Following Tuesday’s election, 36 states have created or voted to create medical cannabis programs, but conversations about the substance are still rare in doctors’ offices around the country.
It’s time for that to change, according to a paper published recently in the journal Pain Management Nursing.
Clinicians should create an environment in which patients can openly discuss their cannabis use and participate in shared decisions about the drug’s potential health effects, the paper authored by researchers in Washington State University’s College of Nursing concludes. Too often, the authors found, patients opt not to discuss their cannabis use out of fear of legal or occupational consequences, and physicians frequently avoid the topic due to a lack of available information.
That disconnect between healthcare providers and patients can create confusion among both parties, said WSU associate professor Dr. Marian Wilson, the paper’s lead author. She and her co-authors instead advocate for a shared decision-making (SDM) model, in which the patient and healthcare provider have honest conversations while collaboratively mapping out treatment plans.
“People are using cannabis – it’s very easy for them to get, it’s legal, and there may be some health benefits and there may be some health risks,” Wilson said Thursday. “So, it’s really the place for the healthcare provider to help them navigate the options. … We really just want this conversation to be open, just like any other conversation you would have with a provider about smoking or alcohol or exercise. It really needs to be part of the conversation to help people optimize their health.”
The paper, titled “Shared Decision-Making for Patients Using Cannabis for Pain Symptom Management in the United States,” outlines a suggested SDM model and also calls for the creation of a centralized, scientific repository of information that can be used by physicians and patients for best practices on cannabis use.
Currently, due to marijuana’s federal illegality, there is a dearth of scientific research into cannabis in the U.S. While many users believe cannabis benefits their health, the evidence is largely anecdotal or based on inadequate research. Because of that, according to Wilson, many patients learn about the drug’s health impact from budtenders or their friends.
That’s particularly problematic, Wilson said, because there’s such a wide variety of cannabis products, as well as many different ways to use them. Wilson said she is not necessarily for or against the concept of medical cannabis; rather, she believes people should be able to make well-informed health choices.
“There’s decisions to be made and we need the information to guide patients,” she said. “Having a central repository of high-quality research would be a next step, now that we know the floodgates are going to be opened with more and more people having access to cannabis. We need to make sure we don’t do more harm than good, and we need to help people enter this new [potential treatment] with some caution and some wisdom.”
The paper, published Oct. 30, notes there are several reasons patients often choose not to disclose their cannabis use. In addition to potential conflicts with the law and/or their employers’ drug policies, some patients express worry that their doctor will disapprove of their cannabis use and/or that it could lead to them losing their prescriptions for other drugs, like opioids.
Several studies, some of them with conflicting conclusions, are cited in the paper, highlighting the lack of consensus on marijuana’s potential uses. On top of that, cannabis products are constantly evolving and can be grown, manufactured and consumed in many ways. Often, advertisements and consumer sites are the main sources of information about the products, the paper found.
“This is a challenging scenario for patients who are seeking relief of symptoms within the context of their unique condition, healthcare professionals’ relationships, and state laws,” the authors wrote.
The SDM described in the paper is a six-step process.
Either the patient or clinician can bring up the topic, the paper suggests, and the two should work together to create a priority list and establish shared goals. That conversation should include considerations like: Does the patient wish to seek employment, and will cannabis affect that employment?
The third step involves compiling evidence, based on available research and the personal experiences of the patient and clinician. After that, the two need to evaluate that evidence as it relates to the patient’s symptoms and values, and then formulate a treatment plan.
The final step is to monitor and evaluate outcomes, so the treatment plan can be revised over time to “maximize health benefits and limit harms.”
The paper notes that SDMs can require complex, lengthy conversations, so it calls for the development of further resources – such as websites or online videos – that can be used to help patients more quickly absorb relevant information.
“Health information technologies are needed that can streamline information-sharing and save clinicians time,” the authors wrote. “In community settings such as primary care or oncology, the decision regarding whether to use cannabis may be discussed and decided upon over the course of weeks or months. Patient satisfaction with the outcome of the decision will guide when and how the decision is reconsidered.”
On Tuesday, voters in Arizona, New Jersey and Montana legalized cannabis for recreational use by adults, while voters in Mississippi approved a medical program. The residents of South Dakota voted for both a REC and MED program.
Other states are expected to soon follow, and advocates are hopeful for meaningful federal reform in the coming years.
Those trends point to a lot of potential new consumers, including many who may look to try cannabis for the first time to treat an ailment, Wilson said.
“We know there’s going to be people who are going to be curious,” she said, “so helping them understand the risks and benefits is really important.”
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