It’s been just two months since Long Island’s two medical marijuana dispensaries opened in Riverhead and Lake Success as part of the passage of the state’s Compassionate Care Act.
This past week we sat with a doctor prescribing marijuana right here in Bayport, Dr. Enoch Chan of Best Choice Medical.
Below, Dr. Chan speaks about marijuana, its benefits, and his professional choice to prescribe it to patients. He also touches on opiate use and over-use.
Q: What procedure did you have to go through to get state approvals?
A: The biggest hurdle is a course that you have to take. It’s three modules that, off and on, took me a few weeks. For those who might proceed in a more concentrated fashion, you could probably bang it out in a few days.
Q: Was prescribing cannabis a big decision that you weighed heavily?
A: This is something that in one way is new, but is really quite old. This is a compound that has been around for thousands of years. It can serve as an adjunct to people with chronic diseases who carry with them a lot of suffering. Chronic pain, weight loss due to whatever, cancer. Seizure. It’s really well tolerated. It’s very safe.
There has never been a recorded death association with marijuana, at least not an overdose. And, while I would not say it’s a replacement for current medications, it’s a terrific add-on.
And so, I jumped at the chance. Because it was an extra thing I could offer my patients to make their lives better.
Q: What would you prescribe to a typical patient?
A: It depends on who you are; if you’re marijuana naive, or if you’re not. Because a lot of the side effects of marijuana … let’s say someone smokes and has a bad experience, anxiety, paranoia, memory loss. That is oftentimes a reaction to a dose of THC that’s a little higher than what you’re ready for.
So, if I have a person who’s marijuana naive, I would choose a formulation that is low in THC and is high in CBD. CBD, which is short for cannabidiol, interestingly, reduces the side effect profile of THC. There are also anti-seizure properties so if someone had epilepsy you would choose a low THC/high CBD formulation as well.
The focus is on treating your main problem. We don’t ever want to be too aggressive and bring about some sort of mood, or mind-altering experience for the marijuana. Which is not the point. The point is too dose them just so their chief complaint, their main problem is treated, and give no more past that.
Q: Is possible marijuana dependency a big concern?
A: The likelihood of dependency from marijuana in the grand scheme of things is actually quite low. By some studies, it’s about 8 percent. But that study looked at a population that was using it for recreational uses. And so the incidents of dependency among a population using it for therapeutic reasons is, in truth, unknown. We actually think it’s less, for obvious reasons.
To safeguard against this, is conservative dosing; we never want to give more than what we really need. And every three months we try to implement a little bit of a drug holiday. About two weeks off, every three months.
Q: How does 8 percent dependency compare to, say, opiate pills?
A: Low. Very low. Among studies looking at cocaine, opiates, tobacco, alcohol, it is actually the lowest. Interestingly, the highest is tobacco, superseding cocaine or opiates or alcohol.
Q: What’s the strongest argument against the use of marijuana for medicinal purposes?
A: Medically? You got me.
I think the greatest hurdle is a stigma; that patients might think they’re coming here for a legal, state-approved mind-altering experience, and that’s just not true. So it’s really just a stigma.
But, if you have a history of schizophrenia, or psychosis, it’s probably best that you don’t [use marijuana]. Or, if you have very bad pulmonary status, we probably want to stay away. Or, if you have unstable heart diseases we also probably want to stay away. Stable heart disease is OK. Other than those, it’s really safe. It works well.
Q: What about reports of people in Colorado and elsewhere ingesting too much THC and ending up in hospitals?
A: This is done recreationally and it’s usually through eating. It’s not under the supervision of a physician. When you do it by yourself, you’re gauging it by how you feel. When you smoke it, the desired mood-altering effect comes quickly, like within a minute or two. The problem with ingestion, is it takes a while.
So, people are eating these brownies, or whatever it is, and they’re saying, ‘Hey I don’t feel anything.’ So I’m going to eat more and more. And the problem is, all this really does add up. So in about an hour or so, you will have ingested a tremendous amount of THC that you would never have exposed yourself otherwise because of its delayed effect for oral ingestion.
That’s when these people are exposed to psychosis or memory lapses or anxiety, that’s because they’re exposed to an amount of THC they shouldn’t be exposed to.
Q: How are patients in New York State currently taking the drug?
A: Right now the closest dispensary in Riverhead. That dispensary is offering transmucosal spray, and that’s all that they have. They spray it on the inside of their mouth and it enters their circulation from there. But in about three weeks, they’re anticipating they will be able to offer the vaporizer. But more formulations are coming.
Q: As society grapples with marijuana, one of the biggest arguments against it’s legalization is that it’s a so-called gateway drug. What are your thoughts on that?
A: I understand the philosophy behind it, but just because there’s an association, it does not imply causality. And the only thing you have to look at, are people who take it recreationally, and the dependency rate is low.
Q: As for opiates, with all the societal problems they’re causing, is it surprising that marijuana would have been outlawed while opiates are legal?
A: You can’t get rid of opiates. Ohhh, that would be unethical. If you have metastatic lung cancer, and let’s say there are bony metastases, you’re in agony every day. We’re just not going to give you opiates based on principal? That is unethical.
Despite the fact that it truly is a double-edge sword and there are major problem with regard to overuse, in truth there is no denying it: Opiates are a boon to our race. Because pain is horrible.
Q: How did we get to a place where marijuana became so vilified in this country?
A: The problem is that, for whatever reason, there was a war against drugs and in 1970 marijuana was classified as Schedule I — devoid of any medical benefit. Despite the fact that the AMA vigorously protested this, citing multiple articles showing that it has irreplaceable use, therapeutically. But i guess there was a political movement at the time and I guess, they needed to do what the needed to do, I don’t know of any way of putting it.
Photo: Dr. Enoch Chan with a photo of a table top vaporizer in his Bayport office. (Michael White)