Our November election offered good news for marijuana. Several states, including California, Nevada, Maine and Massachusetts, voted to legalize recreational marijuana, joining Colorado, Oregon, Alaska, and Washington State. Many more states have legalized marijuana for medical purposes- although the qualifying conditions vary by state. A total of 26 states, plus the District of Columbia, have approved this use and these states have been helpful for studying the effects of marijuana on patients as a group.
Overall the studies show that marijuana legalization decreases the deaths from opioid overdoses. Scientific American wrote a great article summarizing the recent studies on marijuana and opioid use. Marijuana (cannabinoids are the names of the chemical group) has been shown to decrease dependence on prescription opioid pills like Percocet and oxycontin and is a pathway for people to get off the dangerous drugs. As people become accustomed to an opiate, they require a higher dose for the same effect. Since these substances can be lethal, the dose required to relieve pain can near the lethal dose and lead to death. In 2014, 14,000 people died from unintentional overdose of prescribed opiates. Guess how many people died in 2014 from marijuana overdose? Zero, and that’s according to the DEA. Marijuana use does not lead to overdose and it is far less addictive than opiates or even alcohol or cigarettes. This is why so many states have passed legislation to legalize it. The hold up, in terms of wider use of cannabinoids in medicine, is with the DEA (Drug Enforcement Agency) which still classifies it as a drug with no medical use. With the Class I status it is difficult to procure the substance in order perform clinical trials. Since the pharmaceutical companies don’t stand to profit from marijuana there is no financial incentive for funding studies or money for lobbying the DEA. Currently, it is easiest to look backwards at data and plainly see how different symptoms or behaviors changed, how many fewer opioids were prescribed, and how many fewer people died when medical marijuana was available to patients. We are also starting to see the benefits of cannabinoids in treating not just pain or nausea, but also in helping with mental health issues as well, such as PTSD and depression. The use of cannabinoids for pain is so widespread now that the NFL is about to consider allowing their players to use cannabinoids for pain as so many ex-players have found relief from its use and have cut their opiate use.
Here in the District of Columbia, the use of medical marijuana is legal, as well as the recreational use by private citizens if it is not sold. Let’s hope the federal government allows states to keep the laws here in DC and across the nation. Let them also see the wisdom in correcting the DEA classification so that bigger studies can be performed and we can incorporate cannabinoids into everyday evidence-based practice.
We will soon be offering telehealth appointments for existing patients. As soon as the last few technical details are completed you will be able to schedule an appointment for a face-to-face video-chat visit using HIPAA compliant software. This is perfect for any type of visit or followup that does not require a hands on exam. When you’re too sick to come in to the office, or too contagious, we can see you through eVisit, which you can use on a computer or through the app on your phone or tablet. We can help you out with mental health concerns, with the stomach bug or influenza, with a urinary infection, a rash, pink eye, an allergic reaction,back pain, and many other common illnesses or follow up appointments. If you need to call us after hours for an urgent medical need we can direct you to sign in if we feel a telehealth visit is needed to properly treat you. You can choose to pay through insurance with just a standard office copay or you can pay out of pocket. We will still submit your prescription to your pharmacy or submit a referral to a specialist- just like a standard office visit. Just make sure you are somewhere you can talk privately!
Click here to go to our telehealth page on our website to read more about it and watch a video. You can click on the link there to be directed to our eVisit site. I recommend signing up now so that all you have to do is sign in when you are sick.
We are so pleased to be offering this to our patients and continuing to be collaborative and efficient in our health care practice.
So the reality of our recent election is setting in. No matter how you voted, there is a lot of uncertainty ahead in the next few months. If the trend continues, it feels like anything could happen in the home stretch of 2016. We have seen horrible violence both abroad and domestically, and some of it has been been perpetuated by our own citizens against fellow citizens. I’ve had many friends ask me not-so-jokingly if I’ve had an increase in requests for xanax. They have symptoms of insomnia, crying, displaced anger and intense muscle tension. They tell me they may be in to see me soon as a patient.
