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June 3, 2019

Educating Physicians About Marijuana

Author Affiliations
  • 1Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, California
JAMA Intern Med. 2019;179(8):1017-1018. doi:10.1001/jamainternmed.2019.1529

I had always heard it was difficult, if not impossible, to die from marijuana use. We hardly learned about marijuana during medical school, and I don’t remember many questions about marijuana on our licensing examinations that went beyond redness of the eyes. Why focus on marijuana when physicians must worry about medical emergencies such as cardiac arrests, sepsis, pulmonary embolisms, opioid overdoses, and alcohol withdrawal?

Just a few years later, marijuana seems ubiquitous. Ten US states have legalized recreational marijuana use among adults, and 33 states have legalized medical marijuana use. A majority of Americans live in states that allow for some degree of marijuana use. In California, where medical and recreational marijuana use is legal under state law, I drive to work past billboards advertising home delivery services for marijuana. Within blocks of my apartment, 3 dispensaries offer marijuana buds, vape pens, oils, cookies, brownies, and gummies with varying degrees of tetrahydrocannabinol (THC) and cannabidiol. Marijuana has become an inescapable part of my medical training, and most of my learning has come from patients.

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3 Comments for this article
Education vs proselytization about marijuana
John Coleman, MS, MA, PhD | Assistant Administrator for Operations (Retired), US Drug Enforcement Administration
Dr. Morris gives a fair but disturbing account of the knowledge base among the medical profession as to the harms of marijuana. That more than a third of a site survey of resident physicians believed marijuana is FDA-approved (and, presumably, OK to prescribe for medical use) is very troubling for a public that depends on the knowledge and skill of their physicians for good health. The paucity of reputable research that Dr. Morris mentions is disappearing quickly as more and more articles are published by serious authors and journals on the dangers and risks associated with the use of marijuana. Regrettably, Dr. Morris failed to mention the burgeoning research on teratological effects of cannabis use and the alarming increases in the rates of certain birth defects in states where marijuana use has been "legalized" for recreation and medical use. Until recently, much, if not most, "research" in this field was biased by authors proselytizing about the virtues and benefits of marijuana. Citing each other as experts and publishing questionable and generally unreplicable findings, it's no wonder such confusion still exists about the serious side effects of marijuana. With the burgeoning of the commercial marijuana industry in the US, and the emergence of large capitalized sources, we may begin to see a rapid increase in the needed research that Dr. Morris suggests is essential. It is unacceptable in this day and age that physicians be expected to acquire their knowledge of this drug on the unverified appraisals of its users. Those appraisals more often than not will reflect the intoxicating or psychic effects of the drug rather than its therapeutic benefits, if any.
National Council of State Board of Registered Nursing July 2018 Pre Licensure and APN curriculum Guidelines for Medical Marajuan
Deborah Bolton, BSN,MSN | Deborah L.Bolton and Associates
The professional publication July 2, 2018 Journal of Nursing Regulation , Vol. 9.Issue 2, has recognized the very issues put forth in the article, supporting literature review, and previous comment to make recommendations the development and implementation of evidenced-based curriculums. It is a start and I hope the medical and pharmacology academic communities move forward.
Not Just Physicians, Budtenders Too (But Doctors Need Significantly More Training)
Mitchell Colbert |
Thank you Dr. Morris for your very well written and balanced article, that weighs both the potential positives and negatives of cannabis use, while also being clear on the limits of our knowledge.

As someone who as presented at CME courses offered to doctors on cannabis, there are not remotely enough opportunities for physicians to learn about cannabis. Although CME courses are better than nothing, doctors need to learn about the endocannabinoid system and clinical endocannabinoid deficiency while they are in school, and still have the chance to pursue research on it. Doctors should not be learning about
cannabis from their patients, they should be educating those patients about it. When I broke my wrist and was curious if cannabis use would delay my healing, my doctor listened to me talk about cannabis and told me "you sound like you know this better than I do, use your best judgment." Can you imagine a doctor saying that about opioids?

Doctors, nurses, pharmacists, and other health professionals are just one piece of this. Increasingly, the first person a would-be cannabis patient speaks to about their cannabis use is the budtender (or wellness consultant) at the dispensary where they are going to buy that cannabis. As a former wellness consultant who has educated over 25,000 patients about their cannabis use, it is clear that our budtenders need a better understanding of the science of this plant as well. Several times a week I would have patients coming in on pharmaceutical drugs with *known* drug to drug interactions that their physician(s) did not disclose to them. I only knew about the drug interactions because I did my due diligence and looked them up online, for every patient on medication. The main thing I was looking for is CYP 450 interactions because research shows that CBD can impact the CYP system in a similar manner to grapefruit juice (perhaps even more, perhaps less, we don't know yet).

This is why I am pushing, not just for better training of our medical professionals, but some sort of standardized training for dispensary employees.