The clinical implications of legalizing marijuana: Are physician and non-physician providers prepared?

Brooks, Elizabeth; Gundersen, Doris; Flynn, Erin; Brooks‐Russell, Ashley; Bull, Sheana

doi:10.1016/j.addbeh.2017.03.007

Cited by 72 publications

(62 citation statements)

References 28 publications

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“…The level of engagement about cannabis has been left to provider discretion, concurrent with increased monitoring of opioid prescriptions. Our results align with literature that suggests that clinicians are not comfortable discussing and/or providing cannabis in clinical settings (Brooks, Gundersen, Flynn, Brooks-Russell, & Bull, 2017; Harle et al, 2015; Herzig et al, 2006; Holland et al, 2016). Clinicians in our study did not discuss cannabis with patients and patients described making decisions to use cannabis for pain management without clinician input.…”

Section: Discussionsupporting

confidence: 89%

Patients’ and clinicians’ perspectives of co-use of cannabis and opioids for chronic non-cancer pain management in primary care

Cooke

Knight

Miaskowski

2019

International Journal of Drug Policy

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Background: The prevalence of opioid-associated morbidity and mortality underscores the need for research on non-opioid treatments for chronic non-cancer pain (CNCP). Pain is the most common medical condition for which patients request medical cannabis. Limited research indicates that patients are interested in cannabis as a potential addition to or replacement for opioid medication. This analysis reports on CNCP patient and clinician perceptions about the co-use of cannabis and opioids for CNCP management. Methods: We interviewed 23 clinicians and 46 CNCP patients, using semi-structured interview guides, from six safety-net clinics across the San Francisco Bay Area, and 5 key stakeholders involved in CNCP management. We used a modified grounded theory approach to code and analyze transcripts. Results: CNCP patients described potential benefits of co-use of cannabis and opioids for pain management and concerns about dosing and addictive potential. Patients reported seeking cannabis when unable to obtain prescription opioids. Clinicians stated that their patients reported cannabis being helpful in managing pain symptoms. Clinicians expressed concerns about the potential exacerbation of mental health issues resulting from cannabis use. Conclusion: Clinicians are hampered by a lack of clinically relevant information about cannabis use, efficacy and side-effects. Currently no guidelines exist for clinicians to address opioid and cannabis co-use, or to discuss the risk and benefits of cannabis for CNCP management, including side effects. Cannabis and opioid co-use was commonly reported by patients in our sample, yet rarely addressed during clinical CNCP care. Further research is needed on the risks and benefits of cannabis and opioid co-use.

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Section: Discussionsupporting

confidence: 89%

Patients’ and clinicians’ perspectives of co-use of cannabis and opioids for chronic non-cancer pain management in primary care

Cooke

Knight

Miaskowski

2019

International Journal of Drug Policy

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“…Given the lack of reliable data on the potential risks and benefits, it is perhaps not surprising that providers are reluctant to discuss marijuana use with their patients. 55,56 Furthermore, physicians may not be aware of the regulations set forth in the enacted law 57 in their state. These facts have led to a call for MM to be included in medical curricula.…”

Section: Discussionmentioning

confidence: 99%

Medical Cannabis Use in Glioma Patients Treated at a Comprehensive Cancer Center in Florida

Reblin

Sahebjam

Peeri

et al. 2019

Journal of Palliative Medicine

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Background: Glioma is a devastating primary tumor of the central nervous system with difficult-to-manage symptoms. Cannabis products have been postulated to potentially benefit glioma patients. Recent state legalization allowed investigators an opportunity to study glioma patients' adoption of medical marijuana (MM). Objective: Our goals were to: (1) determine the prevalence of marijuana use, both through physician recommendation and self-medication, and (2) evaluate its perceived risks and benefits in glioma patients. Design: Self-report data were collected and descriptive analyses were conducted. Setting/Subjects: Participants were adult, English-speaking patients undergoing treatment for primary nonrecurrent malignant glioma in neuro-oncology clinics at an NCI-designated Comprehensive Cancer Center. Measurements: The survey on MM was adapted from previous research and included questions on knowledge and attitudes toward MM; use, frequency, type, and sourcing of MM; and reasons for use of MM and perceived symptom relief among users. Results: A total of 73 patients were surveyed. The majority of participants were aware that MM was legal in the state, and most reported learning of this through the media. Over 70% of participants reported having considered using MM, and a third reported using marijuana products after their diagnosis. Most received recommendations from friends/family rather than a medical provider, and only half of the users had obtained a physician's recommendation. Users generally reported benefits. Conclusions: With the increasing national conversation that accompanies legalization, glioma patients are pursuing marijuana for the treatment for their symptoms. More research and education is needed to bring health care providers into the conversation.

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“…Further, only 68.5% of respondents felt knowledgeable when asked about the risks associated with cannabis use. The lack of knowledge can be attributed to the absence of high-quality literature on medical cannabis and relating health measures (7). In addition, since some physician organizations (e.g., Canadian Medical Association) have taken a stance against medical cannabis, independent practitioners may be less likely to seek out information.…”

Section: Discussionmentioning

confidence: 99%

“…Independently, each of these studies identified a gap among physicians' current understanding and comfort level in various topics related to medical cannabis (7-10). However, the discussions of each study recognized that sample size, variation by location and physician demographics make it difficult to draw any conclusive evidence based on their respective results (7)(8)(9)(10). The number of participants, location, mean age of respondents, mean number of years in practice and field of practice for each study are reported in Table 1.…”

Section: Methodsmentioning

confidence: 99%

Cannabis Therapy Knowledge Study: Toward Establishing a Pedagogical Tool

Shahi

Allain²,

Turner³

et al. 2018

UOJM

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La légalisation imminente du cannabis fait appel aux médecins à augmenter leurs connaissances de l'usage médicinal et récréatif du cannabis. Nous avons analysé les connaissances et les opinions des médecins sur i) le mécanisme du système endocannabinoïde, ii) l'entrainement actuel avec le cannabis, iii) les risques associés à l'usage du cannabis, iv) la création de plans de traitement efficaces par le cannabis et v) les besoins futurs d'entrainement. Les connaissances et opinions des médecins sur le cannabis sont limitées et divisées. Les médecins appuient l'entrainement sur le cannabis par des webinaires, par l'entrainement face à face, par littérature révisée par les pairs ou par lignes directrices cliniques. Un programme doit être développé pour les médecins actuels et futurs pour créer une norme de soins pour le cannabis. RÉSUMÉ COMMENTARY

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The clinical implications of legalizing marijuana: Are physician and non-physician providers prepared?

Cited by 72 publications

References 28 publications

Patients’ and clinicians’ perspectives of co-use of cannabis and opioids for chronic non-cancer pain management in primary care

Patients’ and clinicians’ perspectives of co-use of cannabis and opioids for chronic non-cancer pain management in primary care

Medical Cannabis Use in Glioma Patients Treated at a Comprehensive Cancer Center in Florida

Cannabis Therapy Knowledge Study: Toward Establishing a Pedagogical Tool

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