Practice Patterns and Training Needs Among Physicians Certifying Patients for Medical Marijuana in Florida

Abstract

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.

Medical Students’ Attitudes, Knowledge, and Beliefs about Medical Cannabis: A Qualitative Descriptive Study

“…Many are also not equipped to answer questions from patients regarding its uses and possible adverse effects [ 32 ]. This may be due to the fact that physicians receive minimal or no education regarding MC during medical school [ 32 , 33 ] and that the US Drug Enforcement Administration (DEA) has classified cannabis as a Schedule 1 drug, which is the same legal, regulatory category as heroin (diacetylmorphine), LSD (lysergic acid diethylamide), mescaline (peyote), and MDMA (3,4-methylenedioxymethamphetamine or “ecstasy”) [ 34 ]. Schedule 1 drugs are those that are considered to have no substantiated medical value, a high potential for abuse, and the potential to create dependence [ 34 ].…”

Proceedings of the 2022 Cannabis Clinical Outcomes Research Conference

“…Dosing recommendations for specific product types and dosing for individual patients typically fall on the clinician, but currently, there is little evidence to guide dosing recommendations. Clinicians, therefore, rely on experience from other clinicians or experiences from their patients to determine dosing regimens for each patient [ 4 ]. Clinicians and researchers would both benefit from dosing standardization to identify effective initiating doses for different indications [ 5 ].…”

Clinical Considerations for Cannabis Use and Cardiovascular Health

“…Cannabinoid composition, concentrations, and ratios may substantially vary in these products and between and within users, not to mention that most cannabis users have access to products from outside dispensaries that may not be labeled or could possibly contain contaminants, pesticides, or heavy metals [ 18 ]. Moreover, for medical cannabis users, cardiologists are unlikely to be the authorizing physician [ 62 , 63 ]. Thus, dose adjustments rely on disclosing medical cannabis use in patient counseling.…”