Online Patient-Provider Cannabis Consultations [2020-01-15]

Stanford University

California, the first state to legalize medical cannabis in 1996, references medical cannabis for the treatment of “cancer, anorexia, AIDS, chronic pain, spasticity, glaucoma, arthritis, migraine, or any other illness for which marijuana provides relief.”9 Some states, including New York and New Mexico, list opioid use disorder as a qualifying condition.10–12 The NAS 2017 report also summarized evidence of the adverse health effects of cannabis use, identifying substantial evidence of worsened respiratory symptoms with long-term cannabis smoking; lower birth weight of offspring following prenatal exposure; and the development of schizophrenia or other psychoses, with the highest risk among the most frequent users.6 Prior reports on the adverse health effects of cannabis use identified reduced overall cortical gray matter volumes, increased impulsivity, increased executive dysfunction with adolescent cannabis use onset;13 and indicators of hepatotoxicity with chronic cannabis use.14 Patients are more likely to initiate a discussion about medical cannabis for treatments than their provider.15 However, lacking federal or state regulation of product contents, including THC levels; knowledge of possible medication interactions; or an understanding of health effects with maintenance use, many clinicians and health care systems are wary to recommend cannabis even when legal.16–18 The few studies that have examined providers’ views on medical cannabis have had low response rates and relied on self-reported beliefs rather than observations of actual practices.19–21 With the expanding legalization of cannabis use, more patients are likely to seek direction from clinicians. For patient questions concerning medical cannabis use, a second level of coding for the health condition of interest (e.g., cancer, pain; ) and for provider sentiment (i.e., negative, positive, or mixed; ) was conducted. ConditionFrequency n (%)Example quoteMental illness94 (20.3)“Can weed help with bipolar disorder?”Paina93 (20.0)“Will medical marijuana help for chronic back pain?” “Can marijuana help my migraine headaches?”General medical helpfulness40 (8.6)“Is smoking weed occasionally beneficial for health?” “What’s better for your health medical marijuana or prescribed pills?” Cancer, including lung cancer31 (6.7)“Can marijuana help with colon cancer?”Sleepa31 (6.7)“Does medical marijuana help with insomnia?”Eye conditions30 (6.5)“Can marijuana be used to treat glaucoma?”Conditions of the central nervous systema28 (6.0)“Can medical marijuana help seizures?” “Where can I find some medical cannabis for my multiple sclerosis?”Conditions of the bone, joints, skin, and other tissues23 (5.0)“Can I try cannabis for rheumatoid arthritis in hand?” “Can medicinal marijuana help with symptoms of fibromyalgia?”Respiratory conditions (e.g., asthma, bronchitis, COPD)17 (3.7)“Does smoking weed help people with COPD?”Stomach and digestive conditions15 (3.2)“Is marijuana an effective treatment for gastroparesis?”Nauseaa14 (3.0)“Does smoking marijuana get rid of nausea?”Medical cannabis cards and state laws14 (3.0)“What diseases qualify for a medical marijuana card?”Endocrine disorders12 (2.6)“Can medical marijuana treat adrenal or endo disease?” “Does type 2 diabetes and diabetic retinopathy qualify you for a medical marijuana?”Poor appetite7 (1.5)“I was diagnosed with cachexia and I smoked some marijuana. Provider response sentiment regarding medical cannabis use: A total of 762 provider responses to patient questions regarding medical use of cannabis were posted online by 358 clinicians licensed in 46 states and the District of Columbia. Provider SpecialtyProvider Responses N (%)Sentiment, n (%)Negative (n=505)Mixed (n=242)Positive (n=100)Psychiatry218 (28.6)148 (67.9)62 (28.4)8 (3.7)Addiction Medicine56 (7.3)32 (57.1)18 (32.1)6 (10.7)Pediatrics44 (5.8)32 (72.7)9 (20.5)3 (6.8)Neurology42 (5.5)20 (47.6)14 (33.3)8 (19.0)Internal Medicine39 (5.1)23 (59.0)13 (33.3)3 (7.7)Ophthalmology37 (4.9)24 (64.9)10 (27.0)3 (8.1)Clinical Psychology35 (4.6)28 (80.0)5 (14.3)2 (5.7)Family Medicine35 (4.6)19 (54.3)7 (20.0)9 (25.7)General Practice35 (4.6)8 (22.9)11 (31.4)16 (45.7)Pain Management33 (4.3)15 (45.5)15 (45.5)3 (9.1)Holistic Medicine20 (2.6)4 (20.0)9 (45.0)7 (35.0)Rheumatology15 (2.0)10 (66.7)4 (26.7)1 (6.7)Other Specialties153 (20.1)83 (54.2)47 (30.7)23 (15.0)Total762 Of the 358 clinicians responding to patient questions on medical cannabis use, 58.5% were licensed in states where cannabis use was legalized, 40.7% in states where cannabis use was not legalized, and 0.8% did not have their state listed.

https://www.ncbi.nlm.nih.gov/pmc/articles/7035882

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