A Doctor's Guide To Using Weed

Massachusetts-based physician Benjamin Caplan, M.D., didn’t have weed on his radar until about a decade ago. Sure, a few of his buddies smoked pot in college, but he was busy getting into medical school, and he didn’t give marijuana much thought. That is, until he was practicing family medicine outside of Boston in 2014 and noticed a spike in patients admitting to using weed to treat everything from depression to insomnia to chronic pain and nausea — about 20 each week.

“The variety of their reasons for consuming was staggering, with almost no two people consuming for the same benefit,” Caplan says. But the pattern was clear. Most of these patients were relieving their symptoms with the help of weed, usually without traditional pharmaceuticals at all. At the same time, they were all using pot in different ways and buying their “medicine” from “some guy.”

Still, this “patient-led revelation” compelled Caplan to do a deep-dive into the medical research, where he found a smoking gun — or blunt, rather. In Caplan’s words, he discovered a “treasure trove of medicinal compounds” in cannabis that had been stigmatized, politicized, and otherwise swept under the rug, potentially at the expense of public health and wellbeing.

“While my career choices might invite judgment of me from the medical industry, I often find myself disappointed in my colleagues who overlook what is now a well-known opportunity to effectively address their patients' pleas for relief,” Caplan says.

Despite the potential pushback from his fellow physicians, insurance companies, and even banks, Caplan founded the CED Clinic in 2017, after Massachusetts legalized medical and recreational cannabis in 2012 and 2016, respectively.

One of the biggest challenges he has faced in his practice is getting patients and colleagues to understand the complexities of cannabis and how to use it in a therapeutic way. Distilling research with infographics, video, and other media, Caplan developed a comprehensive guide to help parents, professionals, and potheads medicate with cannabis without falling into the traps of self-medicating. “For consumers without medical guidance, it’s often trial and error, and most are either left to their own devices or faced with following the best advice of whomever happens to be behind the counter that particular day. Think for a moment: How would we feel if that medicine were Percocet? Gabapentin? Even Ibuprofen?”

This guide will be released on Caplan’s website caplancannabis.com in October 2023, along with the The Doctor-Approved Cannabis Handbook in print. In the meantime, he sat down to share his insights, not as “some guy” selling you weed, but as the doctor who wrote the book on it.

How would you compare cannabis to traditional medicine?

While many individuals find relief with conventional pharmaceuticals and others thrive on a purely cannabis-based regimen, the combination of traditional and cannabis medicines seems to complement each other.

Cannabis offers a form of relief that many patients don't derive from single-molecule pharmaceuticals, which form the backbone of mainstream medicine. These pharmaceuticals, though meticulously tested for purity and safety in rigorous clinical trials, often lack the internal complexity that can inherently be therapeutic.

Some argue that even those using cannabis purely for recreational purposes are, in fact, utilizing it therapeutically — after all, isn't joy therapeutic?

A diverse diet — comprising different fruits, vegetables, proteins, fats, and minerals — provides a breadth of nutritious components, far more than a single food item could offer. Likewise, natural medicine nourishes various soothing pathways in the body that common medications for depression, anxiety, pain, sleep disorders, and inflammation often fail to address.

What instances do you find yourself prescribing cannabis for? Are there any unexpected uses?

Many people tend to believe that cannabis is exclusively used for serious medical conditions like seizures, Multiple Sclerosis, or cancer. Additionally, research is underway to explore cannabis's role in neuroprotective functions, potentially aiding in conditions such as Parkinson's disease and Alzheimer’s.

However, the truth is that its usage extends far beyond these severe cases. A wide range of individuals dealing with daily issues such as work stress, sleep disorders, and various types of chronic pain also find relief through cannabis. Its applications aren't limited to extraordinary circumstances.

Cannabis has a broad scope of potential medical benefits. Its efficacy as a potent anti-inflammatory, mood enhancer, and muscle relaxant alone indicates that cannabis could potentially address a wide array of modern medical ailments. Some argue that even those using cannabis purely for recreational purposes are, in fact, utilizing it therapeutically — after all, isn't joy therapeutic?

It's increasingly being recognized for its potential in managing mental health conditions such as anxiety and depression. While it's not a panacea, for many people, cannabis offers a natural alternative to pharmaceutical interventions, bringing them comfort and improving their quality of life.

