Posted by Marijuana Doctors on 06/21/2019 in Medical Marijuana
Dr. Koffler: Most people do not go through their own medical doctor for a marijuana recommendation, and the reasons for that could be many.
For starters, only certain doctors are certified to recommend medical marijuana to their patients. And so while it’s fine to inquire about your condition as it relates to marijuana with your own doctor, they may need to refer you to a cannabis doctor in your local area anyway.
Secondly, many physicians are not knowledgeable—or even supportive, in some cases—of medical marijuana, despite its demonstrated safety and efficacy. This could vary widely by state, or by even by individual doctor.
While it’s your diagnosis that determines whether or not you will be able to get a medical marijuana card in your state, once your physician has given you a diagnosis of an approved condition—and its history is well-documented in your medical records—it’s up to you how to pursue a marijuana license to treat that condition.
Other than needing a copy of your medical records, it won’t be necessary for your personal doctor to know anything about your interest and request for marijuana—as long as you seek out an approved source, and register with your state.
As for how to find a local doctor: most of my patients found me by using a site like MarijuanaDoctors.com where you can do a simple search find doctors in your area.
Dr. Koffler: In terms of results or quality, there’s no difference. But in efficiency and convenience, if you ask me, telemedicine is definitely changing the way we do healthcare. These days you can speak with a patient face-to-face on video, offer a diagnosis and prescription—all regardless of geographical location or even condition.
Telemedicine is very well-suited for cannabis referral. This is because as a marijuana-recommending doctor my job is not to make a diagnosis, but to determine if marijuana is indeed well-suited for the condition diagnosed by another physician. For example, if a cancer patient comes in with a clear medical history, there’s no need for me to repeat the oncologist’s work. I simply review the records, determine if there’s a need and benefit for marijuana medication, educate that patient on what to expect, and then we proceed. Even for states that require a physical before certification—this would still go through a patient’s own doctor. I simply review the materials, and offer the paperwork needed for a patient to register with the state to legally buy and medicate with marijuana.
Dr. Koffler: There’s a few reasons. First, it’s cheaper. Medical marijuana users will often get access to preferred pricing and discounts that aren’t available to recreational consumers. Secondly, the products can be different (stronger formulas, more strains containing the CB’s, etc).
Finally, and I think most importantly, dosing is notoriously hard to get right with marijuana. Just like with any other medication, there’s a huge amount of variables that contribute to a person’s reaction. Even something simple like a pain reliever can have the desired effect for some people and not for others. Once in a blue moon, someone even gets sick—and that’s just aspirin.The endocannabinoid system is so much more complex. Undesirable effects are definitely possible with marijuana if you don’t get the dosing right, and a single dose can range between 2mg to 40 mg. That’s a huge variance! It’s a real mixed bag. Therefore, when you’re working with a certified cannabis doctor, you’re more likely to settle more quickly into an appropriate dose.
Dr. Koffler: A certified recommendation for marijana is, for all intents and purposes, just a prescription. But since marijuana is still filed as a Schedule 1 drug under federal law—in other words, illegal—doctors would be liable if they “prescribed” it. But we can certainly advise on, educate, and recommend marijuana to our patients, and we can provide the state with a written document that says so called a verification or a “certification,” which state regulators will accept all across the country, which allows you to medicate with marijuana for your condition, according to each state’s stipulations. In all other ways—a “prescription,” “certification” or a “recommendation” are all pretty much the same thing.
Dr. Koffler: You’ll need to provide a few things—either to be brought with you, or scanned and emailed or uploaded prior to your appointment. You’ll need:
Dr. Koffler: I want to know a few specifics. Namely: has this patient ever used marijuana? If yes, how experienced are they? What’s been their overall reaction to using it? In other words, how much will I need to educate this person? From there, I’ll better know how to navigate the type and dosing of their cannabis medication.
I’ll also need to know a bit about their lifestyle, such as their occupation. There are certain jobs, such for the TSA, or mechanical jobs such as construction workers or crane operators, where I have a hard time recommending marijuana because of federal regulations. For almost everyone else—including jobs that drug test, because new legislation protects marijuana patients with a doctor’s rec—so with very few occupational exceptions I’m able to proceed as long as the patient meets the established requirements for certification.
