Updated: Oct 9
A January 2021 peer-reviewed research study entitled "Communication Between Healthcare Providers & Medical Cannabis Patients Regarding Referral & Medication Substitution" that was published in the Journal of Cannabis Research explored the relationship between wellness professionals/caregivers and medical cannabis patients.
"People report using cannabis as a substitute for prescription medications, but may be doing so without the knowledge of their primary health care providers," noted the study. It reported that the tenuous relationship between healthcare professionals and patients is exacerbated by the large number of patients who have access to medical cannabis programs. "Thirty-five states in the U.S. have enacted medical cannabis programs," noted the scientists.
The research provided legal background for cannabis and noted that the herb has been a Schedule I drug since 1970, when the Controlled Substances Act took over for the Marihuana Tax Act passed in 1937 that initially outlawed cannabis and hemp. Schedule I drugs indicate a "high potential for abuse and no accepted therapeutic use" by official definition.
"The study noted evidence supporting the therapeutic value of cannabinoids (active compounds in cannabis) for chemotherapy induced nausea and vomiting, chronic pain, and multiple sclerosis-related spasticity."
However, the study noted that a National Academies of Sciences, Engineering, and Medicine report identified evidence supporting the "therapeutic value of cannabinoids (active compounds in cannabis) for chemotherapy induced nausea and vomiting, chronic pain, and multiple sclerosis-related spasticity."
Despite this, the researchers noted that "the evidence for most conditions allowed by state medical laws (e.g., depression) was insufficient." They wrote that there is a "mismatch" between scientific and news [mass media] reports "of individuals substituting cannabis for opioids and other prescription medications." The study reported that this may be problematic because it includes "conditions for which there is limited evidence that cannabis has therapeutic value."
It noted that "many individuals using cannabis believe that [it] is useful for medical conditions, with no evidence base" and that this fact illustrates "the need for a strong healthcare provider presence in conversations about safe cannabis use in the context of medication substitution."
The design of this study involved an anonymous online survey involving patrons of Om Medicine, a medical cannabis dispensary in Ann Arbor, Michigan. Participants were solicited via flyers, email, and social media platforms from April 2019 through February 2020.
Om Medicine dispensary in Ann Arbor, Michigan
"Study participants reported using cannabis to treat a wide variety of health challenges, including pain, PTSD, arthritis, migraine headaches, anxiety, depression, and cancer."
All study participants were over the age of 18 and current users of "cannabis for medical purposes" at the time of the survey. "Participants freely consented to participate and were not compensated." The majority of those who responded to the survey solicitation completed the survey, which resulted in 275 participants.
Study subjects reported using cannabis to treat a wide variety of health challenges, including pain, PTSD, arthritis, migraine headaches, anxiety, depression, and cancer.
The study's authors noted that their findings "are somewhat consistent with registration patterns in Michigan" where "chronic pain and severe and chronic pain were the most common qualifying conditions in the state (52 percent and 55 percent of conditions, respectively), followed by arthritis (20 percent), cancer (five percent), and PTSD (five percent)."
"Sixty-four percent of study participants decided to use cannabis based on their own experiences, with only 24 percent citing primary health care provider advice."
Sixty-four percent of study participants "decided to use cannabis based on their own experiences," with only 24 percent "citing primary health care provider advice." Their reasons for adopting cannabis as medicine are listed below:
Anxiety/panic attacks: Five percent
Arthritis: Six percent
Cancer/leukemia: Five percent
Depression: Four percent
Headaches/migraines: Six percent
Pain: 31 percent
PTSD: Seven percent
Stress: Four percent
The majority of study participants (80 percent) reported that their primary health care provide was aware of their medical cannabis use, regardless of how the patient obtained it or if the advice of a wellness professional was involved. Despite this, 41 percent of subjects "reported that their primary health care provider had not always known."
Health Care Providers Found Ignorant
Only 14 percent of study subjects "obtained their medical cannabis authorization from their primary health care provider." More revealing is the fact that only 14 percent of participants "rated their primary health care provider's knowledge about medical cannabis as very good or excellent" and a mere 21 percent "were very or completely confident in their doctor's ability to integrate medical cannabis into their treatment."
"Only 14 percent of participants rated their doctor's knowledge of cannabis as very good or excellent and a mere 21 percent were very or completely confident in their doctor's ability to integrate cannabis into their treatment."
A whopping 86 percent of survey respondents had "substituted cannabis for pharmaceutical medications." Sixty-nine percent of those who reported substituting cannabis for pharmaceutical treatments also reported a "gap in their primary care provider's knowledge of their substitution." Nearly half of survey participants (44 percent) "reported that their doctor was currently unaware of their substitution" of cannabis for pharmaceutical drugs.
Patients Have "Low Confidence" in Docs
Study participants reported "generally low confidence in their primary health care provider's ability to integrate medical cannabis into treatment," perceived their doctor's knowledge about medical cannabis to be "poor or fair," and considered their doctors to be "not at all, somewhat, or [only] moderately supportive of medical cannabis."
The study concluded that its findings spotlight "the need for better integration between medical cannabis and mainstream healthcare, including enhancing health care provider education on cannabis, the endocannabinoid system, and the benefits and risks...of cannabis in relevant therapeutic contexts."
"Our results show the poor integration between medical cannabis and mainstream healthcare, suggesting a need for improved physician education."
The research revealed that many patients are self-medicating with medical cannabis for a number of conditions, but that "many do not disclose this substitution" to their doctors or caregivers. "Our results show a poor integration between medical cannabis and mainstream healthcare, suggesting a need for improved physician education around appropriate cannabis use."
View the original study.
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