What are your thoughts on the use of medical marijuana?

March 11, 2019

"There are better ways to manage people’s medical problems with drugs, especially in routine urologic care. I just don’t agree with marijuana," says one urologist.

Urology Times reached out to three urologists (selected randomly) and asked them each the following question: What are your thoughts on the use of medical marijuana?

"There are better ways to manage people’s medical problems with drugs, especially in routine urologic care. I just don’t agree with marijuana. It’s possibly useful in other areas, and I could perhaps use it for palliative care, but not for routine care.

I don’t manage chronic pain patients. With the opioid crisis and state mandates, I send them to pain management. I only manage pain in the immediate postoperative period.

I actually had this question recently. Somebody asked if I would prescribe it, and I said it’s outside my scope. I would never prescribe it.

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If a pain management specialist recommended medical marijuana to one of my ongoing patients, I would probably say, ‘You’ve got to do what you think is best’-but I’m still unswayed.

A lot of people with chronic pain have other unmet needs, whether they’re psychological or not. Chronic pain issues are often treated with antidepressants. With increasing anxiety in our population, it probably helps, but maybe they should have better therapy. We have a shortage of psychiatric doctors, and that’s bad considering the growing need for mental health care. A lot of chronic pain is psychosomatic. I’m not saying it all is-some people have chronic pain from metastatic cancer. That’s totally different, but some have chronic pain with no identifiable cause. Medical marijuana may help because people relax and experience less anxiety.

There’s no data really supporting any of this yet. I would like to see proof marijuana’s actually helpful. I don’t like just medicating people without getting to the actual problem.”

Natalie Singer, MD / Cincinnati

Next: "I think it definitely has a place. Some patients with neurologic issues, chronic pain, cancer patients have seen exceptional benefit from it."

"I think it definitely has a place. Some patients with neurologic issues, chronic pain, cancer patients have seen exceptional benefit from it.

Read: How concerned are you about patients taking counterfeit meds?

I haven’t used it, but some of my patients have obtained it from outside sources. They’ve reported they’ve felt improvements. It helps create more positive outlooks on life for people who’ve had depression from chronic disease or neurologic disease or cancer or chronic pain. These patients have had psychological counseling, they’ve had antidepressants, but medical marijuana has given them more relief. It definitely does more than a placebo. People on antidepressants or anxiolytics report at least augmented improvement on medical marijuana compared to prescribed medicines.

The literature also shows benefits medically since it can relieve pain-some of it neurological and some from chronic disease.

If it were legalized in Georgia, I would certainly investigate any potential urologic implications.

Patients with advanced cancer, perhaps in hospice, might benefit from it-if they have chronic pain syndrome, pelvic pain particularly-I would have to investigate that. I have not prescribed it. I just have anecdotal reports from my patients telling me they’ve had improvement.

There are exceptional alternative medical treatments, but a lot of narcotics have side effects: chronic constipation, increasing tolerance, and blunting of mentation.

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I don’t take care of depression and anxiety, but a lot of urologic conditions, like in all fields of medicine, have some relationship with depression and anxiety.”

George Jabren, MD / Stockbridge, GA

Next:"If it’s done properly and not abused, it probably has benefits."

"There’s definitely a role for marijuana in certain conditions. Some studies show it helps with certain side effects of treatment. If it’s done properly and not abused, it probably has benefits.

My concern is that sometimes people use the label ‘medical marijuana’ for things other than what may actually be legitimate. I’ve seen people say they have a condition requiring medical marijuana when they actually don’t, but they’re able to get what they want because it is available. A lot of patients may benefit from medical marijuana, and we should offer it in a way that allows those patients to benefit.

Read: What has been your experience with ERAS pathways?

I have patients who use it. I don’t routinely prescribe it. I did many years ago but not now. I had a patient I thought could benefit from it; I stopped because I feel it’s something that requires monitoring and follow-up. I wasn’t able to do that on a regular basis. Now, I turn those patients over to pain specialists or primary care physicians.

Patients are pretty positive about its benefit. Physicians who use it think it relieves nausea from chemotherapy, and it helps certain pain conditions.

Medical marijuana was available here before recreational became legal, so it’s been out for a while. As I said, I don’t have a huge experience with it, but I’m open to it if patients feel like there’s benefit. My only concern is making sure that people are monitored and it’s used appropriately.”

James Porter, MD / Seattle