Even as half of all Americans live in medical marijuana states, many doctors don’t feel empowered to recommend cannabis to their patients.
Medical marijuana has been legal for twenty years in California, and there are currently 25 medical marijuana states in the U.S. However, doctors in many medical marijuana states continue to be unprepared for questions regarding the benefits of cannabinoids and the use of medical marijuana. Patients with concerns are hoping doctors can answer inquiries about medical marijuana, but many physicians are still completely unprepared.
A recent article posted on the Kaiser Health News site further illustrates this point. Even though citizens of Maine have had access to legal medical marijuana for nearly two decades, longtime Farmington physician Jean Antonucci still feels “completely in the dark” when counseling patients who could benefit from the plant.
Patients come to Antonucci looking for answers to their questions, but she says despite trying to keep up with the medical literature, she doesn’t know the ideal way to use marijuana to treat ailments. Because the material still isn’t covered in medical school, doctors like Antonucci feel ill-equipped. Antonucci remarked, “It’s very difficult to support patients but not know what you’re saying.”
There is a great deal for physicians to learn. With about a hundred cannabinoids present in cannabis and a number of application methods, like topicals, tinctures, vaporizers, and edibles, it is challenging for some doctors to speak confidently about the many aspects of medical marijuana.
On top of this, the laws covering medical marijuana in the U.S. are just as confusing. Often physicians are afraid to discuss or recommend medical marijuana to patients for fear of reprisals. This is even more true for doctors in the Veterans Affairs system.
Medical marijuana programs in the U.S. usually specify a list of conditions for which medical marijuana may be used. The role of the physician then is to simply verify that patients have one of the state approved ailments. However, some doctors say that a lack of knowledge on cannabis and its effects, both positive and negative, means even writing a patient a recommendation makes them uncomfortable.
“We just don’t know what we don’t know. And that’s a concern,” said Wanda Filer, president of the American Academy of Family Physicians.
The discrepancy between state and federal laws also discourages doctors, who often feel caught between contradicting policies. In a recent decision, the DEA again decided marijuana should remain a Schedule I drug because, according to their understanding, it has no medical value.
“Typically, when we’re going to prescribe something, you’ve got data that shows safety and efficacy,” Filer said. This data often includes results of double blind clinical trials, the gold standard in medical research.
Researchers are slowly unraveling the benefits of cannabinoids on the human body, and with tens of thousands of studies published on cannabis and its constituents, they are building a body of information to help guide the future uses of medical marijuana. However, clinical trials for specific conditions are only recently being completed, and it is these clinical trials for which the health authorities and the DEA are waiting.
In the meantime, continued education and physician training programs may be the answer. Some medical marijuana states have included this training as part of their medical marijuana laws. Others have not. Nonetheless, it appears doctors welcome the idea of enhanced education and training.
A 2013 study revealed that 80% of physicians in Colorado saw cannabis specific training as necessary. However, making it too difficult to gain certification might have a negative effect, discouraging doctors from participating in state medical marijuana programs.
“You need a multi-hour course to learn where the medical cannabis works within the body,” said Stephen Corn, an associate professor at the Harvard Medical School. “As a patient, would you want a doctor blindly recommending something without knowing how it’s going to interact with your other medications? What to expect from it? What not to expect?”
Despite adhering to state laws and educating themselves regarding medical marijuana, some doctors still find themselves at odds over their participation in medical marijuana programs. Four doctors in Colorado were recently suspended for exceeding an “unwritten standard” in plant counts for patient home-grows. The doctors have since sued to have their licenses reinstated. Similar suspensions took place in Massachusetts, blurring the line of legality and prompting some doctors to avoid becoming involved with medical marijuana patients altogether.
This knowledge gap between cannabis and physicians has slowly started to close. The recent publication of a medical marijuana textbook, Medical Cannabis, Basic Science & Clinical Applications, demonstrates this need for basic medical marijuana education. Intending to become the standard resource for using medical marijuana as a treatment, the textbook was designed for those already practicing medicine. However, medical school classes focusing on the medicinal properties of cannabis can also make use of the textbook to educate the next generation of physicians before they start practicing.
Legal risks and a lack of accepted documentation of the effects and risks of medical marijuana have kept many doctors from engaging with patients who bring up the topic of cannabis. However, there is hope that more doctors will come around to the benefits of medical marijuana. There are now over 300 medical providers in Maine who are certifying patients to use cannabis. Although there is no way to show the growth of the program (participating doctors have only been tracked since 2015), anecdotally Maine’s medical marijuana system is expanding.
In the meantime, patients should bridge their doctor’s knowledge of marijuana by doing their own research from a trusted source. There are thousands of articles posted in respected peer reviewed medical journals revealing the many possible uses for medicinal marijuana. The more you know about the effects of cannabis on your condition, the more confident you will be when discussing treatment options with your physician.