How to Talk to Your Doctor About Marijuana

Before Illinois legalized marijuana, Leslie Mendoza Temple, MD, a physician specializing in integrative medicine in Glenview, Illinois, didn’t talk about cannabis with her patients. They didn’t bring it up and neither did she. Five years later, patients seeking medical marijuana make up the bulk of Temple’s caseload.

“My patients come to me because I’m known for talking about it and being open about it,” she tells Verywell. “They seek out my information. I’ve gotten a lot of referrals from other physicians.”

Following the 2020 general election, nearly one in three Americans live in a state where marijuana has been legalized either for medical or adult-use, also referred to as recreational. Medical marijuana is now legal in 36 states, Guam, Puerto Rico, U.S. Virgin Islands, and Washington, D.C. Adult-use marijuana is legal in 15 states plus Guam and Washington, D.C., for those aged 21 and older.

Legalizations are expected to continue as lobbyists and elected officials in several states have already proposed or plan to introduce legislation for the legalization of medical and adult-use marijuana, as well as the decriminalization of possession of small amounts of cannabis.

As more people become interested in products derived from the Cannabis sativa L. plant, there’s an opportunity to bring marijuana discussions out in the open—and for trusted healthcare providers to fill those knowledge gaps. But in some ways, the laws and attitudes surrounding marijuana are changing faster than medicine.

“There are therapeutic uses for [cannabis], but there’s a lot of discomfort on how to recommend it,” Temple says, adding there are a number of reasons why a physician, medical practice, or healthcare system might not be cannabis-friendly. “Since it’s still federally illegal, some folks won’t even go there because they don’t want to have to worry about it.”

Physicians and Marijuana

The Controlled Substances Act of 1970 made marijuana a Schedule I drug, placing it alongside opioids, methamphetamine, and other substances that are, among other criteria, considered to have a high potential for abuse.

It is difficult to conduct studies of Schedule I substances because access to them, even for research purposes, is highly restricted. Not surprisingly, scientific findings on cannabis by U.S.-based researchers have been limited for decades.

In fact, that’s one reason why the American Medical Association has adopted policies against cannabis legalization for medical and adult-use. Among the association’s concerns is the education of medical staff on cannabis use, effects, and withdrawal syndrome.

Two-thirds of U.S. medical school curriculum deans said their graduates were not at all prepared to prescribe medical marijuana, and 25% said their graduates were not at all prepared to answer questions about medical marijuana, according to findings from a national survey published in November 2017. Researchers also found only 9% of medical schools have medical marijuana documented in their curriculum.

Simply put, nursing schools and medical schools are not preparing students for what they will face in the field. And rapid policy, education, and attitudinal changes are creating confusion among patients. As a result, many may not be having the conversations they want or need with medical providers about marijuana.

That needs to change, Eloise Theisen, RN, MSN, AGPCNP-BC, an expert faculty member at Pacific College of Health and Science’s Medical Cannabis program, tells Verywell. Theisen is also president of the American Cannabis Nurses Association, a national nursing organization focused on the emerging field of endocannabinoid therapeutics.

“Many patients are embarrassed or ashamed that they have resorted to cannabis as an option,” she says. “I would encourage patients to start the conversation with their providers and be transparent about their usage. The more we normalize cannabis as a medicine, the more healthcare providers will need to become familiar with it.”

Before Your Appointment

Rahul Khare, MD, a former emergency room doctor, has been incorporating medical cannabis alongside traditional therapies in his practice since Illinois legalized marijuana for medical and adult-use in 2014 and 2020, respectively. Khare is CEO and founder of Innovative Care, a group of medical practices offering primary, urgent, and behavioral care in the Chicago area. He tells Verywell that over the years, his team has helped certify more than 18,000 patients for medical cannabis. For some patients, cannabis is an appealing alternative to other traditional treatments.

“Patients were curious, even excited about the possibility of exploring cannabis,” he says. “People are also eager to find alternatives to pharmaceuticals such as opioids and benzodiazepine drugs, which are commonly prescribed. As the opioid epidemic grew in our country, so did the desire to find alternatives.”

Often, patients are interested in cannabis because they hear it can help with a chronic condition, back pain, or even cancer. Theisen says most of the patients she works with are new to cannabis and don’t know where to begin. One place to start is by checking your state laws to see whether adult-use or medical marijuana is legal.

Patients must first meet with an authorized physician—often, the board has a list or registry of physicians who can prescribe cannabis—to discuss their health, review their medical history, and conduct an in-person exam. The state board determines what health conditions qualify for a medical marijuana card. These conditions vary by state and are updated on a regular basis but often include cancer, Crohn’s disease, fibromyalgia, glaucoma, HIV/AIDS, multiple sclerosis, and post-traumatic stress disorder.

Medical marijuana programs dictate how much and how often patients can purchase cannabis products from a state-licensed medical dispensary. Cards need to be renewed after a set period of time, such as every three years, and medical marijuana is not covered by health insurance.

Some considerations to discuss with your doctor include what other treatments you have tried, what medications you are currently taking, whether your employer has a zero-tolerance drug policy or conducts drug tests, and if you work or plan to work in a field where there are industry standards for cannabis use. For example, truck drivers can lose their job and have difficulty finding a new job if they fail a drug test since marijuana is still a federally illegal substance.

Because the exam room can be intimidating or induce anxiety for some, it may be a good idea to write down any questions or concerns you wish to discuss with your healthcare provider during your visit.

