Cannabis and the Health Care Provider 

by Kelly Pierce 

At the Chicago NORML 420 Health Fair in April 2021, several doctors and medical cannabis patients offered their advice on how cannabis consumers can obtain informed, enlightened care. Felicia Santiago from Chicago NORML’s Board of Directors interviewed Peter Grinspoon, M.D., about cannabis use & men’s health.  Grinspoon is a Harvard-trained physician and a primary care doctor at Massachusetts General Hospital and an instructor at Harvard Medical School.  He is currently serving as a board member of the advocacy group Doctors for Cannabis Regulation, which works towards legalizing cannabis with an eye toward social justice issues.  Dr. Greenspoon is not a newcomer to this work.  His father is Lester Grinspoon, a Harvard Medical School psychiatrist who wrote the 1971 classic Marihuana Reconsidered, an early, blistering criticism of marijuana prohibition. The book helped launch the marijuana legalization movement, giving Ivy League credibility to something associated with the hippie counterculture. 

Men and Preventative Care

Santiago asked Peter Grinspoon why it is important for men, particularly black men, to have candid conversations with their doctors about their cannabis consumption. “Communication is the cornerstone of good health.  It is really a team effort between the patient, doctor, nurse, and the whole team. Medicine is a team sport these days.  Without communication, it just doesn’t work at all,” Grinspoon said.  “We as providers don’t know what you are going through. If you are suffering anxiety, if you are suffering depression, we don’t know these symptoms unless we are told by the patient. Also, we have to see you regularly to screen for diseases. Every year we are supposed to screen for diabetes (a little more often if you have it in your family) and we can’t do that if we don’t have a relationship. That’s the beauty of primary care and that’s how it is supposed to work. I have a relationship with my patients, and they have a relationship with me. We trust each other.”

Multiple studies show that men visit doctors less often than women. One study from the Centers for Disease Control found that women visit doctors 33% more than men and women are 100 %better at maintaining screenings and preventive care. 

Santiago asked what the hesitancy men have in going to the doctor.  “If you do not connect with your primary care doctor, you are not going to have a great relationship with them. Second, there’s a shortage of primary care doctors so it is sort of hard to get in and find a good primary care doctor you can connect with,” Grinspoon explained. “Third, primary care doctors are pretty beaten down these days with the computer and we do a lot of data entry, the hospitals and the insurance companies torture us with paperwork.  So even if you have a good doctor, he or she may not be at their best. Fourth, there’s a lot of mistrust of the medical community from people of color. One big problem is that there are very few black male physicians.”  Black males comprised just 2.9% of medical school enrollment during the 2019-20 school year, down from 3.1% of medical school students in the 1978-79 school year, reports the Association of American Medical Colleges. That’s about half the level in the overall US population. Grinspoon explained that people often want physicians of their same gender, race, and who can or understand them culturally. The medical community has a big problem with implicit bias, institutional racism, and horrible experiments. There’s good reason for Black [people] to have, historically, distrust of the medical establishment.”  In 1932, the United States Public Health Service initiated a study of untreated syphilis in 600 black men at the Tuskegee Institute in Macon County, Alabama. The men were poor, illiterate sharecroppers and were intentionally not given any treatment for syphilis, even when some of the men were drafted for World War II and diagnosed with syphilis by Army doctors.  

Despite this action by the medical establishment, Grinspoon says “it is still critical to find a doctor that you can connect with and engage with the medical system. I mean I don’t think the response to these things that have happened and to the institutional biases is to just avoid the medical system.  It is to find people that you trust and engage with [them] because your health is the most important thing. A lot of the things we do as doctors is prevent problems. If I am your doctor, I can make it so you get diabetes at age 80 instead of age 60. That’s a huge win. You don’t develop any of the problems from diabetes. A lot of this stuff we can prevent. There are a lot of understandable reasons why a black male would avoid or not be able to find a primary care doctor they connect with. At the same time, it is absolutely critical they don’t give up and that they do engage in trying to find a primary care doctor.” 

Cannabis Stigma in Medicine

Do men hide cannabis use from their doctors?  In short, yes. “I think less and less as cannabis is increasingly becoming legalized.” Grinspoon believes. “Generally speaking, I think physicians have had a snooty and dismissive attitude towards cannabis.  Many of them have the approach  ‘You don’t use medical marijuana, don’t you?’ The patient is like ‘no, of course not, I would not do that.’ And then the patient does not tell the doctor. Now, the patient has two different systems of care. You got the regular medical care and then you got the medical marijuana care, and they don’t communicate with each other.” Grinspoon continued, “I think doctors have to drop the attitude. As I said in one of the things I wrote, whether you are pro, neutral, or against medical marijuana, you have to communicate openly and without stigma or patients are not going to tell you about their cannabis use and they are going to find different and possibly less credible sources of information.” 

