Urgent care and cannabis: EMTs aren't just ill-informed about medical marijuana, they're biased
Updated 2 years ago on October 17, 2022
It has been 21 years since the first iteration of Canada's medical cannabis program was introduced, and yet the fact that cannabis is the drug of choice for more than 300,000 Canadians seems to keep physicians from dealing with the problem, especially for patients in need of urgent care.
Imagine going to the emergency room with a serious medical problem, and the hospital staff refuses to deal with it after you find out you use medical cannabis. The emergency room staff aren't just poorly trained-they're biased.
It's not just a problem in Canada. There are usually one or two stories in the news about stoned people seeking emergency care, children getting hooked on cannabis, or some tidbit about the increase in hospital visits since the legalization of adult drug use.
Ordinary cannabis users and medical marijuana patients have concerns about whether to report their use when they visit the emergency room. This fear is very real and is often borne out by the dismissive attitudes of medical professionals who consider urgent health problems to be symptoms of "cannabis insanity."
Stigma in health care can range from prejudice to mortality
"I wonder if they would have treated me differently if I hadn't mentioned cannabis," she told me a few days later.
In December 2021, I tweeted a short post about two women who had similar experiences in the emergency room. Cindy,* who lived in Vancouver and suffered from severe chest pain, noticed a change in her first aides' behavior immediately after disclosing her use of cannabis.
The plant she uses to relieve her chronic pain was declared the cause of her pain. After several hours in the hospital, Cindy was sent home with anxiety medication and a pamphlet advising her to seek help for her substance use disorder.
Another woman, Jessica*, said she went to a Toronto hospital for mental health problems. Immediately after she told them she was using cannabis to relieve her anxiety, the hospital staff's attitude changed. She was also sent home with anti-anxiety medication and told to stop using cannabis.
Dozens of people responded to my tweets, some of them talking about their own experiences. A few spoke of positive interactions with medical professionals, but most said that after being pointed out that they were using cannabis, first responders, nurses, and doctors unsubscribed from them, regardless of whether their use was medical in nature.
Some people described being misdiagnosed with Cannabis Hyperemesis Syndrome (CHS), sometimes repeatedly, and noted that failure to properly investigate their problems could have led to life-threatening consequences.
"Never talk about cannabis use, even in legal states," @JosephYartins tweeted. "Once you do, they'll immediately write it off as drug-induced anxiety and give the absolute minimum standard of care [sic]."
A few weeks later, our editor, Ashley Keenan, reached out to me with another story - not firsthand, but about how her husband, Chris, had been treated by emergency room staff when his heart stopped multiple times over a 28-hour period.
Keenan, who speaks openly on social media about her use of medical cannabis and struggles with chronic conditions, told me in an interview with Zoom that, in general, medical professionals are positive about her use of cannabis as a medicine - "unless they use it to write it off as a medical condition," she said.
"I've had experiences where if I had a certain symptom and disclosed my cannabis use, it suddenly became clear that that was what it was supposed to cause, and that was usually the end of the investigation," said Keenan, who noted on Twitter that doctors had wrongly diagnosed her with CHC in three separate cases when in fact she was suffering from painful gallbladder attacks.
Urgent care should distinguish between medical cannabis and adult use. But they don't seem to be interested in that.
Earlier this year, when Chris, who also uses cannabis with his doctor's permission, lost consciousness twice within hours, it was Keenan who tried to convince him that she should call 9-1-1.
"I was walking in the kitchen and I fell in front of Ashley and hit my head," Chris told me in a separate phone interview. "It scared her a little bit, and she tried to talk me into going to the hospital, but I told her I was fine. Then it happened again the next night, and she called an ambulance."
"They were by no means negligent; they were blatantly biased."
Ashley Keenan
The first deputies at the time weren't too concerned about cannabis, one of them noting that it was "a government thing." Upon arrival at the hospital, the first thing that was discovered was that Chris had been using cannabis. When he was hooked up to a monitor, his heart stopped again.
"I truly believe that if he hadn't had another heart attack when he was hooked up to the monitor, they would have sent him home with [a diagnosis of] panic attacks or cannabis-induced paranoia," said Keenan, who expected that line of questioning from hospital staff. "Then they took him to the cardiology department and started taking him seriously."
