Talking to your Doctor About Medical Marijuana: An Interview With Dr. Joe McSherry, MD, PHD

Dr. Joseph McSherry, MD, PHD, Neurologist and Associate Professor at the University of Vermont College of Medicine, in his office on Thursday, August 25, 2016. Photo by Eli Harrington for Heady Vermont
Eli Harrington 30 Aug 2016

Dr. Joseph McSherry, MD, PHD, is a Neurologist and Associate Professor at the University of Vermont College of Medicine. He first joined NORML in 1971, but said that he was not a ‘hippie,’ or necessarily part of a counter-culture movement. “I hadn’t heard of Woodstock until the movie,” jokes the friendly and content Dr. McSherry, once an attentive medical student and resident who disagreed with Richard Nixon’s drug policy, including his decision to bury and discredit the findings of the Shafer Commission, and other National Institute of Drug Abuse (NIDA) studies of the time related to cancer research.

Before Nixon, and even during his time as an undergrad at Harvard University, where he received his B.S. in Physics in 1965, Dr. McSherry started out with a more neutral stance towards cannabis than many of his peers:

“This guy was educated in Brown and he taught us that marijuana does something to your time-sense and is a mild hallucinogen, because that’s what he had been taught — and he had been taught before it was banned. Totally different from the notion that it makes hair grow on your palms and your brain dissolve. So I had a more neutral view on it from high school biology than other people would have.”

In 1942, cannabis was removed from the United States Pharmacopeia, thus losing its therapeutic legitimacy and its place in medical schools as a part of academic training. Dr. McSherry points to that lack of existing academic training and/or widespread clinical research as especially troublesome for the many well-educated medical professionals who oppose marijuana based on lack of knowledge.

“Doctors study a lot, and they think they know a lot … Lots of doctors are not educated on [medical cannabis], but have a lot of education about medicine, physiology, all the stuff that’s been taught in med school since 1941.”

In part to address the lack of available training and research, the University of Vermont College of Medicine recently became the first in the country since WWII to offer a medical cannabis course in the College of Medicine’s Department of Pharmacology. This summer, UVM expanded the educational offerings to the public by offering free online courses with an all-star line-up of professors include the founders of the Vermont Patients Alliance (one of Vermont’s four licensed medical marijuana dispensaries) and the Vermont PhytoScience Institute.

His first foray into cannabis advocacy in the late 1970’s and early 1980’s was almost accidental: “I thought I was being lazy by taking a day off and attending a legislative session, and in a committee room, and they were considering a bill related to allowing oncology research. Senator LeMay asked me what I thought and I almost casually responded that I didn’t think there was anything that bad about it. The next thing I know, I’m quoted as being in favor of it, so I figured if that was going to be the case, I’d better do more research and really know more about the topic. Thankfully, as a doctor, you have a lot of access to research, and although there wasn’t a ton, there was some, and there has been more and more published about the effects of cannabinoids and the various potential ways they work with the body.”

Doctor McSherry has no problem voicing his public support for cannabis and shakes his head disappointingly at the fact that the Vermont Medical Association has yet to support medical marijuana, let alone support legalization and regulation as he does.

Still, Dr. McSherry estimates he thinks that probably 25% of the population has a ‘dysphoric,’ or negative, reaction to cannabis. He points out that not everyone is going to have a favorable relationship with various methods of consuming, and that is expected.

“Vaporizing is better than conventional smoking,” he says, and people ignore the number-one rule to edible cannabis products: “People sometimes have a bad trip and it turns them off, they need to remember to start low and go slow, as the professionals advise … Some people who drink wine do fine, some get migraine headaches, so those people just don’t drink wine.”

