be follow-up.
– How does the patient follow up?
– How frequent makes sense?
– How often do we increase CBD on a patient with seizures?
– When do we add THC-A to the regimen for seizures or other conditions?
– If we add more THC to a cannabinoid regimen, how do we anticipate levels of psychoactivitiy?
– When should we use rectal cannabinoids?
– When should they be used sublingually? Orally? Topically?
– Should we go with a very low dose? CBD? THC?
– What ratio of CBD:THC medicine do we start with?
– How can we be certain the patient is taking what dose we THINK they are taking?
I could go on and on and on. I barely have time in one hour to evaluate most seriously ill patients. I am just learning cannabis medicine. We are all just beginning to learn cannabis medicine.
Should we dose cannabis more casually because it is safer? Sometimes casual is fine, but the sicker the patient the more focussed and serious the visit and dosing regimen should be. In addition, I average 4-5 follow-up messages with patients to dial in their regimen.
I just don’t know how to do it quicker.
Dr. Allan Frankel operates GreenBridge Medical in Santa Monica, CA. Dr. Allan Frankel is an internal medical doctor and one of the world’s leading authorities on dosed cannabis medicine. With over 35 years experience in Internal Medicine, Dr. Frankel applies his knowledge of all aspects of the cannabis plant and its therapeutic value to the treatment of multiple serious medical conditions. Visit his website at www.greenbridgemed.com.
© 2016 Dr. Allan Frankel, M.D. Reprinted with permission. All rights reserved.