Communication between healthcare providers and medical cannabis patients regarding referral and medication substitution

Abstract

Background People report using cannabis as a substitute for prescription medications but may be doing so without the knowledge of their primary health care providers (PCPs). This lack of integration creates serious concerns, e.g., using cannabis to treat medical conditions that have established treatment options. Methods We conducted an anonymous, cross-sectional online survey among patrons of a medical cannabis dispensary in Michigan (n = 275) to examine aspects of their relationship with their PCP and their perceptions of PCP knowledge related to cannabis. Results Overall, 64% of participants initiated medical cannabis use based on their own experiences vs. 24% citing advice from their PCP. Although 80% reported that their PCP knew they currently used medical cannabis, 41% reported that their PCP had not always known. Only 14% obtained their medical cannabis authorization from their PCP. Only 18% of participants rated their PCP’s knowledge about medical cannabis as very good or excellent and only 21% were very or completely confident in their PCP’s ability to integrate medical cannabis into their treatment. Although 86% had substituted cannabis for pharmaceutical medications, 69% (n = 134) of those who substituted reported some gap in their PCP’s knowledge of their substitution, and 44% (n = 86) reported that their PCP was currently unaware of their substitution. Conclusions Patients frequently substitute cannabis for prescription drugs, often without PCP knowledge. Although most participants disclosed cannabis use to their PCP, their perceptions of PCP knowledge ranged widely and many obtained medical cannabis licensure from an outside physician. Our results highlight the need for standardized physician education around appropriate medical cannabis use.

Prevalence of cannabis use for pain management in Quebec: A post-legalization estimate among generations living with chronic pain

“…Even in regions where cannabis is legal, people do not always disclose cannabis use to health care professionals for a variety of reasons, including a perceived stigma, unfavorable attitudes of health care professionals, not wanting cannabis in their medical chart, fear of losing professional status, and fear of losing health insurance. 50 This self-medication raises major concerns regarding drug–drug interactions and management of adverse effects. In terms of support, it has been argued that pharmacists should be providing counsel to medicinal cannabis users 51 , 52 and potentially should be the dispensers of medical cannabis in Canada.…”

Healthcare provider and medical cannabis patient communication regarding referral and medication substitution: the Canadian context

“…We used similar measures to those in the Michigan study and other medical cannabis studies that investigated substitution (Lucas and Walsh 2017 ; Boehnke et al 2019a , 2021 ; Kruger et al 2020 ; Kruger and Kruger 2019 ).…”

“…Pertinently, cannabis use and its substitution for medications and substances often occur without physician oversight (Fitzcharles et al 2020 ). The majority (64%) of medical cannabis dispensary customers in Michigan surveyed in 2019–2020 used cannabis without the advice of their primary care provider (PCP), and 86% received medical cannabis authorization from a provider other than their PCP (Boehnke et al 2021 ). Additionally, most participants lacked confidence in their PCP’s ability to guide their cannabis use and did not report their substitution of cannabis for other pharmaceuticals/substances to their PCPs (Boehnke et al 2021 ).…”

“…The majority (64%) of medical cannabis dispensary customers in Michigan surveyed in 2019–2020 used cannabis without the advice of their primary care provider (PCP), and 86% received medical cannabis authorization from a provider other than their PCP (Boehnke et al 2021 ). Additionally, most participants lacked confidence in their PCP’s ability to guide their cannabis use and did not report their substitution of cannabis for other pharmaceuticals/substances to their PCPs (Boehnke et al 2021 ). Taken together, these results suggest a lack of integration between mainstream healthcare and medical cannabis (Boehnke et al 2021 ).…”

“…Additionally, most participants lacked confidence in their PCP’s ability to guide their cannabis use and did not report their substitution of cannabis for other pharmaceuticals/substances to their PCPs (Boehnke et al 2021 ). Taken together, these results suggest a lack of integration between mainstream healthcare and medical cannabis (Boehnke et al 2021 ). PCPs are a vital front-line interface between patients and the healthcare system (Shi 2012 ); thus, improved understanding of patient-provider communication concerning medical cannabis use and substitution could inform strategies that maximize benefit and minimize harm.…”