What to Tell Your Doctor (And What They Probably Won't Say Back)

The first time I asked my neurologist about medical cannabis, she gave me an answer I now recognize as the standard answer. She said, “There’s some evidence it can help with migraines. I can’t officially recommend it, but I can’t tell you not to try it either.”

I left that appointment frustrated. I had wanted her to tell me what to do. Instead, she had handed me a carefully worded non-answer that seemed designed to end the conversation without actually addressing it.

It took me a while to understand she was being as honest as she was allowed to be.

I want to explain what your doctor is and isn’t saying when you ask about medical cannabis, because I’ve sat on both sides of this conversation — as a patient asking the question, and as a nurse watching other patients ask it. If you go in understanding the constraints your doctor is operating under, you will have a better conversation. If you go in expecting a straight yes or no, you will walk out disappointed.

Here is what your doctor is actually navigating.

Cannabis is still a Schedule I controlled substance at the federal level. Schedule I is the category reserved for drugs the federal government has classified as having “no currently accepted medical use,” which is a legal designation that exists in direct contradiction to the fact that thirty-eight states, including North Dakota, have legalized it for medical use. Your doctor lives inside that contradiction. Their DEA license — the thing that allows them to prescribe any controlled substance at all — is federal. Their medical license is state. When they talk to you about cannabis, they are threading a needle between two systems of law that disagree about whether what you are asking for is medicine.

This is why most physicians will not write you a “prescription” for cannabis. They cannot. What they can do, in North Dakota, is certify that you have a qualifying condition — which is an attestation, not a prescription. The distinction is legal, but it matters. A certification says: “This patient has a condition for which the state of North Dakota allows medical cannabis use.” It does not say: “I am recommending a specific product, dose, or frequency.”

The reason your doctor won’t tell you to take 5 milligrams of a 1:1 THC:CBD tincture forty-five minutes before bed is not because they’re being cagey. It’s because they are not legally positioned to make that recommendation the way they would for gabapentin or amitriptyline. They can’t call it in to a pharmacy. They can’t adjust your dose at a follow-up. Cannabis sits in a category of its own, and most physicians have not been trained on it in medical school — because, again, it’s federally Schedule I, and federally Schedule I drugs don’t get taught as medicine.

So when your doctor gives you the non-answer, they are often telling you the most honest thing they can: I think this might help you. I am not permitted to tell you how.

Now — how to have the conversation anyway.

First, come in with your current medications. All of them. Including the over-the-counter ones. This is not the moment to minimize. Your doctor needs to know what you’re already taking because cannabis can interact with a number of common medications — blood thinners, certain antidepressants, some seizure medications — and those interactions are worth a five-minute conversation. If you are on one of those medications, your doctor may not be able to recommend cannabis, and that’s a useful piece of information to leave the appointment with.

Second, come in with your symptoms. Not “I’ve been feeling bad.” Specifics. How often. How severe. What you’ve tried. What has and hasn’t worked. “I’ve had two to three migraines per month for fifteen years, I’ve tried four different triptans, topiramate gave me cognitive side effects I couldn’t tolerate at work, and the CGRP inhibitor reduced frequency but not severity” is a conversation-starter. “I get headaches and I heard cannabis might help” is not.

Third, ask one specific question, not a general one. The general question — “Would cannabis work for me?” — puts your doctor in the position of making a recommendation they can’t make. The specific question — “Do I have a qualifying condition under the North Dakota medical program?” — is one they can answer yes or no to. Once you know the answer to that, you can move on to the next specific question.

Fourth, ask about interactions. If your doctor is willing to engage, this is where the real conversation lives. “Are there any reasons cannabis would be a poor choice for someone on my current medication regimen?” is a clinical question they are fully trained to answer, and it sidesteps the recommendation problem entirely.

Fifth — and this is the part I want to be direct about — do not expect your doctor to tell you how to dose. They probably can’t. The dosing knowledge that exists for cannabis lives mostly in patient communities, patient educators, and a small number of clinicians who have made it their specialty. Your certifying physician is probably not one of them. Your dispensary pharmacist or patient consultant, if they are good, probably is. This is an unusual medication in that the most useful dosing guidance will come from someone other than the person who certified you.

Here is what I tell my friends when they ask about having this conversation: your doctor is not the villain in this story. Most doctors are doing their best inside a legal framework that wasn’t designed with cannabis in mind. They are not being evasive to frustrate you. They are being evasive because evasion is the shape the law has pressed their honesty into.

If you walk in understanding that, you can have a real conversation. If you walk in expecting them to behave like this is a normal prescription, you will walk out with the same non-answer I got, and you’ll feel the same frustration I felt.

The non-answer isn’t nothing. Sometimes it’s as close to “yes” as a physician is allowed to say.

Learn to hear it.