Many Ohio doctors find Medical Marijuana is effective for cancer and pain
COLUMBUS - Most Ohio doctors who can recommend medical marijuana say they were satisfied with the drug’s effectiveness in treating patients with pain, cancer, fibromyalgia and post-traumatic stress disorder, according to a new State Medical Board of Ohio survey.
The survey found 59.4% of participants were satisfied with marijuana’s effects on pain that is either chronic and severe or intractable, 53.5% were satisfied with its effectiveness for cancer patients, 50.8% were satisfied for fibromyalgia patients and 50.3% for post-traumatic stress disorder patients.
Yet among the 21 other conditions for which medical marijuana can be used under state law, none had a physician satisfaction rate over 50%.
The State Medical Board surveyed the doctors, who all have certificates to recommend medical marijuana in Ohio, between July 1 and Aug. 31. Of the 648 licensed physicians with certificates to recommend marijuana, 583 physicians completed the online surveys. Not all physicians answered every question.
The survey also asked doctors about telehealth, how they diagnose patients, among other questions.
The questions about medical conditions had to do with the doctors’ observations, and not necessarily a review of patients’ records, nor clinical trials of marijuana.
There’s little medical evidence in the U.S. about the effectiveness of marijuana, noted Dr. Ryan Marino, a Case Western Reserve University medical toxicologist, addiction medicine specialist and emergency room doctor. It’s classified as a Schedule I substance under the Controlled Substance Act, meaning the federal government thinks it has a high potential for abuse, and is difficult for researchers to legally obtain for study.
Although the Ohio survey results are based on physician observations, Marino said they are interesting.
“I think those (conditions) are anecdotally what I would also agree are probably things people report having success with,” he said.
Of the 25 conditions approved for medical marijuana, only 10% of doctors were satisfied with marijuana’s effects for Huntington’s disease. That was the lowest satisfaction rate in the survey. Another 16.3 were satisficed with the drug for amyotrophic lateral sclerosis and 16.5% were satisfied with the drug for sickle cell anemia.
In addition to gauging satisfaction rates, the State Medical Board asked doctors if there were any conditions for which marijuana made them dissatisfied. Dissatisfaction rates were low for all conditions —below 1%— with the highest being for Alzheimer’s disease, for which 0.7% of doctors were dissatisfied.
The doctors’ low dissatisfaction rates are likely due to marijuana’s relative low risk, Marino said.
“It’s not to say that marijuana is inherently safe, because it definitely has risk associated with it, but in terms of people who are trying to treat chronic conditions, it either works or it doesn’t work,” he said. “It’s unlikely to cause them any significant distress.”
Dr. Solomon Zaraa, a psychiatrist who is president of Compassionate Cleveland, a medical marijuana practice, said that the survey results are similar to his own experience. He sees many pain patients. Some seek marijuana because they do not want to risk becoming dependent on opioids, which some doctors prescribe for pain, he said.
PTSD patients often do well with marijuana. They report an improvement in sleep almost immediately, he said.
“For many PTSD patients, that’s really a cornerstone issue,” he said. “In the diagnoses of PTSD, a lot of the criteria really are about daytime issues, interacting with others, or how we react to the environment around us. But then there’s a snippet about sleep disturbances and nightmares. In reality, up to a third of your day is sleeping. And quality of sleep can really affect our functioning the next day, both physically and emotionally. So when we can improve sleep, quality of life makes a huge difference.”
PTSD patients also have told him they’re less anxious, jumpy and irritable on marijuana, he said.
“We do have a surprising number of patients who use to do talk therapy for PTSD (but stopped) because it was so distressing,” Zaraa said. “But after medical marijuana, they found that they could engage with therapy better, and they’re wiling to move forward with that kind of treatment.”
Zaraa said that in his experience, marijuana is less effective in managing neurological degenerative diseases, such as Huntington’s, ALS and multiple sclerosis, which is also an approved condition for Ohio medical marijuana.
Only 37.7% of doctors were satisfied with the drug for M.S., according to the survey.
“It’s very unfortunate, it’s tragic,” he said. “It’s very difficult to manage (the diseases)... With M.S. the complaints I’ve heard is that sometimes the doses they require are higher than what the program allows.”
After an initial explosion in doctors being certified to recommend medical marijuana, Ohio has seen a slight dip in those seeking certificates. Doctors can receive a certificate to recommend medical marijuana by taking a two-hour continuing medical education course online.
The first dispensaries in Ohio opened in January 2019. By June that year, there were 512 doctors with certificates. That number increased to 667 by June 2021 but since has dropped to 648.
The reason for the slight decrease is unclear. Zaraa said that many of his colleagues took the two-hour course because it was a one-stop location to learn about marijuana, and many doctors have been curious about it. They may never have been interested in recommending it to patients, or they may work for a hospital or clinic that prohibits recommending marijuana. Those doctors may have let their certificates lapse because they didn’t need to continue to take the same course year after year, he said.
Recommending marijuana via telehealth
In March 2020, the State Medical Board allowed doctors, including those with certificates to recommend medical marijuana, to use telehealth, in response to the COVID-19 pandemic. Last march, a new law went into effect that permitted telehealth for medical marijuana recommendations and renewals.
The survey found 260 doctors said they see patients for marijuana via telehealth.
Zaraa of Compassionate Cleveland said he uses telehealth because most of his patients prefer it.
“With many of our patients, I can diagnose them in an interview (through telehealth),” he said. “Many of the patients already have that diagnosis. As you see in the survey, many of the doctors are pulling together information from multiple sources and a smaller percentage are making a diagnosis at the time of the visit.”
The survey showed just under 300 doctors said they sometimes or always confirm a diagnosis made by an Ohio licensed physician, although some said that they make their own diagnoses.