We've got a long way to go to get physicians caught up on medical cannabis.

This year has been a great one for medical cannabis patients (if you happen to live in a state where its use is legal). There are new studies published every month showing just how effective medical cannabis can be for a wide range of conditions. And society is more accepting of cannabis than ever (despite the prohibitionists that continue to wage their war against a plant). There are single cannabinoid formulations like cannabidiol (CBD) available, which can be a great option for those who do not want the “high” associated with THC, several different methods of administration, and a very wide range of products.

But, it still can be quite tough to jump that first hurdle to becoming a medical cannabis patient–getting your medical card.

While each state in which medical cannabis is legal has its own process in place for obtaining a card, the hardest part may be having that initial conversation with your doctor. Some may fear that their doctor harbors old thoughts about cannabis stereotypes all (although these opinions are starting to slowly change), and therefore don’t bring it up at. Even those brave souls confident in their conversational abilities may end up with a disheartening response, as many physicians are lacking basic education in medical cannabis.

And this is not in the least their fault.

Medical schools are tasked with training students to become physicians in just four years. Once they’ve graduated and complete residency, some may opt to go into specialty fellowships or some may practice primary care. Regardless of choice, each year US physicians must complete courses to stay accredited–these courses are a part of continuing medical education (CME). Physicians can also stay up to date on what’s new in research and medicine by attending conferences, reading medical journals, and browsing web sites that provide credible information.

But, when it comes to medical cannabis, physicians are just not getting this information or training that is available on other topics in research and medicine.

In 2017, Ricco et al. published a study called “The Times They Are A-Changin’.” Researchers administered a survey to faculty physicians and residents on their knowledge of medical cannabis in Minnesota. These survey results indicated a significant lack of understanding of the state’s cannabis program and regulations. This knowledge gap likely affected their decision making, as over half could not think of a patient who could benefit from medical cannabis use, while over one-third were unsure.1

A study that surveyed physicians in New York City found very similar results. While these physicians were more supportive of medical cannabis use for their patients, they too struggled with a basic understanding of both the endocannabinoid system and that state’s program.2

In 2018, ten conditions–amyotrophic lateral sclerosis, cancer, epilepsy, HIV/AIDS, Huntington's disease, inflammatory bowel disease, multiple sclerosis, neuropathy, Parkinson's disease, and spinal cord injury with spasticity–were included in NY’s medical cannabis program.2 These conditions cross several different specialties, and medical cannabis dosing, administration, and symptom efficacy and safety differ across all. If you were a patient with one of these conditions taking medical cannabis, you would likely have many questions. But, at the moment, there are very few physicians that could confidently answer your questions.

And that’s because, in 2017, only 9% of 145 medical schools included medical cannabis in their curriculum.3

So, how do we change this?

Some medical schools have quickly learned that they are sending their students out unprepared when it comes to medical cannabis. And, thus, schools are beginning to offer additional training.

In addition, the Accreditation Council for Continuing Medical Education, the organization that certifies all CME courses, has published a letter encouraging CME providers to develop content for physicians on the regulation and science of medical cannabis.

But it’s not just physicians that need to be better prepared. Other healthcare professionals, including nurses, nurse practitioners, physician assistants, and pharmacists must also be kept up to date.

As of January 2019, 62% of 68 pharmacy schools and colleges currently include medical cannabis and 23% plan to include this content within the next 12 months.4

Times certainly are “a-changin’”, and there’s preliminary evidence suggesting that cannabis education is working. Following a 90-minute presentation, students at the University of Massachusetts Medical School exhibited significantly improved knowledge about state medical cannabis laws. The program also improved self-assessed confidence in making clinical decisions for their patients.5

“As the majority of US states have now legalized medical cannabis programs, the topic represents an important aspect of the future physician’s clinical environment,” said Tamir Bresler, medical student at Washington State University.

“Medical students should be educated on the basic pharmacology of cannabinoids and available clinically significant research, right along with the theorized contraindications and capabilities that have yet to be sufficiently tested.”

There’s still a lot of work to be done. And you can help us get there by strongly advocating for physician education and, of course, full legalization of this healing plant at the federal level.

By Loren DeVito, PhD, Staff Writer for Terpenes and Testing Magazine and Extraction Magazine

References

1. Ricco, J., et al. “The Times They Are A-Changin.’ Knowledge and Perceptions Regarding Medical Cannabis in an Academic Family Medicine Department.” PRiMER. vol.1, no.20, 2017, pp. 1-7. (impact factor: N/A; cited by: N/A)

2. Sideris, A., et al. “New York Physicians' Perspectives and Knowledge of the State Medical Marijuana Program.” Cannabis Cannabinoid Res. vol.3, no.1, 2018, pp. 74-84. (impact factor: N/A; cited by: 3)

3. Evanoff, A. B., “Physicians-in-training Are Not Prepared to Prescribe Medical Marijuana.” Drug and Alcohol Dependence. Vol. 180, 2017, pp. 151-155. (impact factor: 3.349; cited by: 14)

4. Smithburger, P.L., et al. “Evaluation of Medical Marijuana Topics in the PharmD Curriculum: A National Survey of Schools and Colleges of Pharmacy.” Curr Pharm Teach Learn. vol.11, no.1, 2019, pp. 1-9. (impact factor: 0.25; cited by: N/A)

5. McGuire, P., "Medical Marijuana Education for Medical Students." Capstone Presentations. Paper 5. 2017. Available at:

https://escholarship.umassmed.edu/capstones/5

Image Source: https://aroundwellington.com/a-medical-marijuana-education/

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