Why Doctors and Patients Need to Talk About Medical Cannabis

Talking about medical cannabis matters because, right now, both doctors and patients often don't know how to bring it up in the exam room. Plenty of physicians see cannabis as a legitimate medical therapy, yet in one recent survey half of primary care doctors said they weren't ready, or weren't willing, to answer patients' questions about it. Others said they were.

One thing's for sure: there are big gaps in what doctors know, including:

• The workings of the endocannabinoid system
• How well cannabis, hemp and marijuana each work for different conditions
• Dosing and delivery methods: there's no official consensus on strains or starting doses, though "start low and go slow" is the advice you'll hear most
• Possible side effects, drug interactions and toxicity.

These questions were pressing enough that the National Academies of Sciences, Engineering, and Medicine ran a fast-tracked, comprehensive review of the medical literature on the health effects of cannabis and cannabinoids, publishing its report in 2017. The report covered 11 areas, including therapeutic effects, cancer incidence, cardiometabolic risk, respiratory disease, injury and death, and problem use. The committee also identified and ranked a list of barriers holding research back.

On top of that, doctors simply aren't taught about cannabinoids like cannabidiol (CBD) and tetrahydrocannabinol (THC) for medical use.

Two-thirds of the medical school deans surveyed said their graduates weren't prepared to prescribe medical cannabis or marijuana, and a quarter said their graduates weren't prepared to answer questions about it at all.

Training or no training, doctors should expect patients to ask about cannabinoids, especially as more countries legalize them for medical and adult use.

At the very least, physicians who don't feel ready to field those questions should know which doctors or practices in their area are up to speed on cannabinoid medicine, so they can refer patients.

Medical schools have been slow to add cannabinoid medicine to the curriculum, but there are organizations offering continuing medical education and other resources for doctors who want to learn about medical cannabis, marijuana and hemp. These include the International Cannabinoid Research Society, the Society of Cannabis Clinicians, the International Association for Cannabinoid Medicines and the American Academy of Cannabinoid Medicine.

In Argentina, the School of Medical Sciences at the National University of La Plata was a pioneer, launching a graduate program in Medical Cannabis Prescription and Research. It's aimed mainly at physicians and veterinarians, and covers both the legal and the academic side of the topic.

It's encouraging to see universities start giving students more ways to learn about cannabis and get trained in it. We need more courses, degrees and graduate programs that tackle these topics and challenges, to strengthen a field that keeps on growing.

Knowledge is power, and only through research and education can doctors and patients make the most of a plant with a wide range of potential medical and therapeutic uses, one that patients of all ages, from kids to older adults, report can help ease a range of conditions. 

Misinformation, on the doctor's side and the patient's, fuels misuse of cannabis, which feeds stigma and causes problems for the people who use it and for everyone else. 

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