With the legalization of both “medical” and recreational marijuana across many states, patients are turning to cannabis to treat a variety of ailments - often self-medicating without healthcare provider oversight and care.1 While “medical marijuana” may be legal and has demonstrated benefits for some conditions, healthcare providers are not prescribing the drug as they would other pharmaceutical treatments based on clinical trials demonstrating efficacy and safety at a given dose and for a specific indication. Healthcare providers instead are only recommending or certifying use of “medical marijuana” because it is still NOT approved for any medical condition by the U.S. Food & Drug Administration. The current legalization status of cannabis at the state level ultimately puts healthcare providers in the backseat of patient care, which can have serious consequences given potential misuse or drug-drug interactions.
Polypharmacy, or the simultaneous use of multiple prescription medications at one time, has been an issue of concern in the U.S. for some time. A study conducted from 2006 – 2011 found that 35% of older Americans were on five or more prescription medications and that 15% of those adults were at risk for drug-drug interactions.2 Consumers using “medical marijuana” need to know that there is no clinical evidence to validate its superiority to prescription drugs approved for specific diseases and drug-drug interactions are possible. Healthcare providers are ultimately taken out of the equation once they “certify” a patient to get a “medical marijuana” card and this can impact patient safety, especially for the elderly and people with chronic diseases or kidney and liver conditions.3
Healthcare Providers in Partnership with Patients Should Drive Treatment Decisions
When a healthcare provider writes a prescription for a medication that has been FDA approved, they know that medication has been evaluated based on clinical data related to efficacy, safety, and known interactions. When prescribing a medication to a patient, healthcare providers impart knowledge that is supported by scientific evidence about the benefits and risks of the drug they are prescribing for the condition it is intended to treat. In addition, the provider is able to prescribe an appropriate dosing range based on individual patient needs. Because every patient has different needs, dosage levels may need to be adjusted to ensure the drug prescribed provides the most benefit with the fewest side effects. This requires close monitoring and adjustment.4
Pharmacists also play a pivotal role in this prescription-based paradigm of care. When patients fill their prescriptions, the pharmacist knows to look for any listed medications that could interact with the medication the healthcare provider has prescribed. If there are issues, they can raise them with the prescriber, who can adjust current medications to a more appropriate dose or prescribe an alternative. There is also a built-in process to report through the FDA should an adverse event occur.
With “medical marijuana”, none of these safeguards exist. In essence, the healthcare provider is excluded from the risk-benefit discussion, which is left to retail dispensary staff. In states where “medical marijuana” is legal, the process typically involves a patient seeking out a healthcare provider who can “certify” their condition and use of cannabis. The certifying physician is a provider who may not be specialized to treat the condition a patient is hoping to treat. Once a patient and provider are connected, a discussion occurs about the use of “medical marijuana” for their condition. If the healthcare provider “certifies” a patient, this allows the patient to obtain a card to ultimately shop on their own at a retail dispensary. Once there, patients are guided by staff members commonly known as “budtenders.”5 These individuals are responsible for recommending a type or strain to use for the condition the patient is hoping to treat.
The inherent danger is that budtenders are NOT healthcare providers. They are retailers. Much like any other retailer, their job is to sell products. In most cases, they know very little about the patients they see, including their medical history. Furthermore, they have little, if any, knowledge of the possible interactions the product they are recommending could have with any or all of the medications or supplements the patient may be taking.
In short, the dispensary “medical marijuana” process puts healthcare providers in the back seat of patient care, cuts them out of important conversations and ultimately can put patients at risk. The current process does not have the same level of evidence-based data to track drug-drug interactions or other potential adverse events as prescription drugs that have been FDA approved. Healthcare professionals need to push for more research and better clinical data to ensure patients have access to safe and effective treatment options guided by a medical professional.
1Sarvet, Aaron L. et al. “Self-medication of mood and anxiety disorders with marijuana: Higher in states with medical marijuana laws.” Drug and Alcohol Dependence. May 2018. Available at https://www.sciencedirect.com/science/article/abs/pii/S037687161830111X Accessed July 23, 2021.
2Changes in Prescription and Over-the-Counter Medication and Dietary Supplement Use Among Older Adults in the United States, 2005 vs 2011, JAMA Internal Medicine, available here https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5024734/ Accessed on June 24, 2021.
3Alsherbiny, Muhammad A and Guang Li, Chun. “Medical Cannabis-Potential Drug Interactions.” Medicines. December 2018. Available at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6473892/pdf/medicines-06-00003.pdf. Accessed August 17, 2021.
4Use of Titration as a Therapeutic Individualization Strategy: An Analysis of Food and Drug Administration Approved Drugs, Clinical and Transitional Science, available here https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6510374/, Accessed on June 24, 2021.
5Priming Primary Care Providers to Engage in Evidence-based Discussions About Cannabis with Patients, Addiction Science and Clinical Practice, available here https://ascpjournal.biomedcentral.com/articles/10.1186/s13722-019-0171-3, Accessed on June 24, 2021.