Perspective

Medical marijuana uptake hinges on physician training, best practices

Guohua Li
Guohua Li

Since California became the first state to legalize medical marijuana in 1996, 28 states have followed suit, increasing the number of patients that physicians encounter who wish to utilize medical marijuana – or who already do. This makes it increasingly important for physicians to be aware of their states’ laws and infrastructure that relate to medical marijuana use.

This July, the Pennsylvania Department of Health announced the creation of a practitioner registry for physicians who intend to recommend medical marijuana. It is the most recent development in an ongoing process to implement the state’s medical marijuana program, which was enacted into law in April 2016.

“Many physicians treat these patients every day and understand the impact this medication could have on their treatment. Once these physicians register and complete the required continuing education, they can be approved to participate in the program,” Rachel Levine, MD, acting secretary of health and physician general of Pennsylvania, said in a press release.

Education

Physicians will be required to complete 4 hours of training before they can register in Pennsylvania.

“Most state medical marijuana laws require some training for health care providers before they are authorized to issue medical marijuana cards,” Guohua Li, DrPH, MD, Finster Professor of Epidemiology and Anesthesiology and founding director of the Center for Injury Epidemiology and Prevention at Columbia University, told Healio.com. “The curriculum would cover medical marijuana laws in the state, such as what is considered a qualifying medical condition; the procedures for verifying the condition(s); the dosage, potency, mode and duration of medical marijuana use; concurrent use of medical marijuana and medications and the benefits and risks regarding medical marijuana.”

The ways in which patients obtain marijuana, and the format in which it can be consumed, vary; some states, like Pennsylvania, require physicians to become registered prescribers of medical marijuana, while others have patient ID card programs.

“The requirements for physicians to issue medical marijuana cards differ from state to state,” Li said. “There is no uniformly adopted rule in the states that have enacted medical marijuana laws. Generally speaking, every state has a registry of practicing physicians via its medical board, but not every physician is authorized to issue medical marijuana cards.”  

Almost all participating states require that patients have a specific, physician-confirmed diagnosis to receive medical marijuana. In New Jersey, for example, patients must have one of the following “debilitating” conditions: ALS; multiple sclerosis; terminal cancer; muscular dystrophy; inflammatory bowel disease (including Crohn’s disease); and what they call “terminal illnesses,” which are conditions with a physician-issued prognosis of less than 12 months.

Research

Providers should also do their own research to remain up-to-date on the regulations and research related to medical marijuana, according to Donald I. Abrams, MD, professor of clinical medicine at University of California, San Francisco, chief of hematology and oncology at Zuckerberg San Francisco General Hospital and integrative oncologist at the Osher Center for Integrative Medicine.

Donald Abrams
Donald I. Abrams

“Although we do not have a wealth of information from randomized, placebo-controlled clinical trials on medical marijuana, it is a useful botanical that benefits patients with a number of ailments that are difficult to treat, and [it] offers a safer alternative in some patients with chronic pain than currently prescribed opiates,” Abrams told Healio.com. “The National Academies of Sciences, Engineering and Medicine just released The Health Effects of Cannabis and Cannabinoids, which is a useful volume for providers to be familiar with. There are a host of lay books that may also be useful.”

Currently, 29 states — including Pennsylvania — as well as the District of Columbia, Guam and Puerto Rico have established a medical marijuana program. In Pennsylvania, results of a survey conducted by the state’s Department of Health demonstrated 75% of 191 physicians asked would register with such a program.

“It appears that more states are approving medical marijuana every year, so I suspect that, before too long, most — if not all states — will be defying federal law,” Abrams said.  “The majority of Americans already live in a state where marijuana is available as medicine. Not everyone should receive the recommendation for medical marijuana, and not everyone will benefit, but that doesn’t mean no one should be given the opportunity.” – by Julia Ernst, MS

References:

National Conference of State Legislators. State medical marijuana laws. Available at: http://www.ncsl.org/research/health/state-medical-marijuana-laws.aspx. Accessed July 31, 2016.

Pennsylvania Pressroom. Department of health launches practitioner registry for medical marijuana program. Available at: http://www.media.pa.gov/Pages/Health-Details.aspx?newsid=439. Accessed July 31, 2017.

State of New Jersey Department of Health. Medical marijuana program – patient FAQ. Available at: http://www.nj.gov/health/medicalmarijuana/pat_faqs.shtml#7. Accessed July 28, 2017.

Disclosures: Abrams and Li report no relevant financial disclosures.

Guohua Li
Guohua Li

Since California became the first state to legalize medical marijuana in 1996, 28 states have followed suit, increasing the number of patients that physicians encounter who wish to utilize medical marijuana – or who already do. This makes it increasingly important for physicians to be aware of their states’ laws and infrastructure that relate to medical marijuana use.

This July, the Pennsylvania Department of Health announced the creation of a practitioner registry for physicians who intend to recommend medical marijuana. It is the most recent development in an ongoing process to implement the state’s medical marijuana program, which was enacted into law in April 2016.

“Many physicians treat these patients every day and understand the impact this medication could have on their treatment. Once these physicians register and complete the required continuing education, they can be approved to participate in the program,” Rachel Levine, MD, acting secretary of health and physician general of Pennsylvania, said in a press release.

Education

Physicians will be required to complete 4 hours of training before they can register in Pennsylvania.

