Expert: Medical Community Should Be Leading the Charge on Cannabis Treatment, Dispensing to Avoid Cannabis Overuse, Use Disorders

To recognize National PTSD Awareness Month in June, Pharmacy Times interviewed Jordan Tishler, MD, president of the Association of Cannabis Specialists, faculty at Harvard Medical School, and a cannabis specialist at inhaleMD, on how medical cannabis can be used to treat post-traumatic stress disorder (PTSD) among veterans and the general public.

Alana Hippensteele: So, what are some areas in which you see the medical community may benefit from further education on how medical cannabis can be used as a legitimate treatment?

Jordan Tishler: Well, I think that the medical community at the moment has largely ignored this issue, which I think has been problematic politically because if there's any group that should be sort of leading the charge and making sure that this gets done well and safely, it's physicians.

For me personally, the reason I do this is purely based on my own super ego, my moral need to provide this kind of care for people. I actually worked for the VA for 15 years before doing this as an emergency room physician, and I left that stable environment to do this because I felt that once I had gained a certain amount of knowledge about this, that I needed to kind of go out there and provide that.

I think that the broader community needs to sort of acknowledge that they've been fed a line of hui about how reckless and irresponsible cannabis is, and to acknowledge that we've got 70 years worth of not bad data—it's not as good as we'd like it to be, but it's not bad—that supports its use for various treatments, and in acknowledging that, then they need to just simply understand what it's good for and for whom it would be helpful.

I speak to my physician colleagues on this topic several times a week—I'm doing one this afternoon, I'm doing one tomorrow morning, and I am universally greeted by engaged curiosity. My physician colleagues almost never say this is baloney or any of those sorts of things. What they say is wow there's so much to know, I'm really interested, thank you for teaching me about this, and I'm so glad there are some people like you doing this.

I think that we really have to think of this as a team effort and getting those primary frontline people to be aware and understand enough that they can understand not only the medicine but also the availability of specialists for whom they can refer—that sort of creates a workable dynamic.

Alana Hippensteele: Absolutely, yeah. What is your outlook on the future of both care for patients with PTSD and acknowledgement of the role of cannabis in its treatment?

Jordan Tishler: Well, I think that our country in particular, though I don't think it's limited to the United States, is certainly seeing an explosion of mental health issues, much of which pre-dated the pandemic, but certainly have been amplified by the pandemic.

We know that our treatments for a lot of these mental illnesses, like anxiety and PTSD, are adequate but not great, or something to that effect. So, we need to keep pushing forward on that research.

We need to acknowledge the mind-body connection that people with psychological illnesses may have medical manifestations, and perhaps equally if not more importantly, people with medical illness are going to have psychological manifestations, and we need to say think about the psychological health of people who say have major illnesses. If you have a heart attack and follow that by a bypass surgery, you can be sure that you're going to have a certain amount of rehab after that, and we need to start thinking a little bit more about what are the psychological rehabs that need to happen.

So, I think that we need to grow in terms of our country's view of psychological illness as well as medical and the way these things interface, and I think we're going to get there. The real question in my mind is are we going to put our money where our mouth is as a country.

Basically, are we going to really devote the kind of resources that are necessary to both research and also provide the care to the people who need it. If it were up to me, I would buy a whole lot fewer F-35s and fund a lot more mental health clinics.

But frankly speaking, unfortunately nobody's asking me. Well, you asked me, but nobody in Congress has asked me.

Alana Hippensteele: Yeah, I wholeheartedly agree with that sentiment. What is the value of the pharmacist in supporting the care and treatment of patients with PTSD?

Jordan Tishler: Wow. Look, I think the pharmacist is in a unique role, and I think that when the relationship between the physician and pharmacist is working well, I think it's an amazing process.

I have had some of the most engaging and interesting discussions with some of my pharmacist colleagues, so I think that there's a huge role that they play in this entire process.

Certainly, we know that patients ask pharmacists lots and lots of questions, and I think that pharmacists do a very good job of answering them, and also knowing when that question needs to be turfed back to the doctor, so I think that's phenomenal.

When we start to think about the cannabis landscape, the problem is that that kind of education, and I don't mean just sort of factual education, but sort of beyond factual into sort of the professionalism and collegiality, I think that—I didn't go to pharmacy school, so I can't speak to how it's taught—but pharmacists generally come out, it would seem knowing something about who physicians are and what they do and how that relationship is supposed to work, and I just don't see any of that in the cannabis world at this point.

In fact, unfortunately, the overriding message to the public seems to be oh forget about the doctor, just come to us and we'll tell you what to buy and how to use it, and I can tell you from both observing the population as well as the effects that that message has had on my own patient population, that that can lead to problems of overuse, to tolerance, and ultimately potentially to use disorders.

Obviously, we don't want people to come to harm from the medicine that we're giving them, so that's sort of a primary concern for me. It gets me right back into that discussion of having a binding prescription because if the prescription says for cannabis like it does for other medicines, sell 30 tablets or sell an eighth of an ounce of botanical or whatever, then that whole incentive to sort of upsell and side cell goes away, and we can really then be concentrated and confident that the patient is going to get what they need. Whether they use it though, that's a different question. But at least then that's a relationship question between that doc and that patient.

Alana Hippensteele: Right, absolutely. Thank you so much for taking the time to speak with me today, Dr. Tishler.

Jordan Tishler: Oh, it's my pleasure. Let me take 2 seconds here just to remind everybody that if they're looking for resources about cannabis medicine, they should visit the association of cannabinoid specialist website which is cannabis-specialist.org. Thank you again.