However, I also want to know a little bit about their daily schedule so I can educate the patient on how best to use marijuana, what strains are good for daytime versus nighttime, how they can medicate without getting high, etc.
Finally, I’ll use information about their condition and symptoms in order to determine what type of marijuana to recommend. This is the “ratio” of THC-to-CBD content which can be prescribed in any one of three combinations: a high-to-low THC-to-CBD, a 50:50 mix, or, a low-to-high ratio for a higher CBD effect.
Dr. Koffler: Besides approving a patient for medication, I’d say my main function in the certification appointment is to educate the patient. Even experienced recreational users can learn new things from me. Maybe it’s been a long time since they’ve tried marijuana, or maybe they’re a frequent user, but not up on the latest research. My goal is to fill in the gaps.
I always go over the basics about Indica strains versus Sativa strains, their qualities and uses, and information about the THC ratio I’ve chosen for them based on their condition. We also go over, in detail, each ingestion method available based on their state—whether a vapor, pill, tincture, or flower—and the benefits or considerations for each one so we can decide together what’s most appropriate.
However, I tend to leave a lot of the detailed strain and terpene information for the dispensary to go over with the patient—as each will have their own specific products they sell. And by law, just like with any other medication, I can’t tell a patient where to buy their medication. I can only refer them to a few local dispensaries and from there, a patient will need to shop around for the price and product they like best.
Dr. Koffler: This doctor’s appointment is like any other—it’s 100% confidential, protected by law—and no, there’s nothing that you could say or do that could get you in trouble.
My goal is to get the patient the medication we both know will make them feel better—and that’s my only goal. Remember: certifying doctors believe in the power of marijuana and its benefits. I’ve seen with my own eyes the relief this medication can bring to patients who have tried, quite literally, everything else. Medical marijuana has changed the quality of these patients’ lives—for the better. So no, there’s nothing to worry about when it comes to being candid with your doctor.
Dr. Koffler: Very few and far between. There are certain side effects and contraindications for marijuana—such as certain anticoagulants (blood thinners), mental health conditions such as schizophrenia, and some blood pressure medications can interact a bit with CBD, etc—but contraindications are very rare. Even SSRIs and other brain medications can be worked with while taking marijuana. And, to a large extent, patients who come to me who use or abuse alcohol or other drugs—I know very well, that often patients have been self-medicating with these other substances for years, to cope with their pain and suffering. And so more often than not, I actually see an improvement from these addictive behaviors when a patient is medicated properly with marijuana.
The only consideration I do weigh heavily before proceeding with a recommendation is when a patient has in the past had a particularly bad experience with THC. Some patients can get very paranoid, or in extreme cases, experience unpleasant hallucinations. But part of my job is to help patients learn how to use marijuana in an appropriate way, where this sort of thing wouldn’t happen. Or, I will consider a ratio much lower in THC for that patient.
Dr. Koffler: It varies state to state. New York is the fastest — you can get certified in as little as 24 hours. In Florida, you have to wait about 2 weeks, and in Connecticut, the waiting period is more like 2-3 months.
Dr. Koffler: Whatever it is, definitely ask away! There are no silly questions, and it’s what we’re here for. The process, the benefits of marijuana, the endocannabinoid system—you name it. We want you as our ally in using this new and powerful medication. So the more you know, the better-equipped you’ll be able to experience the intended benefits of your new marijuana medication.
Dr. Richard Koffler, MD, received his medical degree from the Sackler School of Medicine at Tel Aviv University in 1993. He completed his internship in Internal Medicine at Roosevelt Hospital in New York City, followed by a residency in Physical Medicine and Rehabilitation at the Rusk Institute at NYU Medical Center in New York City. He was board certified in 1998. Dr. Koffler is also certified to perform acupuncture, and his practice integrates proven conventional Western medicine with Eastern practices, as well as other proven complementary approaches to musculoskeletal injuries/diseases, peripheral neurological related issues, as well as pain management. Currently, Dr. Koffler is the Medical Director in practices in NYC, Stamford CT, and more recently in Miami Beach, FL, and is certified to recommend medical marijuana in all three states.
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