Dr. Joseph McSherry, MD, PHD, Neurologist and Associate Professor at the University of Vermont College of Medicine, in his office on Thursday, August 25, 2016.
Dr. Joseph McSherry, MD, PHD, Neurologist and Associate Professor at the University of Vermont College of Medicine, in his office on Thursday, August 25, 2016. Photo by Eli Harrington for Heady Vermont

With his background as a researcher and a neurologist, Dr. McSherry also graciously shared advice for potential patients who might be interested in registering for the medical marijuana program in Vermont (and elsewhere) but who aren’t sure where to begin.

Subscribe to the Heady Vermont podcast on iTunes and Soundcloud and listen to the entire interview.

HEADY VERMONT (HVT) : So to wrap up our conversation, how can I talk to my physician about cannabis? Let’s say I’m out there and I’m interested, I don’t want to take pills, maybe I’ve got nausea issues — whatever your condition, pain relief, insomnia, appetite — What are the tips to start that dialogue with a doctor?

Dr. McSherry: Basically, we have this limbic system in our brain, which protects us from forbidden thoughts — it’s what the apple did when Eve and Adam ate it — so it’s not subject to rational analysis. So if your physician says right off the bat, no, that’s bad, I won’t sign anything, then you need another doctor to get that signed because he or she isn’t going to change and peer-reviewed articles aren’t going to help.

I would suggest being very gentle with the doctor and saying, look, I’ve got a lot of pain and I know that you’re giving me lots of good medicine for that but I’ve got a lot of pain still and either say, ‘I’ve tried cannabis and it’s helped a lot — which would be the ideal way of going in there, because if you haven’t tried it, it might not help — so if you have (used it) and can say that it’s helped a lot, and it’s for one of those conditions for which the state allows (learn more about qualifying medical marijuana conditions In Vermont).

The doctor also needs to be reassured that he doesn’t need to recommend it. You’re not looking for a recommendation, you’re just looking for a signature: This is my diagnosis, and I am your doctor.

“You’re not looking for a recommendation, you’re just looking for a signature: This is my diagnosis, and I am your doctor.”

In Vermont, that’s all you have to do. You don’t have to say that you think it’s valid medicine or that it’s the best treatment for this patient.

In most of the states, you need a recommendation from a doctor … It’s very nice in Vermont that the doctor doesn’t have to commit at all, in fact, he/she can write that “I tried to persuade the patient for two hours that it’s not a good thing to do, but this is his diagnosis and I am his doctor.”

Now it’s three months that the patient and doctor have to have a relationship, but some doctors are never going to sign it. Some doctors are going to sign it, but not for five years until they get more used to the idea.

On why alcohol is widely accepted, even though it’s acknowledged it’s objectively worse for you, including driving impairment:

Because people believe that it’s bad because that’s what they’ve been taught and trained to believe. The police believe it’s bad, alcohol is not so bad, as long as it’s .08 or less, but actually, .08 is four times more likely to get in an accident as .00, but they’ve been trained that .079 is okay, and any cannabis is bad. So that’s what they (the police) testify, but that’s not correct.

HVT: That’s what’s so unique in Vermont, that you can reassure your doctor that he/she isn’t endorsing or recommending the use of marijuana — medical or otherwise — they’re simply affirming that yes, I am your physician, and yes, you do have one of the qualifying conditions. You can say that yes, I have one of these conditions, and yes, I’d like to try it.

Dr. McSherry: Yea, and physicians, all the time are filling out slips that say, yes this is my patient, this is what I’m seeing him/her for, and I’d like to be paid. This is the same thing except that it’s for the patient and they don’t have to go to jail and I don’t think doctors fully understand how insignificant what they’re doing is.

I had originally suggested to the legislature that they just get a copy of the office note —

HVT: — Which is even easier —

Dr. McSherry: A patient should be able to get a copy of their office note. But, that’s got a lot of other information that’s not necessary so the legislature set it up so that there’s this scrubbed-clean form that just says you either have this diagnoses or you don’t and you’ve got a doctor relationship or not.

