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For patients, physicians, and providers who have experience with medical marijuana, the issue can seem like a straightforward one. As medical marijuana laws expand to new states, it certainly seems clear that support is growing and important progress is being made for patients in pain. But it’s important to understand that the issue may not seem as simple to those who haven’t shared our experiences. Creating a productive dialogue surrounding medical marijuana requires us to recognize and respect the fact that this issue is challenging for many. Fortunately, history shows us that anyone can evolve in their views about medical marijuana if given the right information and enough time to consider it. Consider, for example, the fascinating story of how Republican Senator Lindsey Graham recently became interested in the issue:

Graham, he is at pains to point out, rejects marijuana for recreational use, but he told POLITICO Magazine, “I am open-minded to the idea that the plant may have medical attributes that could help people.…I’m convinced that we should, as a nation, research the medical applications of the marijuana plant….It could be life-changing. I just want to do it in a scientific way…and the current system doesn’t allow for the research that we need.” “I have several people that I personally know who have children who have some epilepsy and other diseases,” Graham told POLITICO, “and the parents seem to think this helps. And…what stuns me is how little we know and how much more we could know. Some of these [diseases], like epilepsy, the families tell us that it has changed the child’s life. That’s why I want more research. Is that anecdotal, or is it real? To me, that’s very exciting.” [Politico]

While many of us have felt that excitement for a long time now, Senator Graham’s willingness to begin discussing the issue and working to promote further research is commendable nonetheless. Once an unlikely ally, he is now part of the conversation, and that’s the kind of progress that must happen in order to increase medical marijuana research and improve patient access. Graham acknowledges, interestingly, that it was his own relationship with families facing pediatric epilepsy that led him to take a closer look at the medical marijuana issue. This is easy to understand, but it’s a rather remarkable development when one considers that the emergence of CBD-rich medicines in the treatment of pediatric seizure disorders has occurred primarily within the past 5 years or so. CNN Medical Correspondent Sanjay Gupta’s groundbreaking coverage of the subject only began in 2013, meaning that many families confronted by life-threating seizure disorders have only recently learned about the role of cannabis-based medicines in treating the condition. By bringing Senator Graham into the conversation surrounding medical marijuana, these families demonstrated one of many critical ways in which they are quickly changing the way both the public and political leadership view the issue. In the course of our daily work with medical marijuana patients and their caregivers, we’re still learning more all the time. We recognize that this knowledge isn’t immediately available to everyone and it sometimes takes patience and openness to revisit a subject that can at times invite divisive and contrasting perspectives. Fortunately, as new research emerges and brave patients and families share their stories, opportunities for a productive dialogue become more available to us than ever before.

When welcoming new patients to the dispensary, we hear countless stories about the health challenges they’ve faced. Our patients have experienced a wide range of symptoms and conditions, but there’s one thing they have in common: other treatment options didn’t provide the relief they needed. In particular, patients who’ve been prescribed powerful opioid medications are often desperate for better options:

Sullivan, who suffers from arthritis and nerve and muscle pain, takes a capsule at night, two or three times a week. It makes her feels sleepy and relaxed, “sometimes a little giggly,” she said. And almost pain-free. The next day, her pain returns but is significantly milder than it would be otherwise.

Sullivan turned to cannabis because the opioid her doctor prescribed — tramadol — gave her insomnia. Others are trying marijuana because their doctors, worried about new guidelines on opioid use, have cut back on prescribing pain relievers.

Dr. Uma Dhanabalan, a Natick family practice physician who specializes in assessing patients for marijuana certification, said she has lately seen an increase in pain sufferers looking for an alternative to opioids.

“Cannabis is not an entrance drug, it is an exit drug from pharmaceuticals and narcotics,” she said. [Boston Globe]

Once viewed as a possible gateway to the use of more harmful substances, marijuana is now emerging instead as a promising alternative to the dangerous drugs often prescribed to patients in severe pain. Recent data show that opioid overdose deaths have fallen in states with medical marijuana laws, suggesting that regulated dispensaries may do more than just help patients relieve pain; they could actually be saving lives.

Indeed, the risk of developing dependency, the prevalence of debilitating side effects, and especially the threat of a fatal overdose are concerns our patients communicate to us every day in explaining why they’ve chosen cannabis as an alternative. Sadly, the limited options available for treating serious chronic pain have often forced patients to choose between living with unbearable symptoms, or adopting a regimen of medications whose side effects disrupt their ability to perform basic tasks and enjoy their lives. Many have discovered that medical cannabis provides a middle ground, in which pain can be reduced while maintaining a mental and physical state that allows them to be comfortable, alert, and productive.

