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Expert psychiatrist Dr. Timothy Fong explains the complexity of using marijuana as treatment in a primary care setting and shares advice on how to address it with patients.
At Pri-Med West 2022, the Anaheim Convention Center Ballroom CDE filled with physicians who have always wondered, "what conditions is cannabis really useful for?" or, "what does it work for?"
There may not be a simple answer to these questions, however, they were addressed in the "Curbside Consults" session on top questions from primary care providers (PCPs) about marijuana, led by Timothy Fong, Md, Professor of Psychiatry, Co-Director, UCLA Gambling Studies Program, David Geffen School of Medicine at UCLA, Director, UCLA Addiction Psychiatry Fellowship, David Geffen School of Medicine at UCLA.
Fong gave further insight on the topic in an interview with HCPLive, saying that the overall reception to marijuana has drastically shifted in the US within the last decade and as a result, there's been an increase in research.
There are currently a few medical conditions in which the US Food and Drug Administration (FDA) have approved medications that come from cannabis or cannabinoids. However, the only medication that's derived CBD from the plant itself is cannabidiol (Epidiolex), which treats intractable seizures in infants and young children, he explained.
Other treatments like dronibanol (Marinol) are synthetic and, like cannabidiol, unlikely to be used in a primary care setting, Fond said, since they're indicated by the FDA for anorexia associated with weight loss in patients with acquired immune deficiency syndrome (AIDS), and for nausea and vomiting associated with chemotherapy in patients with cancer and who have inadequate response to conventional antiemetic treatments.
What about the cannabis that's available in dispensaries? What about the cannabis that's available on the street? What about the cannabis that people borrow from their friends? Can those be effective for medical conditions? These are some of the common questions that PCPs and patients ask Fong, so he spoke about some of the risks and benefits of this type of thinking and the current landscape.
"Right now, we know that through cannabis research over the last 25 years, there are only a few conditions to which we think cannabis is really, really helpful for right now, in addition to chemotherapy-induced nausea and vomiting, chronic pain, muscle spasticity for multiple sclerosis (MS)," he explained, "those are the ones that we know that cannabis is probably helpful for--all the other conditions which people come into offices for, insomnia, depression, gaining weight, anxiety management, PTSD--unfortunately, the science right now does not support the use of cannabis for those conditions."
From a therapeutic perspective, cannabis is incredibly interesting, according to Fong, because the active ingredient goes beyond THC. There are hundreds of different chemical compounds, or cannabinoids, in any cannabis plant, and there's not enough research examining it.
"When patients come in asking about cannabis, it definitely is our duty as physicians to explain the risks and benefits of cannabis," he explained, "the side effects of cannabis, and to what medical conditions we know, scientifically, it's useful for."
"For patients," Fong continued, "we also had to explain to them that it's much more important and better practice of medicine for us to be using standard approved medical treatments for that condition."