Is Illinois turning to pot?
Illinois is carefully evaluating its pilot program of the sale of medical marijuana, and while the revenue recreational marijuana sales could produce may be tempting for lawmakers, Illinois has not gone down that path – yet.
So it’s here, whatever your stance. What does that mean for dentistry?
It seems there are at least three prisms for dentists to view the presence of medical marijuana:
- its availability as a prescribed pain reliever for patients who can’t tolerate other medications, or as an alternative to opioids;
- its purely physical consequences, including its use by patients and possible interactions with medications used during a procedure;
- its stigma and acceptance (or not) in a dentist’s patient base.
It was 2013 when the Illinois General Assembly approved the pilot medical cannabis program; dispensaries started opening by 2015. So far, retail sales in the state have hit $42 million, despite a raft of restrictions and a narrow list of conditions medical marijuana can be used to treat. While Illinois allows 41 conditions, Colorado – an early and lenient locale for medical and recreational sales – allows medical marijuana cards for a broad range of symptoms and conditions.
As more alternatives are sought to prescription opioids, marijuana is considered a safer and less addictive pain reliever. According to an article in Scientific American this year, several pharmaceutical companies are developing “marijuana-derived” drugs, though final approval from the Federal Drug Administration could be a decade away. But with ultimate approval, an “FDA-approved marijuana-based painkiller would ensure consistent dosing and potency, and availability across the country,” the magazine noted. “Doctors like to be able to write a prescription and know that whatever they wrote is pure and from a blinded, placebo-controlled trial,” Brian Murphy, CEO of California-based drug company Nemus, was quoted on the potential for medical marijuana drugs.
There are different worries for dentists, however, that require vigilance in the office. Dentist and author Harold Crossley cautions in his programs to dental groups that marijuana use increases the potential for periodontal disease as it does for any smoker.
Other research notes that marijuana use produces stains on the teeth, xerostomia and even chronic inflammation and delays wound healing. Additionally and importantly, Dr. Crossley urges the dentist and staff to assess whether a patient in for treatment uses marijuana or is under the influence at the time because its use makes IV and oral sedation more powerful.
How to handle patients who use marijuana is a work in progress. While its use is more accepted today, patients under its influence may present questions about informed consent for procedures. The National Institutes of Health points to a case where a dental clinic patient in need of a tooth extraction refused treatment after staff questioned him about his marijuana use hours earlier. The patient was offered an appointment the next day, “but he refused, citing bias in regard to his cannabis use.” Our culture today is more likely to see marijuana as a “soft” drug, or even no drug at all. Old stereotypes of the “stoner” don’t square today with people of all cultures, ages, genders and socioeconomic backgrounds who use marijuana. Many of your patients may be marijuana users for medical reasons, anxiety relief or simple relaxation. How you and your staff open conversations with these patients about their marijuana use should be delicate but honest.
There are consequences for their oral health, and patients should be informed and educated on special care. You can expect to hear more about marijuana sales in Illinois and elsewhere. In the U.S. and Canada, marijuana sales grew by a staggering 30 percent in 2016, to $6.7 billion, according to Forbes magazine.
And that total is generated from only eight U.S. states with recreational sales and 23 states with medical sales. Chances are good legislators will return to this potential revenue source. Remember the shift on casino gambling?The views expressed in this column are those of the writer and not necessarily the opinions of the Chicago Dental Society. CDS presents Front Desk, a column addressing problems dentists and staff members experience in the office. Front Desk is prepared by Stephanie Sisk, a freelance journalist.
Photo by istockphoto.com.