Medical Marijuana, and addressing Black Men’s Health

        Lesson #3 on Herbal medicine ( A Discussion on Medical Marijuana)

We live in a time where even mild forms of mental or physical discomfort can result in excessive prescription drug use. Opioid epidemic has existed for most of my career, Ambien and Xanax sell on the street as frequently as hard drugs, clinics have turned into pill mills, seizure meds and antidepressants are abused  and I’ve watched elderly patients become addicted to  cough syrup and muscle relaxants. Psychoactive drugs has put a stain on medicine & health care.
So naturally I was not overly enthusiastic about Medical Cannabis . It was another scheduled substance that would be over-prescribed. 
But there was benefit!!!!!!
Working in long term care I saw debilitated many Black men (both mentally and physically) ,  where medical marijuana would have been appropriate and could also lead to further discussion about Black men’s health. Although the discussion below can apply to all gender and ethic groups,Black men and Latino men interact with the healthcare system the least, often missing preventative services and seeking only acute or emergency care
I believe that consulting with Black men about medical marijuana provides an opportunity to improve discussions on Black men’s health. 

  1. Mental Health 
       Men and women of all races use marijuana. Obviously Blacks men are no exception. Some smoke marijuana for the euphoria , many just followed their peers, but there is something more logical , that may keep young black men and adolescents using this natural relaxant . Systemic racism, community violence and even household trauma puts Black boys ( and girls ) in a constant state of stress. Our nervous system is in constant “fight or flight” mood (also known as acute stress response) . This is a neurologic and physical reaction that evolved for us to protect ourselves , responding to attacks, bad events or a threat to survival. Chemicals in the brain and hormones are released to help us respond by running or fighting and are manifested by being reactive, increasing heart rate, blood pressure, having muscles contract etc. Excessively being in this mood or response , is naturally draining and often leads to depletion and anxiety.  

        The contrast to this reaction known as “relax and reset(parasympathetic response), prepares our body to chill out including breath slower, relax muscles and focus on others like sex and digestion. Marijuana can act as a natural parasympathetic, it relaxes people, can reduce anxiety , relax muscles , even make you hungry.  Many black men who use marijuana use as a natural anxiolytic and to stimulate the latter reaction. The problem is that many black men are not even conscious of their stress, anxiety, or trauma. Medical cannabis does not help people address ,acknowledge or cope with the anxiety , trauma or anger they are dealing with. It sort of a band-aid actually. Even with its use there still remains risk of poor coping skills, poor interpersonal relationships, incarceration , and repetitive abusive behaviors. 
          Seeking marijuana medically can open the door to  discussing mental health . Evaluation for the use of medical marijuana can act as introduction to discuss anxiety symptoms, PTSD , screen for other mental health disorders and possibly more treatment including psychotherapy . While Medical cannabis is considered a holistic treatment to some, true holistic treatment goes beyond a prescription or herb and should be an opportunity to include other interventions.

2. Injuries

         Unintentional injuries is a major problem affecting African Americans and Latinos, typically associated with accidents from work or assaults (especially with firearm) . Traumatic spinal cord injury is real-life complication of these injuries. Spinal cord injuries can cause paralysis, dependence with ambulation, chronic pain and lifelong disability. Other complications can include blood clots, skin breakdown, and sacral ulcers with infections. Black and Latino men with spinal cord injuries are likely to be younger (20’s- 30’s, ) more likely to have associated mental health issues, more hospitalizations and may not have a large support system. Worse pain control due to health care bias is another problem. Medical marijuana is approved for pain associated with spinal cord injury due specifically to its effects on neuropathic pain. While there are not a lot of controlled studies, pain and associated anxiety is known to improve. As medical marijuana increase in availability, consultation with clients should open the door to discuss additional treatments , complications and quality of life. Consultation can and should lead  physical therapy referrals , home care referrals, providing  information about support groups , assessing for DME ( medical equipment needs and other holistic measures 

3. Pain
            We know there is bias when prescribing pain medication to minorities. This bias is potentiated if client or patient has history with substance abuse or past incarceration. But the problem doesn’t lie in prescribing medication. It is also in referring for therapy, alternative treatments  and in diagnosing and identifying root cause. A big contributor to chronic pain and overuse of pain medication, is the lack of a holistic approach to identifying the source or contributing factors to pain. Root causes can vary from overuse activity that is not addressed, to rheumatic and autoimmune disorders that are not diagnosed. Evaluation for medical cannabis for pain , should not end with just approval. It is an opportunity to discuss the role of diet , exercise, affect of occupation and full medical evaluation. 

Medical Cannabis should not be an isolated treatment. There should also be discussion of potential adverse effects , such as increase risk of stroke in African American men with concomitant tobacco use, or cognitive slowing in adolescent use. Similarly , we should discourage using when medically unnecessary, just as with other medicine or supplements. Evaluation for medical cannabis/ marijuana , should be thorough as with prescribing any other medication. . It should be used as an opportunity to holistically address physical and mental health and introduce behavioral changes as well as other treatments. 

Trauma Exposure and Stress-Related Disorders in Inner City Primary Care Patients
Charles F. Gillespie, Bekh Bradley, Kristie Mercer, Alicia K. Smith, Karen Conneely, Mark Gapen, Tamara Weiss, Ann C. Schwartz, Joseph F. Cubells, Kerry J. Ressler
Gen Hosp Psychiatry. 2009 Nov–Dec; 31(6): 505–514

Racial Disparities in Health Outcomes After Spinal Cord Injury: Mediating Effects of Education and Income
James S Krause, Lynne E Broderick, Lisa K Saladin, Joy Broyles
J Spinal Cord Med. 2006; 29(1): 17–25.

Defining Racial and Ethnic Disparities in Pain Management
Jana M. Mossey
Clin Orthop Relat Res. 2011 Jul; 469(7): 1859–1870. 

Dr Isable
Health Empowerment for African Americans and Latinos 


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