Health systems remain in the cloud
I find it ironic how legalization for recreational cannabis sparked health system policy writers to action. I am not surprised as it is important to align organizational behaviour with changing laws. My issue is with 20 years of regulated medicinal cannabis experience, most health systems remain poorly prepared. I am thinking the recreational cannabis legislation will only perpetuate their pigeon holing of those who consume cannabis as Cheech & Chong-like characters. I say this because I am of an age. Back in the day, I listened to their albums, watched their movies and my contemporaries are now the ones who write, edit and control current health system policies. I want to believe we have come to an end of an era, where we stop stereotyping “those marijuana users” as stoners, but I fear it is not so.
To this day, there remains a lack of knowledge of cannabis science within health systems which is odd, when statistics suggest some of those individual health workers probably consumed illegal cannabis back in the day. I understand why a dense cloud continues to hang over cannabis. Generations were told of the horrors of marijuana, while my generation started using it for our amusement. Then Canadians’ relationship with cannabis changed; it took the courts to tell health systems cannabis actually improves lives. While a small group of patients were teaching an even smaller group of doctors how they self-medicated, the greater health system simply ignored cannabis, refusing to recognize it as something other than a self-indulgent substance. The lack of policies and treatment protocols recognizing cannabis as something good, demonstrates the importance given by those who controlled health systems after the courts’ decision.
When the Trudeau government legalized recreational cannabis, money suddenly became available. Policy makers took notice and started creating policies preparing for the sky to fall. We now have new educational programs, behavioural guidelines and workplace policies all focused on recreational use, while cannabis researchers suffer from a lack of dollars to study cannabis as medicine. Whereas, some health authorities have policies for medicinal cannabis, now more are regulating the consumption of recreational cannabis by employees. Some of the Colleges, those regulating health professions, are developing continuing education programs fixed on the oncoming addiction issues we are to expect from recreational cannabis legalization. Many health system regulators and practitioners alike are, suspicious and officially, by policy, not recognizing cannabis improves patients’ lives instead, much of the funding is spent to protect us from cannabis.
Yes, there are still “stoners” out there and it is important to recognize how we stereotype them when they wear their freak flag so freely. It is also hard to ignore the Pig-Pen-like cloud of cannabis following them into a clinic room. Over the years, I have met zealots who look up with a vacant, red squint, leisurely respond to simple questions and defend cannabis as a saviour. Cannabis as a saviour? What do I do with that? Many practitioners view these people as stoners when there is an argument suggesting all users, including recreational users, consume cannabis as medicine. It is okay for the system to be skeptical, but if the person believes cannabis is helping for what ever reason, who am I to disagree? As society is changing its perceptions of cannabis, policies within many health systems still do not view it as medicine.
I recognize cannabis presents a relationship conundrum. This problem creates confusion, because “patients are completely in control” with deciding the dose and route of consumption. Many within health professions are puzzled by the intimacy people have with the plant when they grow cannabis as medicine. When cannabis was thrust upon the health system, health professionals were simply not prepared. Many practitioners see cannabis as nonsense, because there are not enough clinical studies to treat it otherwise. This is not defendable as many of these same practitioners use other therapies off-label. This means today’s practitioners are making clinical decisions without having the appropriate studies to support those choices, so why is cannabis seen differently?
Let us consider, before prohibition, cannabis was medicine with hundreds of clinical studies completed. It became part of the Pharmacopeia in the 1880’s, and cannabis was used for all sorts of illnesses until alternative medicines became available. Our modern knowledge started with the isolation of CBD in 1940 and by 1995, we learned our bodies create its own Endocannabinoids and very few medical professionals apply this information to their practice. To be fair, it was not part of their original education. Yet to this day, very few post-secondary colleges and universities are teaching the Endocannabinoid System and I suspect most still do not teach the pharmacology of cannabis. Here we have cannabis part of the health system for decades, with new science being published in respected journals and schools are still not properly preparing future health workers to fully understand cannabis as something good.
I want to believe the stigma of cannabis use has gone up in smoke, but I know clinical judgement is still influenced by bias. Actually, the real irony occurred when the courts, a system which criminalized cannabis, created the backdrop for it to be acceptable as medicine. It is good to see health policy regulators more aware of cannabis. It remains unacceptable to see how health systems are still so influenced by satirical comics. It is time for schools to update their curriculums. Our future health system regulators must start applying the science of cannabis to new policies; they need a deeper understanding. Maybe once we clear the smoke of ignorance, health authorities can start operating on policies supporting cannabis as something good. Maybe, I am an optimist.
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