Background: Little is known about the clinical training or practice experiences among physicians who certify patients for medical marijuana. The objective of this study was to determine information sources, factors influencing recommendations, clinical practices in patient assessment, communications, and recommendations, and priority areas for additional training among physicians who certify patients for medical marijuana. Methods: A cross-sectional state-wide anonymous survey of registered medical marijuana physicians in Florida between June and October 2020 was administered. Numerical responses were quantified using counts and percentages. The frequencies for “often” and “always” responses were aggregated when appropriate. Results: Among 116 respondents, the mean (standard deviation) age was 57 (12) years old, and 70% were male. The most frequently used information sources were research articles (n = 102, 95%), followed by online sources (n = 99, 93%), and discussions with other providers and dispensary staff (n = 84, 90%). Safety concerns were most influential in patient recommendations (n = 39, 39%), followed by specific conditions (n = 30, 30%) and patient preferences (n = 26, 30%). Ninety-three physicians (92%) reported they “often” or “always” perform a patient physical exam. Eighty-four (77%) physicians provided specific administration route recommendations. Half (n = 56) “often” or “always” provided specific recommendations for Δ-9-tetrahydrocannabinol: cannabidiol ratios, while 69 (62%) “often” or “always” provided specific dose recommendations. Online learning/training modules were the most preferred future training mode, with 88 (84%) physicians “likely” or “very likely” to participate. The top 3 desired topics for future training were marijuana-drug interactions (n = 84, 72%), management of specific medical conditions or symptoms (n = 83, 72%), and strategies to reduce opioids or other drugs use (n = 78, 67%). Conclusions: This survey of over 100 medical marijuana physicians indicates that their clinical practices rely on a blend of research and anecdotal information sources. While physicians report clinical factors as influential during patient recommendation, patient assessment practices and treatment regimen recommendations vary substantially and rely on experimental approaches. More research is needed to inform evidence-based practice and training, especially considering details on drug interactions, risk-benefit of treatment for specific clinical conditions, and strategies to reduce opioid use.

Objective: More patients are turning to medical marijuana as an alternative treatment, yet there are apparent knowledge gaps on the risk benefit of medical marijuana for a variety of indications. This study aimed to determine the priorities for medical marijuana research from the perspective of multiple stakeholders including patients, clinicians, and industry representatives. Methods: An anonymous survey was administered to attendees of the 2019 American Medical Marijuana Physicians Association annual meeting in Orlando, Florida. Respondents completed the survey on paper or smartphone via Qualtrics. The survey included questions on demographics and medical marijuana research priorities under the following broad categories: clinical conditions, safety issues, marijuana types, populations, and others. Results: Forty-six participants (56.5% female, mean age = 51.6 ± 14.1) responded to the survey. A majority were medical marijuana qualified physicians in Florida (56.5%), 30.5% other physicians or clinicians, and 21.7% medical marijuana patients (multiple choices allowed). The top conditions prioritized for research by this group were chronic pain, cancer, and anxiety, and the top priority safety issues were dosing/product choice, complications from smoking/vaping, and drug interactions. Regarding marijuana types, the group prioritized research on THC/CBD ratios, different modes of consumption, and terpenes. Conclusions: Findings from this survey indicate that medical marijuana stakeholders perceived a broad range of research topics as priorities. More research is needed to advance the evidence in these areas and provide guidance to patients, physicians, and the medical marijuana industry.

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Objective: In this qualitative study, we investigated how public schools in the Miami-Dade County School District identify and manage students' underage alcohol use and to explore the benefits and challenges of systematic screening for underage alcohol use in district schools. Methods: We conducted face-to-face interviews with 16 school officials directly responsible for addressing underage alcohol use incidents at district middle and high schools. These individuals included assistant principals, guidance counselors, social workers and school-based health-care professionals. A grounded-theory approach was used to code and synthesize informants' responses. Results: No informants reported systematic screening for underage alcohol use at their schools, although their middle and high schools employed a range of intervention strategies. Emergent themes reflected common ways by which students using alcohol were identified, factors influencing underage alcohol use, and barriers to screening intervention implementation. Lack of access to acute intoxication events, differing policies across schools, inadequate resources, and reliance on administrator discretion rather than explicit policy mandates appear to undermine the development of consistent strategies for addressing suspected or reported underage alcohol use. Conclusion: Public schools may serve as key implementation contexts for future universal or selected screening initiatives to identify and manage cases of underage alcohol use. The benefits and challenges perceived by school staff and administrators – especially for implementing consistent policies across schools – are critical to the development of acceptable, feasible, and sustainable alcohol screening initiatives.

Medical marijuana (MMJ) is legal in the state of Florida for the treatment of specific qualifying medical conditions.1,2 As of July 2020, over 2,450 physicians are authorized to order MMJ, and 360,000 patients are registered in Florida’s MMJ program.3 With this rapid uptake come concerns regarding physicians’ knowledge about MMJ,4–7 and the lack of preparing physicians-in-training to manage MMJ.4,7,8 We conducted a state-wide survey of certified MMJ providers in Florida. The survey was developed by the Consortium for Medical Marijuana Clinical Outcomes research team. The aim of the survey was to inform physicians of the mission of the consortium, which is to support and disseminate research. The survey items were developed accordingly, and the survey was pilot tested with a small group of physicians. We identified all physicians licensed to certify patients for MMJ who care currently practicing in the State of Florida (n=1609), to investigate their information sources and training needs regarding MMJ. The survey was disseminated via mail and email, including a $40 incentive for survey completion. Preliminary responses from 51 (5%) providers (mean age 56, 74% male) are summarized here. The sample included providers from 22 Florida counties and represented a broad range of medical specialties. The majority (92%) practiced in both medical marijuana and traditional medical practice. To learn about MMJ, 98% used research articles, 90% used online sources, 86% learned from dispensary staff, 84% learned from discussions with other providers, 72% used books, 65% used conferences, 61% used magazines, and 35% had a personal experience with marijuana. The sources most cited as “very useful” were conferences (51%), research articles (50%), discussions with other providers (47%), and online sources (47%). Topics rated as a high priority for training included drug-MMJ interactions (80%), strategies to help patients reduce their use of opioids or other drugs (80%), information about the selection of doses and CBD: THC ratios (80%), evidence for managing specific medical conditions or symptoms (78%), information about the effect of different phytocannabinoids and terpenes (75%), advantages and disadvantages of specific modes of delivery (71%), general updates on research findings (71%), educational information about the endocannabinoid system (67%), the safety of medical marijuana use (55%), identification and management of cannabis use disorder (51%), and comparison of products available in different dispensaries (49%). The majority of providers either strongly agreed or agreed (77%) that they could provide better care if they knew which products their patients receive at dispensaries. Physicians use a blend of primary research, online sources, and exchanges with colleagues to learn about MMJ. Perceived needs for more pharmacological information and indication-specific detail for treatment regimen were high. Most physicians believe that details on dispensed MMJ would improve patient care.