While Chris was hooked up to the monitors, his heart stopped and resumed after 8 to 10 seconds at least one more time, but after a series of tests, including ultrasounds, MRIs and blood tests, the cardiology department doctor told him that his heart problems were "caused by cannabis."
Although the staff said the blood tests and ultrasound looked good, Chris was concerned that the doctor he was dealing with may not have been fully educated about cannabis, and that his prejudice against cannabis had interfered with the diagnosis. They could not explain how cannabis could stop the heart.
"Some part of me was a little worried... Like, 'Is this it? Is there something around the corner that I don't know about?" - he wondered about his health. "[I felt] completely rejected."
Keenan noted that when she asked how the hospital treated patients who used cannabis for medical purposes, the nurse told her that they "don't distinguish [between medical and recreational use]."
"I'm not saying they were negligent, because they certainly weren't," she said. "They were biased."
She was there when Chris was discharged and asked why the hospital staff had stopped investigating the cause of his heart problems. She recalled the nurse's reply, "If you're a hammer and all you see all day is nails, you start to understand what a nail looks like.
His discharge papers read "discontinue cannabis use" without regard to the health consequences of discontinuing treatment. It wasn't until Chris was able to contact his cannabinoid doctor that he realized how cannabis had affected what had happened to him.
Ambulance and emergency personnel need training on medical cannabis and bias, says psychiatric emergency medicine expert
Dr. Julie Holland, M.D., psychiatrist, psychopharmacologist, former emergency room psychiatrist at New York's Bellevue Hospital and author of The Weed Book: The Complete Guide to Cannabis.
The care that medical cannabis patients receive (or do not receive) from hospital staff stems from a profound lack of education, Dr. Holland explained in a telephone interview.
"When I was in medical school, they didn't tell us anything about medical cannabis, about the endocannabinoid system or even that cannabis could be used for medical purposes," she said. "A lot of people who provide medical cannabis have never been educated enough about how it's used."
Dr. Julie Holland, M.D.
Added to the problem of lack of education, Holland says, are layers of shame, stigma, and the doctor's own self-loathing.
"Everybody in the world has a shadow side that they do or don't deal with, including doctors, and it will be involved in the emergency room if you have a picture of people using cannabis and other drugs," Holland said.
"Unfortunately, there is always a patient who is treated disparagingly by a doctor," she said, comparing the treatment of medical cannabis users in the ER to the treatment of women in the Victorian era, who were often rejected by male clinicians and diagnosed with hysteria.
"It's discrimination and stigma and lack of compassion, and it's really dangerous. It's an easy way out," she added. Assuming that the patient is to blame for the problem, she said, doctors don't have to work to find out the root cause. This attitude can be especially common in the ER, "because there's a lot of turnover here, just like in a restaurant."
While cannabis education is absolutely necessary, Holland believes that bias education should be a priority for practitioners so they can learn how their unconscious biases affect the patients they treat.
"People who end up in the ER are often judged because doctors assume they're not taking very good care of themselves, and that's unfair, especially to cannabis users who choose a less toxic alternative and something that's potentially medically beneficial."
Holland, who lives and works in the United States, was surprised to learn that after all these years, Canadian medical professionals are still (mostly) unfamiliar with the concept of cannabis as a medicine.
"The more everyone gets used to the fact that cannabis is a medicine, and the more we know those who use it and benefit from it, the less judgmental we will be about it," she said. "One would hope that we've already made progress in that process."
According to her, "If there has been a medical program for 20 years, they have no excuse. They should know."
If in doubt, see a cannabinoid specialist after an emergency
For Keenan, who works in the cannabis industry to increase public education about cannabis and reduce stigma, the most important takeaway from Chris' experience in the ER was that many doctors don't seem to know or care about the difference between medical and recreational cannabis use.
And their bias affects the quality of care in emergency departments across North America.
He and Chris have since sought counseling from doctors who are more familiar with cannabis and the factors that contribute to heart disease. Chris's health improved and he continued to use cannabis as directed by his therapist without any adverse effects.
"I often forget how stigmatized cannabis still is," Keenan said. "The experience was hopeless and infuriating. It really lit a fire [in my soul] that we still have a lot of work to do."
*Names have been changed forconfidentiality purposesat the request of the subjects.
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