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Despite a lingering social stigma attached to marijuana use, there is a growing interest in medical marijuana (MMJ) among patients, researchers, and health care providers, including some PTs and PTAs. Medical marijuana is a potential alternative to opiates, muscle relaxers, and anti-inflammatory drugs. But is it always safe?

This month in PT in Motion magazine: "A Growing Interest in Medical Marijuana" explores the complicated legal landscape regarding MMJ and how a patient’s use of MMJ may influence physical therapy care.

While state laws regarding marijuana use are inconsistent, there is a trend toward legalization and decriminalization. However, the United States Drug Enforcement Agency (DEA) is still trying to shut down domestic cultivation of marijuana. Mike Pascoe, PhD, a neurophysiologist and assistant professor in the physical therapy program at University of Colorado, says he meets many physical therapists (PTs), physical therapist assistants (PTAs), and students who are "uninformed about federal and state laws and the process for researching marijuana."

Charles Ciccone, PT, PhD, FAPTA, told PT in Motion that "many patients are ahead of the curve" compared with clinicians. While no PT or PTA should ever advise use of any medication, Ciccone says clinicians should be able to educate patients on the "reported benefits of marijuana as regards chronic pain, spasticity, and chemotherapy-induced nausea and vomiting"—as well as potential adverse effects.

Laura Borgelt, PharmD, a pharmacology professor at University of Colorado, educates PT students about how cannabis works in the human body, and how it can be helpful or harmful to certain body systems. Because it is often used to treat pain symptoms, she says, marijuana is "very relevant for a PT." She encourages PTs to be on the lookout for side effects such as cardiovascular issues while exercising, and changes in mood or memory.

Vivian Eisenstadt, PT, MA, is among PTs who are "very much in favor of legalizing" marijuana. "Marijuana helps many people I treat," she says, comparing it to Vicodin or "any other medication a physician has prescribed for management of physical or mental pain." That said, she observes that sometimes marijuana use can affect a patient’s response time or focus. In such cases, she counsels the patient about "not taking the drug before sessions if it’s going to lower the quality" of the therapy session—just as she would for someone taking Vicodin or OxyContin. "As a PT," she explains, "it is my job to navigate the situation with compassion and professionalism."

The variety of forms of marijuana consumption is a concern, as dosage is often inaccurately labeled, says Pascoe. Pharmaceutical-grade marijuana extracts and topical creams differ from commercial products such as baked goods or candy. In addition, the different cannabinoids found in marijuana have varying effects on the body.

When researching medical marijuana’s effects, Ciccone urges PTs to consider the source of the information to be able to provide patients with balanced and valid information. Clinicians "should be vigilant for any problems that may arise if patients are using cannabinoids during physical rehabilitation."


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