Not that doctors are particularly educated about cannabis. Most doctors have a lot to learn. Their heads are filled with nonsense from the drug war instead of good, modern information about cannabis. We really need to educate the medical community so they can educate their patients. It is really important that a doctor knows if his or her patient is using cannabis for a lot of reasons. CBD, for one example, has drug interactions. So, if you are on a blood thinner and you are my patient, I need to know you are also taking CBD because you need to watch out for bleeding. Secondly, if you use cannabis every day and you are going in for surgery, you may need anesthesia.  It could be a big deal if the anesthesiologist does not know if you are on medical cannabis. It’s all about communication.  Finally, it's very intimidating to patients when they can talk to one doctor, who is accepting and open-minded about medical cannabis, and another doctor, and they can be very dismissive and judgmental.  Again, the medical profession has to do a much better job of accepting and accommodating the fact that tens of millions of people are using medical cannabis and excuse me with benefit successfully. They got to open up the doors of communication. It would be better for everybody if there were better communication,” he said. 

Grinspoon says cannabis consumers have a role in getting better health care. “If their doctors have a bad attitude, they need to tell their doctors ‘Look, I don’t think that’s the right attitude.’ I think as more people come out of the closet about their cannabis use that attitude is going to change. Different doctor groups have different levels of acceptance of medical cannabis. Oncologists are quite in favor of it because most of their patients use it for chemotherapy-induced nausea and vomiting. Patients have the biggest role to play. Ultimately, it’s their body.  They need to inform their doctors because it can be dangerous not to, even if they are going to get snooty and dismissive. Unless you are going to get in trouble, lose your job, drug test, that kind of thing, depending what state it is…, and it is completely illegal you may not be open and honest about it but generally speaking the acceptance is growing.” 

We Rock with Knox

This sentiment was echoed in an interview with Chicago NORML executive director Edie Moore with siblings Dr. Rachael and Dr. Jessica Knox.  The Drs Knox are medical doctors who emphasize the use of cannabis in their practices. Both are undergraduates of top-tier schools, and each received their master’s degrees in business administration from Tufts. Dr. Rachel Knox describes herself as an endocannabinologist and cannabinoid medicine specialist. She was trained in family and integrative medicine and practices in Tigard, Oregon, part of the Portland metropolitan area. Jessica Knox is a board-certified preventive medicine physician with a keen interest in health literacy and access. She is an expert in cannabis medicine and practices in Oakland, California. 

Patients Drive the Cannabis Conversation

Dr. Rachel emphasized that doctors need to engage with patients in a way not so personalized so they can be familiar with the benefits and potential risks of cannabis.  “Many people only turn to cannabis when they are dealing with a life-threatening condition, but, cannabis could be the first line we can use to treat some of the very common conditions.” She asks people to ask a simple question of their health care provider, doctor, or nurse practitioner. “What do you know about the benefits and risks of cannabis?” 

Dr. Jessica added “Progress in cannabis and cannabis legalization really has been a patient-driven phenomenon. It is unfortunate, but most health care providers still know very little about cannabis as medicine and about the endocannabinoid system, which is the physiology in our body that cannabis works on. It is our patients who are pushing clinicians to learn more by asking those questions. It is not good enough for us as clinicians to say ‘I don’t know enough.’ Or ‘there’s not enough research or there’s not enough evidence.’  The more patients ask their providers about it, the more pressure those providers will feel to go and learn from all the information that is out there and available. I know it can be scary and intimidating for patients to bring up these conversations, particularly because of the historical and still remaining stigma around cannabis, but working up that courage is really important for yourself and your own personal care, but also as a whole to push all of us forward.”  

While both cannabis-enlightened doctors are independent practitioners, today’s medical system is designed where patients are in large insurance groups who negotiate prices and treatment coverage with large health care systems of hospitals and providers.   Dr. Rachael explains that medical groups and hospitals “censor doctors” from recommending or discussing the effectiveness of cannabis as a treatment.  “In some regards, it is not really your doctor’s fault that they aren’t counseling you. In some cases, they’ve been told not to do so by their employer, the hospital system, the health care system at large, or their licensing board. It becomes important to promote legislation that prohibits licensing boards, or hospitals systems, or health care systems how a doctor counsels a patient on cannabis therapy.” 

Cannabis doctors and medical cannabis advocates agree that people must have frank, open and honest communication with their doctor and health care provider about their cannabis use. If doctors are hostile or unsupportive, find another physician. The best doctors will learn the benefits of cannabis to treat their patients more effectively. Sometimes though, many doctors are simply well-paid employees of a corporatized health care delivery system that orders providers to strictly deliver only standardized protocols from national associations for specific conditions. These never include cannabis or any other herb.