“Most state medical marijuana laws require some training for health care providers before they are authorized to issue medical marijuana cards,” Guohua Li, DrPH, MD, Finster Professor of Epidemiology and Anesthesiology and founding director of the Center for Injury Epidemiology and Prevention at Columbia University, told Healio.com. “The curriculum would cover medical marijuana laws in the state, such as what is considered a qualifying medical condition; the procedures for verifying the condition(s); the dosage, potency, mode and duration of medical marijuana use; concurrent use of medical marijuana and medications and the benefits and risks regarding medical marijuana.”

The ways in which patients obtain marijuana, and the format in which it can be consumed, vary; some states, like Pennsylvania, require physicians to become registered prescribers of medical marijuana, while others have patient ID card programs.

“The requirements for physicians to issue medical marijuana cards differ from state to state,” Li said. “There is no uniformly adopted rule in the states that have enacted medical marijuana laws. Generally speaking, every state has a registry of practicing physicians via its medical board, but not every physician is authorized to issue medical marijuana cards.”  

Almost all participating states require that patients have a specific, physician-confirmed diagnosis to receive medical marijuana. In New Jersey, for example, patients must have one of the following “debilitating” conditions: ALS; multiple sclerosis; terminal cancer; muscular dystrophy; inflammatory bowel disease (including Crohn’s disease); and what they call “terminal illnesses,” which are conditions with a physician-issued prognosis of less than 12 months.

Research

Providers should also do their own research to remain up-to-date on the regulations and research related to medical marijuana, according to Donald I. Abrams, MD, professor of clinical medicine at University of California, San Francisco, chief of hematology and oncology at Zuckerberg San Francisco General Hospital and integrative oncologist at the Osher Center for Integrative Medicine.

Donald Abrams
Donald I. Abrams

“Although we do not have a wealth of information from randomized, placebo-controlled clinical trials on medical marijuana, it is a useful botanical that benefits patients with a number of ailments that are difficult to treat, and [it] offers a safer alternative in some patients with chronic pain than currently prescribed opiates,” Abrams told Healio.com. “The National Academies of Sciences, Engineering and Medicine just released The Health Effects of Cannabis and Cannabinoids, which is a useful volume for providers to be familiar with. There are a host of lay books that may also be useful.”

Currently, 29 states — including Pennsylvania — as well as the District of Columbia, Guam and Puerto Rico have established a medical marijuana program. In Pennsylvania, results of a survey conducted by the state’s Department of Health demonstrated 75% of 191 physicians asked would register with such a program.

“It appears that more states are approving medical marijuana every year, so I suspect that, before too long, most — if not all states — will be defying federal law,” Abrams said.  “The majority of Americans already live in a state where marijuana is available as medicine. Not everyone should receive the recommendation for medical marijuana, and not everyone will benefit, but that doesn’t mean no one should be given the opportunity.” – by Julia Ernst, MS

References:

National Conference of State Legislators. State medical marijuana laws. Available at: http://www.ncsl.org/research/health/state-medical-marijuana-laws.aspx. Accessed July 31, 2016.

Pennsylvania Pressroom. Department of health launches practitioner registry for medical marijuana program. Available at: http://www.media.pa.gov/Pages/Health-Details.aspx?newsid=439. Accessed July 31, 2017.

State of New Jersey Department of Health. Medical marijuana program – patient FAQ. Available at: http://www.nj.gov/health/medicalmarijuana/pat_faqs.shtml#7. Accessed July 28, 2017.

Disclosures: Abrams and Li report no relevant financial disclosures.

    Perspective

    Greg Gerdeman

    Cannabis as medicine is a uniquely misunderstood area, and the need for physician education is pronounced. Despite scientific advancement in the understanding of the endocannabinoid system as a therapeutic target that rationalizes cannabis-based botanical medicines, education has only recently entered medical school curricula.

    In rheumatology, the molecular targets of cannabinoids hold the potential to not only mitigate painful symptoms, but also slow disease progression by inhibiting the release of metalloproteases and proinflammatory cytokines. This is without the immunological risks of some disease-modifying biological drugs.

    A great deal of education for physicians on new therapeutic strategies comes from the producers of the new drugs that hold promise. As a maligned botanical medicine, cannabis’ different background has kept physicians suspicious and unsure how or why it should be taken seriously.

    In newly emerging, state-regulated markets, scientists with formal training are beginning to engage in continuing medical education (CME) courses as mandated by state laws for physicians who recommend cannabis. Aside from these courses, CME-accredited online modules, such as those by the Society of Cannabis Clinicians, are available to help physicians get up to speed in the science of the endocannabinoid system.

    In the United States, pain is the largest indicator for which patients seek cannabis, and there is quality scientific evidence that incorporating cannabinoids into treatment can help reduce the use of opioid narcotics and related overdoses. The promise of cannabis medicines is real, and education is key. Rheumatologists will continue to see surging numbers of patients who seek this option, and their reasons are legitimate.

    • Greg Gerdeman, PhD
    • Chief Scientific Officer, 3 Boys Farm
      Ruskin, Florida

    Disclosures: Gerdeman reports he is the chief scientific officer of 3 Boys Farm, a licensed producer of cannabis-based medicines in Florida; has been paid to contribute to CME courses on cannabis as a medicine; and is a research affiliate member of the Society of Cannabis Clinicians.