So I have just started with a patient referred due to high utilization of ED for non-intractable vomiting and nausea, likely from the marijuana use. Last year 7 ED visits, 3 hospitalizations including surgery. After my initial outreach to him I am thinking that some of you may have experience with similar cases and/or advice!

Patient is mid forties, was run over by a vehicle when young which left him with chronic back pain. Hx of using pain medications, but desired to be off of them and began to use marijuana more often (not medical marijuana). He does admit to seeing a pattern with increased use leading to cyclical vomiting. Has depression treated with Effexor (PHQ9 10 today). Difficulty sleeping with nightmares waking him, takes seroquel to help that.. Hx of suicide attempt in 2012, no SI currently. Not seeing a therapist at this time, stating that both is PCP and mental health provider left practice here, was hesitant to “start all over”.

He has just accepted care coordination. We have discussed his marijuana use, gotten medication refills to address symptoms and assessed the depression. He agreed to establish with a provider he has seen before, to consider if medications should be adjusted or changed, as well consider if he will see a mental health professional again. My thoughts are: would he have less symptoms if he switched to medical marijuana (less THC)? It seems like a pain clinic would be advisable, but we have none nearby that I know of. Finances with all the medical bills are also difficult for his family. I feel like I lack in resources to help with pain management options and understanding of medical marijuana. Any ideas are welcome, thanks!