- An anxiety state defined by our medical coding is “Apprehension or fear of impending actual or imagined danger, vulnerability, or uncertainty” (ICD 10 code 2016-17 where ICD means International Classification of Diseases). While generalized anxiety disorder is defined as persistent physical symptoms of anxiety for 6 months, an anxiety state may be temporary. If this temporary state is interfering with your ability to live your life you may need some short term medical help. In a couple of weeks I imagine some people will meet the criteria for an adjustment disorder or even depression. Here are two definitions from the ICD codes that qualify a diagnosis of adjustment disorder- they sound pretty relevant right now don’t they?
- A category of psychiatric disorders which are characterized by emotional or behavioral symptoms that develop within 3 months of a stressor and do not persist for more than an additional 6 months after the stressor is no longer present.
- Social, psychological, or emotional difficulties in adapting to a new culture or similar difficulties in adapting to one’s own culture as the result of rapid social or cultural changes.
The bottom line is that if you are concerned about how you’re handling the turmoil of this year, especially with the recent election, please talk to someone about it. We want to help you and throw you a life preserver if needed.
While fewer people are smoking nowadays, there are still plenty of people who smoke. It may be only when they are out with friends, or with family who smokes, or when they are extra stressed. Some people can stop for years but fall back into it quickly due to a big stressor in their life. We understand. Most of us need help with healthier coping mechanisms and can develop addictive behaviors (think food, alcohol, wasting hours on Netflix, or getting grumpy with our loved ones). But nicotine is an incredibly addictive chemical and it’s a behavioral habit. For this post let’s focus on cigarettes. The New York Times this week had an article reporting on a recent study that 28.6% of cancer deaths nationally are caused by smoking tobacco in some way. The rate varies on location, with a low of 21% in Utah and a high of 38% in Kentucky. There is also a big difference rates between genders with men significantly more affected than women. What are these 12 cancers that are directly related to cigarettes? Obviously lung, mouth and throat cancers. But also stomach, colon, bladder and even a type of leukemia. This study did not include cancers due to other types of tobacco like chewing tobacco which would add many more life altering and deadly cancers. How do we get these numbers to decrease? By implementing recommended programs in each state that help people stop smoking and prevent them from ever starting in the first place. The World Health Organization recommendations come down to three basics: prohibitive cost of tobacco products, no advertising, no smoking in public, and an engaged health system.
Here in primary care we can be engaged in finding out your smoking habits and helping you quit when you’re ready. We won’t shame you- promise- but we ask if you are ready to quit or reduce smoking. This upcoming cold and flu season is a great time to quit! Most people don’t have the urge to smoke as much when they’ve got a cold so take advantage of this fact and don’t resume your usual smoking frequency. Come in and see us as you may need antibiotics for your bronchitis (smoking changes the bronchi and lungs and encourages the growth of different types of bacteria) and we can discuss medications to stop smoking at the same time. Whether you’d like some accountability while you use the patches and/or gum from the drugstore, or you’d like to try Zyban or Chantix tablets to help reduce the cravings, we are here for you. People often tell us about some creative ways they have reduced or stopped smoking. They’ve had success with a transition to e-cigarettes, or cigars/cigarillos, or water pipes, to keep up the nicotine while they transition off the physical cigarette habit and then transition off nicotine slowly. Different studies have shown varying levels of success with this type of method, but only you know the method that may work for you. We’ve also had patients who found hypnotherapy incredibly helpful in as little as one visit.
Think about the factors that make quitting difficult or that have caused you to relapse in the past. Do you have a friend or family member to encourage you on the way? What has worked to help you reduce or quit in the past? Did you know you can start on a medication while still smoking? Starting on it for a few weeks prior to a quit date can ease a lot of the anxiety that goes along with quitting. And we will meet with you and support you through the ups and downs of the process for however long it takes. There are many methods to quit or reduce smoking so come in and see us at any of our Kelly Goodman Group Locations so we can find one that will work for you!