HVT: In Vermont, licensed naturopaths can also sign off on cards, so it’s not just M.D.s (also Physician Assistants, P.A., and Advanced Practice Registered Nurses, A.P.R.N., respectively)

Dr. McSherry: I believe the naturopaths (N.D.) have to pass a pharmacology test as well, but that’s worth looking into. 

Some groups of doctors feel more strongly than others — pediatricians are a group that are totally opposed — and it’s not clear because in the current status, kids can get it. One of the reasons that Ginny Lyons (Vermont State Senator Ginny Lyons, D-Chittenden) who supported medical marijuana is that people came to her and said, “Look, I’ve got to get my grandson to go out and find medical marijuana for my husband who’s dying of liver cancer and I think there ought to be a legal way for him to get that, rather than our grandson going to school to get it — because it’s just so much easier for kids even now. I’d have no idea who to call – which corner do I go stand on?”

HVT: I know that’s a big issue for patients even in legal states, I’ve got the card and am ready, who do I call and where do I go?

Dr. McSherry: That’s where the dispensaries can offer some help, and I hope that eventually patients can do enough communicating with sufficiently defined chemo-types of cannabis, so that they can share the information: “This has really worked well for my chronic back pain, this has worked well for my insomnia, this has worked really well for my anxiety without messing up my thinking … But again, you have to have a regulated product.

For the pediatricians, they don’t want kids using it. And I totally agree with them — I would like kids not to smoke cigarettes, drink alcohol, use cannabis, smoke crack, do cocaine, whatever. The problem is the kids are using those things, and do have access, and with cannabis, have access to unregulated stuff and don’t know what it is.

It’s true, after legalization they could still conceivably get it, I don’t think the state — if it legalizes it in a controlled and regulated fashion, so that there’s no advertising and it’s like going into a liquor store (kids don’t go in there), then I don’t think it’s going to give the impression to kids that they’re now authorized to use it.

That’s the argument they had for medical marijuana: If you call it medical marijuana kids are going to think it’s safe.

HVT: Yea, I don’t think there are kids who see a prescription bottle and obviously think that medicine is safe, I think it’s usually the opposite.

Dr. McSherry: Yea, kids are not as ungifted as their parents think they are, and they’ll continue to make judgments based on what their parents have to say and what colleagues and peers can tell them, and if the parents or the pediatrician tell them things that are wrong, they just won’t trust that source of information.

HVT: That seems like the biggest failure in our drug education system now, is that you have people telling you that the sky is green, and telling you and telling you, and one day you look up and see that the sky is blue, then that person no longer has credibility, whether if it’s a teacher or any kind of authority figure.

Dr. McSherry: Yea, parents particularly. Parents really shouldn’t give up the trust of their kids if they can avoid that, so saying stuff that happens to be incorrect doesn’t help.

But legalizing it would mean that they would get their stuff from an older brother or someone over 21, instead of a dealer who might also be offering up some pills or something. So the people who are most opposed are the drug dealers and the pediatricians — not all pediatricians — but the the Project SAM people and the drug dealers are the ones opposed because the legalized and regulated stuff puts the drug dealers out of business. I don’t know why the Project SAM people are against it.

HVT: Yea, I don’t think they want to be on the same side of history and the same side of the table in agreeing with the drug dealers about keeping Prohibition in place.

Dr. McSherry: That’s where they’re at … Then you’ve got some people in favor who would like to have it freely available to anybody all the time. Vermont Cannabis: Heady Vermont Watermark

Disclaimer: No part of this interview should be interpreted as medical advice, and the opinions of the medical professional interviewed here are solely his own and do not necessarily reflect the views of his employers and professional associations.

Editor’s Note: Thank you again to Dr. Joe McSherry for sharing his time and opinion as a medical professional who has been researching medical marijuana for well over a decade, testified in front of the Vermont Legislature several times and published several op-ed letters supporting legalizing and regulating cannabis.

Subscribe to the Heady Vermont podcast on iTunes and Soundcloud and listen to the entire interview.

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