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doctor focus
cannapatientcare.com march/april 2022
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cannabis patient care
"She came to me and had the stigma about cannabis," Dr.
Weiner said. "But she was just on all these meds. For me, I
look at someone who has something like fibromyalgia, which
is a chronic pain condition. Opioids treat acute pain. So, when
she goes back to the doctor every time, he just increases her
medication, but that's not really helping her at all."
The woman was functioning completely fine, Dr. Weiner not-
ed, but had the same pain issues. "It took me about three
months to wean her off of her opioids," she said. "As I started
to use cannabis with her, I used it like a short-acting tincture
to be comparable to her short acting opioid. Then we used
long-acting forms of cannabis, like a capsule or an edible, to
represent more of the long-acting opioid."
Dr. Weiner was able to wean her off all her opioids. "The in-
teresting thing is that she had no pain. Then she was able to
significantly reduce her cannabis," she said. "So, I think that's
an interesting concept, the fact that they don't even real-
ize that they have this opioid-induced hyperalgesia where
the pain medications are actually making her more sensitive
to pain. It's like a wind-up phenomenon where once the pain
starts, it's not able to calm down. Cannabis really puts the
body into this parasympathetic mode, but it also is treating
this wind-up phenomenon."
How She Has Changed
Dr. Weiner thinks that her clinic has changed in the sense that
she no longer treats the patient in that patriarchal way—here's
a medication for the condition that you have—but becomes
more of a conversation of understanding what's going on in the
patient's life and treating the whole person.
"My clinic is very different now because I actually want to
get to know the patient a little bit because there's a lot of
things that they're not sharing," she said. "Or if it's a situation-
al thing, perhaps they're not going to improve. I think the al-
gorithm for how I treat pain and how I look at the patient has
changed. I talk to them about sleep hygiene. That's an impor-
tant one. I think people don't put enough influence on get-
ting a good night's sleep. I talk about resilience to stress. All
of that, I think, really has to do with lifestyle changes because
I don't want the cannabis to fail because other parts of their
lifestyle are not really going in the right direction."
She wants her patients to understand who they are. "I think
that's really the most special thing about cannabis is that it
does have the ability to alter our consciousness and it can
transform how we view ourselves," she said.
Her experience with cannabis as a treatment option has led
her to believe that medical professionals need to get away
from this daily pill, pharmaceutical type of mentality. "We
need to focus a little bit more and put evidence into looking
at lifestyle changes, talking more about nutrition and move-
ment. Also, really just to have physicians have a little bit more
of an open mind. If they see that things are not working, don't
just increase the dose. If we don't have good treatment op-
tions, then we need to go find better options and we need to
be honest with the patient," she said.
Conclusion
Dr. Weiner believes in the next five years a lot is going to
change with mental health and chronic pain. "I think we're go-
ing to really get away from the opioids to treat chronic pain and
only give that for like three to seven days after an acute trauma
or surgery. Patients are going to start to understand how to
use botanical medicine and rely less on physicians," she said.
"I think as we modulate the endocannabinoid system, we'll be
able to decrease chronic conditions, which is really the goal."
References
(1) https://drmichelleweiner.com.
(2) https://ballotpedia.org/Florida_Medical_Marijuana_
Legalization,_Amendment_2_(2016).
(3) https://www.health.harvard.edu/blog/the-endocannabinoid-
system-essential-and-mysterious-202108112569.
(4) https://nida.nih.gov/drug-topics/opioids/opioid-summaries-
by-state/florida-opioid-involved-deaths-related-harms.
(5) https://journals.lww.com/pain/Abstract/2022/02000/
Prevalence_of_chronic_pain_among_adults_in_the.31.aspx.
(6) https://www.webmd.com/depression/features/
what-does-ketamine-do-your-brain.
(7) https://www.dea.gov/drug-information/drug-scheduling.
(8) https://nursing.fau.edu/news/newman_marijuana.php.
(9) https://spinewellnessamerica.com/dr-michelle-weiner/.
(10) https://www.drugs.com/percocet.html.
(11) https://www.drugs.com/ambien.html.
About the Author
DAVID HODES has written for many cannabis publications, and
organized or moderated sessions at national and international
cannabis trade shows. He was voted the 2018 Journalist of the
Year by Americans for Safe Access, the world's largest medical
cannabis advocacy organization.