Many of my older patients, often lifetime cannabis users, are among the happiest individuals I've encountered.

Are there other surprising medicinal benefits that you didn’t expect?

One surprising application of cannabis I've encountered in my practice involves patients using cannabis nebulizers, a combination of saline mist and medication, to combat sinus infections. It's not commonly known that cannabinoids possess robust antibacterial properties. Interestingly, they don't necessarily disrupt healthy bacterial colonies within our bodies, unlike many conventional antibiotics. This unique trait finds utility in several applications, especially in treating conditions that affect our skin's natural bacterial colonies like acne and rosacea, our gut, and even our nasal and sinus passages.

From my understanding, cannabis is discouraged for anyone under 25, because their brains are still growing. Should adults who use cannabis be concerned about their brains in the future?

Many adults were first introduced to cannabis as adolescents and most continue consuming it, at least for a substantial part of their lives. We understand that long-term use seems to leave an impression on some individuals, but the extent of these long-term effects remains largely undefined.

When it comes to assessing cognitive abilities or long-term sharpness using certain cognitive tests or short-term memory evaluations, and especially when participants are not asked to refrain from cannabis use prior to testing, it's common for studies to conclude that regular or long-term cannabis users do not perform as well as those who consume less or for a shorter period.

On the other hand, if success is measured by personal happiness, life enjoyment, peacefulness, and overall comfort, it's worth noting that lifelong cannabis consumers often manifest these traits much more commonly than those who don’t consume cannabis. As a physician, I've found that many of my older patients, often lifetime cannabis users, are among the happiest individuals I've encountered. They tend to be easygoing, live in the moment, exhibit carefree attitudes, and generally don't dwell on things that distress them or cause discomfort. Instead, they strive to make the most of their waking hours.

Physicians continue to prescribe alternatives to cannabinoids that may be less safe, less effective, and bring unpleasant side effects.

It's not surprising then that studies may reveal cognitive challenges specific to cannabis users. For some people, in such a serene state, tasks that are intellectually demanding or that exercise memory, cognition, or physical ability may become less of a priority.

However, when considering the broad impression that cannabis users are, in general, happier and healthier, these cognitive challenges may be viewed as an acceptable trade-off for some. Of course, this won't be the case for everyone, and some may find their ideal balance somewhere in the middle.

What about if there is an issue with dependency or Cannabis Use Disorder — does this change the cognitive effects?

Sometimes specific skills may be lost when a person becomes dependent on cannabis. But it's hard to distinguish whether these losses are directly caused by cannabis or as a result of changes in habits or practiced skillsets. This can be seen in cases where an individual uses cannabis for comfort instead of seeking help from friends, for example.

Individual differences also significantly contribute to varied responses to cannabis. Just as cannabis use can be therapeutic, cessation of use can also present challenges. Ensuring that patients have access to resources and support to manage these changes is a vital part of my practice.

So is it fair to say that changes in cannabis use, whether starting or stopping, should be handled like medication changes — carefully and with the guidance of a medical professional?

That is correct.

The medical industry remains largely behind the times and under-informed about cannabis.

In your opinion, has cannabis been legitimized as medicine?

Cannabis has not yet fully gained legitimacy as an equal medicine. While we've made considerable progress, and there is cultural acceptance in many parts of the world (either through legal recognition, habitual use, or societal pressure), the medical industry remains largely behind the times and under-informed about cannabis.

It's worth noting that physicians continue to prescribe alternatives to cannabinoids that may be less safe, less effective, and bring unpleasant side effects. This practice, to me, underscores a persisting lack of understanding. Federal recognition of cannabis — whether through rescheduling or outright legalization — could certainly bolster its legitimacy.

Cannabis education should be integrated into medical training to cultivate a new generation of physicians who are knowledgeable and unbiased about its therapeutic uses. Even if a "federal magic wand" could instantly change public opinion, it would take years to educate these professionals on the benefits of cannabis — a truth many in our society have already embraced, often in spite of significant obstacles.

Like any other field of medicine, Cannabis Medicine is a practice. It's a craft to be honed and an ongoing journey of learning, revising outdated understandings, and overcoming obstacles with fresh insights. Many, including myself, are sometimes guilty of complacency, falling into old habits, and becoming trapped in fixed ways of thinking about illness and medicine.