Medical Cannabis: Physicians play pivotal roleSep 25, 2019 11:52AM ● By Cat Carrel
By Karen Keough
Physicians are pivotal to the fledgling Texas medical cannabis program. In fact, it cannot succeed without them.
Recent law changes have added a great urgency for physician buy-in to the program. When the Compassionate Use Program (CUP) was first established in 2015, only patients with intractable epilepsy were eligible. This past June, Governor Greg Abbott signed legislation (House Bill 3703) that significantly expands the list of qualifying conditions to include all forms of epilepsy, seizure disorders, multiple sclerosis (MS), spasticity, amyotrophic lateral sclerosis (ALS), autism, terminal cancer, and neurodegenerative diseases.
This expansion also means that potentially hundreds of thousands of new patients qualify for low-THC medical cannabis products that are rich in the non-intoxicating compound cannabidiol (CBD), and they will be looking to their physicians to guide them in their treatment.
Texas is unique compared with other state programs: Physicians play an active role in working with patients to establish dosing regimens and determine which state-regulated products would be their best option. This oversight of patient care is invaluable.
However, in order to address this influx of new patients effectively, many physicians need to confront barriers, including their apprehensions and need for education in prescribing medical CBD. These barriers are real, but surmountable, and overcoming them will be life-changing for the patients served.
Potential Legal and Professional Repercussions
Physicians who practice in private firms or HMOs, or in academic and research settings, are often subject to policies or institutional guidelines that prohibit the prescribing of medical cannabis or derivative products. Physicians have personally witnessed the value of medical CBD, but said they were still hesitant to prescribe it for fear of potential professional consequences.
There are safeguards in place to protect physicians who participate in state-sanctioned medical cannabis programs, and Texas lawmakers established legal protections for physicians who participate in the program. On the federal level, a key provision in the annual federal spending bill prevents the U.S. Department of Justice from prosecuting businesses, physicians or patients in states that have established legal medical cannabis programs, as long as all parties operate in accordance with state laws.
As for any unwritten stigmas in our institutions and workplaces, letting prejudice dictate behavior doesn't help. Doctors can pivot from these stigmas by treating medical cannabis like the legitimate medicine it is.
Perceived Dearth of Medical Cannabis Research
It’s a classic Catch-22 when it comes to cannabis research: Because the federal government for decades has classified it as a Schedule I substance, there are onerous restrictions on conducting cannabis research. And without sufficient research, it’s difficult to amass conclusive evidence of medical efficacy.
More double-blind, placebo-controlled clinical trials and lab research must be done. But the argument that we have no evidence for the medical value of cannabis is simply untrue, and new findings are published regularly. There is clear and undeniable conclusive evidence for efficacy of CBD in the treatment of refractory epilepsy, which led to U.S. Food and Drug Administration approval of Epidiolex, the only currently available CBD-based pharmaceutical drug, limited to patients with certain rare types of epilepsy.
Meanwhile, researchers are documenting and categorizing research on CBD and other cannabinoids for their potential to relieve spasticity related to MS, alleviate the side effects of cancer treatment and other serious, often-debilitating conditions.
A landmark 2017 research review by the National Academies of Sciences, Engineering and Medicine (NASEM) examined 10,000 study abstracts conducted since 1999. This report concluded that: “There is conclusive or substantial evidence that cannabis or cannabinoids are effective” for the treatment of chronic pain, chemotherapy-induced nausea and vomiting, and for improving spasticity in MS patients. Since then, researchers abroad have pursued small-scale trials with patients who have autism spectrum disorder (ASD), as well as preclinical studies of the neuroprotective qualities of cannabinoids.
Lack of Familiarity with Medical Cannabis
Some physicians feel they do not have enough familiarity with medical cannabis to confidently prescribe it. In this writer’s experience, medical CBD displays such efficacy that the effort required to investigate and implement customized treatment programs for patients has been well worth it.
Learning about medical advancements is an essential element of every physician’s practice. Yes, it takes time and effort to dig into research findings and figure out how to establish a new treatment regimen. It’s always easier to stick with a familiar strategy, but the reality is that our patients need us to get out of our comfort zones.
Texas physicians are gatekeepers. We must set aside biases about medical cannabis, carefully consider whether the benefits outweigh the risks for a patient and open the gate as warranted.
Confront these barriers, ask questions, get educated around Texas-regulated medical cannabis and most of all, enroll in the Compassionate Use Registry of Texas. It’s time for Texas physicians to step up for our patients facing serious health challenges and pursue a treatment option that could fundamentally improve their quality of life.
They literally can’t do it without us.
Karen Keough, M.D., is a board-certified child neurologist and epileptologist with fellowship training in neurophysiology. She specializes in treating intractable epilepsy at Child Neurology Consultants of Austin, and serves as Chief Medical Officer for Compassionate Cultivation, a licensed Texas medical cannabis provider. For more information, visit TexasOriginalCC.com.