Because Dr. Jacob Mirman is an internist who is well known locally for his expertise in medical cannabis, reporter Matt DeLong of the Star Tribune recently contacted him for an interview for the article: “Some THC products are now legal in Minnesota. Here’s what you need to know”.
Dr. Mirman I know you have certified more than 3,500 patients for Minnesota’s medical cannabis program and that you have stressed that marijuana can be an effective medication. Do you personally advise the use of recreational marijuana?
"Cannabis is a very powerful and very effective medication for multiple conditions. But in my opinion, medications are not supposed to be used for fun. That is a slippery slope. On the other hand, if you want to drug yourself up for fun, cannabis is probably the safest drug to do it with, compared with alcohol, tobacco, opioids, cocaine, etc. As long as you don’t use dangerous equipment (car, etc.) after indulgence.”
How is medical cannabis handled differently than recreational cannabis?
“Pharmacists working with the medical cannabis program start patients on a small dose and build up from there. Each patient gets medical cannabis formulated especially for them including the type of formulation they may need, the strength they need etc. This is very important to the success for each patient.
Recreational cannabis on the other hand has no “ground rules”. Anyone considering using recreational cannabis for the first time should do it at home and have someone else around in case they experience side effects, which definitely do occur.
You never know what's going to happen to you when you ingest marijuana, so if you're going to try it, my recommendation is to first do it at home. Give it some time, so you know what it does to you. Do not do activities such as driving or operating heavy machinery, etc.
Is the dosage of recreational marijuana regulated?
“By law in Minnesota the maximum THC level is 5 mg per dose. I am surprised that this high of a dose has been established for recreational use. THC may not kill you, but it can easily cause adverse reactions especially in someone using it for the first time.
For comparison sake, Green Goods green tablets (balanced, medium dose) contain 2.5 mg of THC per tablet. This means that the maximum recommended dose of 5 mg of THC contained in two of these pills, which may be too high of a dose, especially as a starting dose, for some people.
Here is an example of what can happen when people take too much THC: I once had a 90-year-old man take only one quarter of one Green Goods green pill which amounts to only 0.625 mg of THC. Unfortunately, this man developed a severe paranoid reaction which lasted two hours.”
More and more patients are being certified for medical cannabis.
Here are the most frequently asked questions regarding medical cannabis:
1) If I am using medical cannabis, can I keep taking other medications that are prescribed from my doctor such as opiates?
Dr. Mirman agrees to the emerging research that shows that medical cannabis should be considered as first line pain medication. It appears to be safer than all other pain medications available by prescription or over the counter. It does not cause severe side effects and overdose deaths like opioids, GI bleeding (including fatal) and kidney failure like NSAIDS (ibuprofen and others), liver and kidney failure that acetaminophen (Tylenol) has been shown to occasionally cause. Its side effect profile is much more favorable than most pain drugs.
Medical cannabis also appears to be more effective than most other pain medications. Using cannabis in patients already on opioids for pain tends to decrease their opioid doses, and in many cases make them unnecessary. There is no medical or legal reason to refuse prescribing opioids to patients certified for medical cannabis. Unfortunately, some pain clinics have a policy against combining opioids and cannabis and cut people off their needed opioid prescription for a urine test positive for THC (resulting from taking medical cannabis).
The following article provides good information and references indicating that such policies may be short-sighted. If your pain doctor is not amenable to managing your opioids as appropriate while you are on medical cannabis, contact Dr. Mirman for a referral to a more reasonable pain doctor.
Article: Emerging Evidence for Cannabis' Role in Opioid Use Disorder
2) What forms does medical cannabis come in?
The use of pills, oils, topicals or vaporizing of a cannabis compound through a device similar to an e-cigarette is allowed as well as “dried raw cannabis” which patients can smoke or vaporize using a device. Different patients like different types of preparations. In particular, the topicals seem to work very well. And many patients like the flower version as it is more economical because very little of it needs to be used.
3) What is the cost of certification?
The cost from Life Medical for initial certification is $250 for initial certification and $200 for the annual recertification. We give veterans 10% off for these certification charges. The government also charges between $50 and $200 for both initial approval and re-approval depending on the patient’s status (the cost is discounted for people with disabilities due to military service and people with other types of disability or on medical assistance).
4) How long does the process take?
It usually takes less than a week from the time patients are certified at Life Medical to the time they are approved by the State of Minnesota. Legally the state is allowed 30 days to approve but in most cases the process is completed in 7 days.
5) Am I going to get in trouble at work drug testing from cannabis?
If you use medical cannabis you will definitely test positive for it. But according to MN law, workers should not be discriminated against for this when they are legally certified. If there is an issue with this drug testing at work, Dr. Mirman is happy to talk to the Human Resources staff to explain the laws. These rules however do not apply to federal agencies, so medical cannabis use can still be an issue for federal employees.
6) Where are the dispensaries located?
There are several dispensaries in the Twin Cities so getting the medical cannabis is not an issue for patients in the metro area. Unfortunately, they are not as easily available in greater/outstate Minnesota, and people sometimes need to travel long distances to get to the closest dispensary.