the experience of one physician gatekeeper

Dr. Ben’s White Coat Perspective on Medical Cannabis

Author, Benjamin J Barenberg, MD & President of Cannabis Research & Development

The birth of the cannabis industry in Oklahoma has provided both complimentary and therapeutic alternatives for patients with chronic ailments that were unresponsive to traditional therapies. While it is obvious that currently over 100,000 cannabis patients will have access to life altering therapies; what it is less obvious is the effect writing cannabis recommendations has on the recommending physician.

            As I Reflect on my experiences as a recommending physician since the passage of SQ788, there is one event that highlights the gravity of the service that recommending physicians provide. In early April, I partnered with Cindy Keeton of A Better Bloom Health and Wellness and Corey Hunt of Select Healthcare Dispensary in Oklahoma City to provide a free cannabis recommendation clinic to streamline the recommendation and application process for children around the state.

            As I pulled up to the clinic in the middle of a monsoon, I couldn’t help but notice the line of parents and children wrapped around the building waiting to be seen. Kids in rainboots and rain slickers and parents trying their best to keep the kiddos dry with umbrellas. For those that do not know, obtaining a pediatric recommendation in Oklahoma is difficult. These recommendations require two physicians to agree that cannabis therapy is of potential benefit to the child. While the rules in place are there to protect minors from inappropriate cannabis exposure, it does place both a financial and logistic burden on parents seeking cannabis therapy for their children.

            My initial impression when I agreed to help with this clinic was that I would likely be seeing teenagers whose parents were allowing them to get cannabis cards to keep them on the right side of the law. I remember thinking to myself, “There are going to be quite a few pissed off parents and kids when I decline their petition for application.” My gut instinct could not have been further from the truth. Every single parent and child I evaluated that day was turning toward cannabis as an alternative or adjunct therapy to already failing traditional western medical approaches. We had children ages 5-17 years-old with autism spectrum disorders, attention deficit and hyperactivity disorder, mood and personality disorders, seizure disorder, neuromuscular disorders, and traumatic brain injury. These families were in search of healing and nothing more.

            I met a family whose young daughter is on the autism spectrum who recently moved back home to Oklahoma from Colorado where they moved in order to have access to cannabis treatments. Their child prior to cannabis would lash out and inflict harm on herself and others. She was essentially unable to interact with anyone safely. While in Colorado, these parents educated themselves on cannabis and started their child on cannabis products that improved her ability to communicate and function. I remember them sharing a before and after video with me. I could not believe the child sitting in front of me was the child in the video. She was calm, talkative, respectful, and as sweet as one would expect a young lady to be. The passing of SQ 788 allowed this family to move home and has been a blessing in this little lady’s life. While her experience with cannabis medicine was life changing, what is even more amazing is that her story is not unique. Family after family who had previous access to cannabis shared their stories and experiences with me and other hopeful parents seeking a similar result.

            We had many parents seeking new therapeutic alternatives for their child’s ailments. With the potential for novel therapies came hope and promise but also came concern, questions, and fear. “Will my child become addicted? Are they going to be high all the time? What’s the best cultivar for XX? What is the best dosing protocol for YY? What if it doesn’t work? What dispensaries are reputable? Is it better to grow our own product? What is the data regarding cannabis use to treat XX?” The echoes of responsible parenting resonated consult after consult.

While cannabis medicine has been around since the days of the ancient Egyptians, modern directed evidence-based medicine, as defined by peer-reviewed medical literature, for certain conditions is lacking due to the unnecessary governmental prohibition of cannabis. While the lack of quality research makes it difficult at times to adequately counsel parents on what to expect with cannabis therapy for their children; the biologic plausibility of the molecular structure and physiologic function of the cannabis plant on the endocannabinoid system provides promise of safety and efficacy for many chronic complex conditions.

Parents are turning toward cannabis as a more naturopathic avenue for therapy with limited downside risk. The risk of addiction is <10% with no plausible mechanism for fatal overdose when utilizing quality cannabis products with and without THC. Parents were relieved to learn that there are cannabis dosing methods where you can employ all the medical benefits of the plant without the psychotropic high. While there are effective traditional approaches to managing complex conditions, many of these are not without undesirable side effects. While cannabis alone may be effective for many disease states, it is important to remember that cannabis as a complementary therapy to traditional therapies may provide an avenue to limit the undesirable side effects of common western medical therapies while simultaneously amplifying the therapeutic effect.

On that rainy Saturday in April, did I create the next generation of Mall Rats and Jay and Silent Bob? I venture to say no. While there is still much to learn about the application of medical cannabis in the treatment of the pediatric patient, I feel comfort in knowing I can stand on the anecdotal evidence I witnessed with my own two eyes, the biologic plausibility of cannabis pharmacology, and the emerging evidence-based medical literature when treating one of the most vulnerable patient populations in our community. Children’s author, Shel Silverstein, sums up my pediatric cannabis experience perfectly: “Listen to the mustn’ts, child. Listen to the don’ts. Listen to the shouldn’ts, the impossibles, the won’ts. Listen to the never haves, then listen close to me… Anything can happen, child. Anything can be.” To those physicians who stand in solidarity with the cannabis movement may you gift Refuah Shlema (healing): May those in whose care they are entrusted, be gifted with wisdom and skill, and those who surround them, be gifted with love and trust, openness and support in their care.

Dr. Barenberg is a dual board certified complex gynecologic surgeon and reconstructive pelvic surgeon at Optimal Health Associates in Oklahoma City. He is also the President of Cannabis Research at Green Cloud Agency.  He can be reached directly via Facebook and Instagram by contacting @oklahomaspelvichealthexpert or on Twitter @DoctorBen @GreenCloudAgency