To fully understand and appreciate medical marijuana’s importance to the patients who need it most, one must recognize that every individual’s situation is unique to them. Two patients with a similar diagnosis may experience differing symptoms. A patient whose condition is easily treated in most cases may be allergic to conventional therapies or possess a second diagnosis that creates complications. It is a simple truth that patients and their doctors are best positioned to make critical health decisions in difficult circumstances. That so many are turning to medical marijuana and reporting profoundly positive outcomes gives us great hope for those who’ve too often suffered in silence.

Dispensaries are well known as places where patients can obtain medical marijuana products, but safe access is just one of many benefits to establishing regulated medical marijuana programs. Consider, for example, new data from the CDC showing that Americans are using marijuana more responsibly:

Marijuana abuse and dependency are becoming less common, even as states roll back restrictions on the use of the drug, according to a new federal report.

In 2014, the number of Americans aged 12 and over meeting diagnostic criteria for marijuana abuse or dependency stood at 1.6 percent, a decline from 1.8 percent in 2002, according to the report released Thursday by the Substance Abuse and Mental Health Services Administration and the Centers for Disease Control and Prevention.

Declines in marijuana abuse and dependency were greatest among teens (37 percent decrease) and young adults (18 percent decrease) over that period. The change in marijuana abuse and dependency among adults age 26 and older was not statistically meaningful, according to the CDC. [Washington Post]

This result is very encouraging and should provide some important perspective towards addressing concerns about how young Americans might be affected by medical marijuana laws. While multiple factors may contribute to positive public health trends, it’s important to recognize that declining rates of marijuana abuse and dependency have been achieved even while significantly increasing access for approved patients.

Safe Access

Dispensaries provide a safe and health-focused environment in which patients can obtain marijuana. Many patients have reported to us that obtaining cannabis outside the dispensary setting can be a difficult, disappointing and sometimes frightening experience. Once patients are removed from negative surroundings, it’s easier to develop a healthy relationship with cannabis that’s built on a foundation of education and accountability. One of the primary goals of any well-regulated medical marijuana program is to ensure that patients can access marijuana safely and legally. Once this goal is achieved, it’s easier for patients and providers to promote responsible behavior.

Personal Attention and Care

By building personal relationships with their patients, dispensaries are able to provide insight and guidance that would likely be unavailable in other settings. Patients are made to feel welcome and encouraged to share their health goals and experiences with the sales staff. Experienced employees can make recommendations about product selection and dosage based on knowledge of the patient’s condition. This relationship empowers patients to make better choices and consume cannabis in a way that’s consistent with their individual needs. Abuse and dependence are less likely to occur when each patient has access to science-based guidance on how to use cannabis appropriately.

Product Quality and Selection

The sophisticated breeding and cultivation techniques employed by modern medical marijuana cultivators create customized solutions for patients with specific needs. By identifying the right strain or product for their unique symptoms, a patient may be able to better treat their condition without experiencing unpleasant side effects or other unwanted outcomes. Patients learn to titrate (adjust) their dose to achieve the desired benefits without becoming overmedicated.

Furthermore, advanced genetics such as strains with elevated levels of CBD offer symptom relief without intoxication, creating revolutionary new options for patients seeking a milder cerebral experience. Laboratory testing and labeling for potency and purity provide critical guidance to patients who wish to moderate their consumption and anticipate the effects of the products they consume. Cumulatively, this knowledge serves to facilitate smarter approaches to cannabis consumption that mitigate negative outcomes and reduce potentially unhealthy experimentation.

Changing the Conversation

Overall, the collective efforts of patients, providers, physicians, public officials and other stakeholders to establish well-regulated medical marijuana programs serves to advance a forward thinking approach to the role of medical marijuana in promoting public health. As the dialogue grows more visible and data become more available, individuals who may benefit from medical cannabis have access to the information and support they need. Responsible marijuana use is a more achievable goal when positive messages are presented to the public. Education serves to assist individuals in understanding when the use of cannabis can be beneficial and when it may not. By changing the way marijuana consumers understand their own behavior and experiences, an evidence-based approach to medical marijuana serves as an important intervention against unhealthy choices.

Of course, we also recognize that this important work is just beginning. We’re excited to see strong statistical evidence that Americans are using marijuana more responsibly, and we expect that the relationship between licensed medical marijuana businesses and positive public health trends will continue to be studied and discussed. At the core of our work rests the desire to make a difference in the lives of patients and we have the privilege of observing outcomes every day that warm our hearts and remind us why we’re here. As new research continues to expand our understanding of the relationship between marijuana and public health, we’re confident that the medical cannabis conversation will become more interesting, encouraging and inclusive than ever before.