Jordan Tishler
Member, Hadassah Associates & Physicians Council

Understanding Medical Cannabis: My Tikkun Olam

Image courtesy of Hadassah.
Artwork courtesy of Hadassah.

I am a physician and cannabinoid specialist from Harvard Medical School. I’m also the founder and president of the Association of Cannabinoid Specialists. I’ve been honored to present to the Hadassah Physicians Council and the Hadassah Attorneys and Judges Council on the practice and legal implications of cannabis medicine. I am also a life member of Hadassah and have joined the Physician’s Council. My mission, and a large part of Hadassah’s mission, is to bring the best patient care to those who need.

I got interested in cannabis medicine, which I’ve been doing now for over 10 years, while working as an emergency physician for the Veteran’s Administration (VA). After seeing countless vets harmed by alcohol and a small smattering of other substances, yet never cannabis, I started to wonder about its prohibition and its potential to alleviate suffering for patients. After seeing tens of thousands of patients, delivering many lectures, and conducting a lot of research, I find myself recognized as one of the world’s experts.

My father was a great physician, researcher, and teacher. He specialized in rare genetic disorders that few have heard of and only the families of sufferers care about. His patients suffered because of this lack of public interest. When I pivoted into cannabis care focused on providing relief from major problems like pain, insomnia, and cancer, I thought that these would be issues that would provoke huge public engagement. This would be my own tikkun olam.

Sadly, we again find progress for humanity impeded by the greed of humanity. We need to understand that, as exciting as the new global legalization of cannabis for either or both medical and recreational use may be, it’s really being driven by financial interests. This leads to significant misinformation being used to boost sales and this directly harms patients. Of course, the counterbalance to this is greater involvement and guidance from physicians.

Medical cannabis can be used to alleviate suffering. For patients who are struggling with chronic pain, anxiety and depression, insomnia, or other symptoms associated with serious illnesses, medical cannabis can be a crucial tool in their treatment plan. Studies have shown that cannabis can be effective in reducing pain, improving sleep, controlling nausea and vomiting, and increasing appetite, among other benefits.

In Jewish law, the principle of derech eretz (the way of the world) requires us to use the most effective means available to achieve a given end. If medical cannabis is more effective than the conventional options, Jewish law would generally favor this treatment.

However, when it comes to medical cannabis, the issue is more complex. Cannabis is a psychoactive substance that can alter one’s mental state, cause development of tolerance, and, in the worst-case scenario, lead to addiction. Depending on the dosage, cannabis can cause reduction in symptoms as well as feelings of well-being and relaxation, but if used improperly, it can provoke anxiety and even paranoia. Overuse can lead to all those worst-case outcomes we’d like to avoid.

The cannabis industry is not truly interested in your well-being. They’re interested in cannabis sales. This leads to the recommendation of products that have no basis in science and doses that are excessive and harmful.

In light of these considerations, Jewish law takes a nuanced approach to the use of medical cannabis. While there is no blanket prohibition against the use of cannabis for medical purposes, there are certain conditions and restrictions that must be met. Patients who are using medical cannabis should be careful to use it only in the dose and manner prescribed by their doctors. Patients should avoid using it in a way that would impair their judgment or ability to function.

Jewish law also emphasizes the importance of medical guidance when it comes to the use of medical cannabis. This is where we circle back to my own tikkun olam. Just as with any other medical treatment, the use of cannabis should be overseen by a qualified health care professional who can ensure that the treatment is safe and effective. I would argue that this is a two-way street and that it is incumbent on physicians to become properly educated about cannabis so that they can meet this need for their patients. This is part of why I founded the Association of Cannabinoid Specialists (ACS)  – to provide that education to clinicians.

It is gratifying that policy statements from both ACS and Hadassah are aligned in their view that countries, especially the United States, must legalize cannabis for medical use. Further, they both emphasize the crucial role of physician-patient decision-making and call for detailed human trials to support it. ACS goes so far as to call for binding prescriptions to assure physician-patient decisions carry through to the point of sale and a moratorium on unfounded medical statements, which are often made by dispensaries and manufacturers to promote sales.

Medical guidance is particularly important because cannabis can interact with other medications and can have side effects that need to be carefully monitored. For example, cannabis can lower blood pressure, which can be dangerous for patients who have coronary artery disease. This does not mean that nobody with heart disease can safely use cannabis but, rather, that its use should be monitored. Similarly, Cannabidiol (CBD) is now on every corner, but not only is there little human data to support its use, it also can interact with many conventional medications in dangerous ways.

In Jewish law, the principle of pikuach nefesh (preservation of life) requires us to take all reasonable precautions to protect our health and safety. This includes seeking out medical guidance when using cannabis for medical purposes. Patients who are considering using medical cannabis should consult with a qualified health care provider who is familiar with the person’s medical history, medications, and other treatments.

Moreover, the use of medical cannabis should be monitored and evaluated regularly to ensure that it is having the intended effect and is not causing harm. Jewish law recognizes the importance of ongoing medical care and encourages patients to seek out appropriate medical care throughout the course of their treatment.

As you and I work to improve the world, let’s take the suffering of patients seriously and work to alleviate their plight.  Encouraging the approval of medical cannabis alone is not enough. Patients must be able to get the guidance and care they need and not be misdirected by financial interests.  Only then will we be able to safely and successfully use this treatment to alleviate suffering and promote healing.

About the Author
Jordan Tishler, MD, a life member of Hadassah’s Physicians Council and a member of Hadassah Associates, is a cannabinoid specialist, a term that he coined as he sought to increase the standard of care for patients and the level of education of his colleagues based on data and best practices. He is the Founder and President of the Association of Cannabinoid Specialists, an Internist, a reformed Veteran’s Administration Emergency Physician, and faculty member at Harvard Medical School and Mass General Brigham. He is recipient of Clinician of the Year awards from Americans for Safe Access and the Marfan’s Society. He is advisor to Massachusetts Cannabis Control Commission and board member of Council for Federal Cannabis Regulation, Massachusetts Patient Advocacy Alliance.