While not required, it can also be helpful to learn more about cannabis, how it works, and available cannabis products. Theisen, Khare, and Temple recommend checking out:

• Project CBD
• Leafly
• American Cannabis Nurses Association
• Society of Cannabis Clinicians
• NORML
• Americans for Safe Access

You can ask your physician for additional resources, too.

During Your Appointment

Physicians typically have very tight schedules, so mention marijuana upfront to make the best use of your appointment time. If cannabis is not your main reason for your visit, consider booking another appointment so you can have a more thorough discussion.

“Sometimes, you have to bring it up,” Temple says. “The doc’s not going to bring it up because they have all these other things they’re supposed to talk to you about.”

When that time does come, explain why you are interested in cannabis, and ask your doctor for his/her opinion.

“Many patients fear that their healthcare provider will not be open to the topic,” Theisen says. “If they are working with a qualified cannabis healthcare professional, I suggest that they lead with that. Many providers will be relieved to know that the patient isn’t out there trying to medicate or navigate cannabis on their own.”

Your doctor will likely review what medications you are currently taking, your health history, and any chronic conditions. Your doctor may also ask about your lifestyle behaviors, including alcohol and drug use. Be honest. It will help give your doctor a complete picture of your health.

It’s important to remember that marijuana can offer benefits, but it is not without potential risks. Marijuana is the most commonly used illegal substance in the United States. It’s addictive and can lead to the development of marijuana use disorder. It is difficult—and controversial—to estimate the number of people who are addicted to marijuana, but studies suggest that 9% of people who use marijuana will become dependent. That number rises to about 17% for those who start using marijuana in their teens.

With that in mind, a thorough discussion with a knowledgeable healthcare provider can help you understand the bigger picture. Here are some of the most commonly asked questions Theisen, Khare, and Temple say they field:

• Will cannabis help my medical condition?
• Is there a specific kind of cannabis that is best for my condition?
• How do I consume cannabis?
• How much should I take?
• What type of product should I use?
• What if I don’t want to smoke it?
• What kind of side effect(s) might I experience?
• How do I reap the benefits without getting high?
• What should I take with me when I go to the dispensary?
• How do I communicate cannabis use with family, friends, and employers?

Theisen says there are lots of factors to consider and lots of options for those interested in cannabis, and it’s important for providers to offer guidance on dosing, routes of administration, potential drug-drug interactions, and side effects as well as benefits of use.

After Your Appointment

After your appointment, review any notes you took or your visit summary along with any materials, resources, or research studies your physician suggests. That also includes consulting with other qualified cannabis professionals as necessary.

Khare believes that most doctors do not provide adequate follow-through, leaving patients to navigate cannabis for themselves. As a result, Innovative Wellness hired cannabis consultants to help bridge this gap.

“The cannabis consultants at Innovative Wellness talk with patients about their career, family, and individual preferences to help determine which products may be best suited for their unique needs,” Khare says. “We pride ourselves in not only certifying patients, but also educating patients. Our team has tracked patient progress to determine which strains are best suited for each condition. These protocols serve as a guide, allowing most patients to find relief faster.”

Khare advises patients to keep a log of what cannabis products they have tried and their opinions to discuss at future visits, such as preferred consumption methods (e.g., smoking, edible, tincture, topical) and which strains they feel are better at reducing pain.

Temple acknowledges there are so many choices at a dispensary that it can be overwhelming. She also connects her patients with a cannabis concierge for more personalized feedback as they find what works for them. Once they have a regimen, she often finds those patients returning to discuss other health concerns.

“The reason they’re coming to me, the bread and butter, is chronic disease management,” she says. “It gets people in the door at my practice, but we go so much further beyond cannabis. They get their card—big deal—but they don’t disappear. I’m managing their other symptoms in conjunction with their doctors and getting their specialists and primary [care physicians] more comfortable with the idea that they’re being watched by someone they trust on cannabis. Cannabis is just one aspect of it.”

What if Your Doctor Doesn’t Want to Talk About Marijuana?

Patients must trust their doctors in order to feel comfortable broaching the topic of marijuana. After all, they’re likely embarrassed, concerned about being judged or treated differently, and worried about what the doctor might note in their medical record.

Temple says she feels bad when she hears patients say they asked another physician about cannabis and was told absolutely not, because that’s the end of the conversation. It can feel like a judgment of patients, but she says it’s more likely a reflection of the physician’s education, experiences, and comfort with cannabis.

“When you get that kind of response, they’re either not as well-informed on it, so the clinical experience is not enough to feel confident to [recommend cannabis],” Temple says. “They might have their own convictions—it could be religious, moral, whatever. Or, they had a bad experience with a patient who got addicted and they just never want to touch cannabis for anyone else, which is a shame. Or, they don’t think there’s enough research.”

It can be a combination of all these reasons and others that make it all too easy for physicians to dismiss or not recommend cannabis. It’s often an unfortunate reality because it leaves a lot of patients out in the cold, so to speak.

Temple says if cannabis is a viable option to help patients, then physicians should consider it. As with other drugs, physicians should do their own research and not write cannabis off altogether. Good doctors, she says, will admit what they don’t know or aren’t comfortable with, but they can still refer patients to other physicians.

“Every physician and healthcare worker is going to be at a different stage of education because there’s no standardization when we are training,” Temple says. “All we learn in med school is what are [marijuana’s] potential detrimental effects, which is important.”

But it’s not the whole picture of cannabis.

“We need more education of our physicians so we can stop turning them away and making them find their information somewhere else,” she says. “It’s getting better, though.”