By Dr. Joseph Rosado, MD, MBA, DC | Rosado Advisory
Medical cannabis has evidence supporting certain uses, but its potential benefits and risks vary depending on the condition, product, dose, medications and individual patient. If your doctor avoids the subject, asking specific questions about evidence, interactions, risks and their own cannabis training can help turn silence into an informed clinical conversation.
Picture this: you’ve been living with chronic pain, muscle spasms, or chemotherapy-induced nausea for months. Someone you trust mentions medical cannabis. You decide to ask your doctor—and notice how the conversation changes.
They don’t say yes. They don’t explain why not, either. They simply avoid the subject.
You’re not alone. Many patients encounter healthcare professionals who don’t feel prepared to talk about cannabinoids, even when medical cannabis is already legal or regulated where they live.
Your doctor’s silence does not necessarily mean cannabis is appropriate for you. But it doesn’t constitute a clinical assessment, either.
Why Do Some Doctors Avoid the Conversation?
There are several reasons.
The first is a lack of training. For decades, the endocannabinoid system and the clinical use of cannabinoids received little attention in medical education. Studies involving physicians and healthcare professionals in training have identified significant gaps in knowledge and confidence when it comes to advising patients.
That doesn’t make your doctor negligent. It means they were likely trained within a system that did not prepare them to answer these questions.
The second reason is legal complexity. Regulations vary across countries, states, and provinces. A doctor may fear violating regulations, exposing themselves to professional liability, or making a recommendation outside the scope of their license. That caution may be understandable, but it should be communicated clearly.
The third is stigma. After decades of prohibition, some people continue to associate all cannabis use with substance abuse. Doctors are not immune to that cultural conditioning.
There is also another legitimate explanation: the evidence is not equally strong for every condition. A responsible healthcare professional may recognize potential benefits for certain indications while also considering the data insufficient for others.
What the Evidence Actually Says
Science does not show that medical cannabis is a cure for every disease. Nor does it support the idea that it is completely safe.
A systematic review published by Whiting and colleagues in JAMA in 2015 evaluated 79 clinical trials on cannabinoids. In 2017, the U.S. National Academies of Sciences, Engineering, and Medicine concluded that there is substantial or conclusive evidence for certain uses, including:
- Treating chronic pain in adults.
- Managing chemotherapy-related nausea and vomiting with certain oral cannabinoids.
- Improving patient-reported symptoms of spasticity in some people with multiple sclerosis.
For other conditions, including anxiety, insomnia, and post-traumatic stress disorder, the findings are more limited, variable, or dependent on the product studied. “Cannabis” does not describe a single medication. The ratio of THC to CBD, the dose, the route of administration, frequency of use, and product quality can significantly change its effects.
That is why the right question is not simply: “Does cannabis work?” The question is: “Is there reasonable evidence for my condition? With what product, with what risks, and toward what therapeutic goal?”
Five Questions You Should Bring to Your Appointment
1. Do You Have Clinical Training in Cannabis or Cannabinoids?
This is not about testing your doctor. It is about knowing whether their answer is based on up-to-date knowledge, clinical experience, or personal opinion.
2. What Evidence Exists for My Specific Diagnosis?
Ask for an answer related to your condition and your goals. Neuropathic pain, chemotherapy-induced nausea, and anxiety are not the same condition and should not be treated as if they were.
3. Can Cannabis Interact With My Medications?
THC and CBD can interact with certain medications or increase effects such as drowsiness, dizziness, and impaired coordination. Any medication review should include prescription medications, over-the-counter products, alcohol, and supplements.
4. If This Isn’t Your Area of Expertise, Can You Refer Me to a Qualified Professional?
A doctor is not required to be an expert in every area. However, they should be able to recognize the limits of their knowledge and help you find reliable information within the applicable legal framework.
5. What Are the Risks in My Case?
Medical cannabis is not appropriate for everyone. Special caution is required during pregnancy and breastfeeding, as well as in adolescents and people with a personal or family history of psychosis, those with unstable cardiovascular disease, substance use disorders, and those taking medications that cause sedation.
You should also ask how it might affect driving, work, fall risk, and memory.
What Should You Do If Your Doctor Doesn’t Want to Talk About It?
First, ask for clarity: “Are you advising against it for a specific medical reason, or because you don’t work with medical cannabis?” That question helps distinguish between a clinical contraindication and a lack of experience.
Then, ask for their position and your questions to be documented in your medical record. This helps maintain continuity among the professionals involved in your care.
If medical cannabis is regulated where you live, look for an authorized doctor or one with verifiable training. Confirm their credentials, ask how they handle follow-up care, and be wary of anyone who guarantees results, recommends the same product to everyone, or presents cannabis as a universal substitute for other treatments.
Dispensary staff may be familiar with the products available, but they do not necessarily have the training required to evaluate diagnoses, interactions, or contraindications. A commercial recommendation does not replace a medical assessment.
If legal access is limited, do not automatically turn to the illicit market. Unregulated products may contain different concentrations than those stated, contaminants, or unknown ingredients. Ask what regulated alternatives exist in your country and what conventional treatment options remain available.
Do not stop taking opioids, benzodiazepines, antidepressants, anticonvulsants, or other medications on your own. Any changes should be coordinated with the healthcare professional who prescribed them.
Silence Is Not a Clinical Answer
Your doctor may conclude that cannabis is not appropriate for you. That may be the right decision if it is based on your medical history, the risks, and the available evidence.
What does not help is ignoring the question.
As a patient, you deserve an honest conversation that includes potential benefits, limitations, interactions, uncertainties, and alternatives. Medical cannabis is not the answer to everything. But silence isn’t, either.
References
Whiting PF, et al. Cannabinoids for Medical Use: A Systematic Review and Meta-analysis. JAMA. 2015;313(24):2456-2473.
National Academies of Sciences, Engineering, and Medicine. The Health Effects of Cannabis and Cannabinoids: The Current State of Evidence and Recommendations for Research. 2017.
Evanoff AB, et al. Physicians-in-training are not prepared to prescribe medical marijuana. Drug and Alcohol Dependence. 2017;180:151-155.
Disclosure: Dr. Joseph Rosado is a consulting physician specializing in cannabis medicine through Rosado Advisory. This article is for educational purposes only, does not promote specific products or programs, and does not constitute medical advice. Consult a healthcare professional for individualized guidance.
