Doctors Struggle With Medical Marijuana Knowledge Gap

Conflicting state and national policies add to the confusion

As the number of states allowing medical marijuana grows—the total has reached 25 plus the District of Columbia—some are working to address physicians’ knowledge gap with training programs, according to a report from Kaiser Health News (KHN). States are beginning to require doctors to take continuing medical education courses that detail how marijuana interacts with the nervous system and other medications, as well as its adverse effects.

Although laws vary, they have common themes, KHN notes. They usually set up a process by which states establish marijuana dispensaries, where patients with qualifying medical conditions can obtain the drug. The conditions are specified on a state-approved list, and the role of doctors is often to certify that patients have one of those ailments. But many say that, without knowing cannabis’ health effects, even writing a certification makes them uncomfortable.

This medical uncertainty is complicated by confusion over how to navigate often- contradictory laws. While states generally involve physicians in the process by which patients obtain marijuana, national drug policies have traditionally had a chilling effect on these conversations.

The Federation of State Medical Boards has tried to add clarity. In an August 9 JAMA editorial, leaders noted that federal law technically prohibits prescribing marijuana, and tasks states that allow it for medical use to “implement strong and effective … enforcement systems to address any threat those laws could pose to public safety, public health, and other interests.” If state regulation is deemed insufficient, the federal government can step in.

That’s why many doctors say they feel caught in the middle, not completely sure of where the line is drawn between legal medical practice and what could get them in trouble, according to the KHN article.

In New York, which legalized marijuana for medicinal purposes in 2014, the state health department rolled out a certification program last October. (The state’s medical marijuana program was launched in January 2016.) The course, which lasts approximately four hours and costs $249, is part of a larger physician registration process. So far, the state estimates that 656 physicians have completed the required steps. Other states have contacted New York’s Department of Health to learn how the training works.

Pennsylvania and Ohio are developing similar programs. Meanwhile, in Massachusetts, doctors who wish to participate in the state medical marijuana program are required to take courses approved by the American Medical Association. Maryland doesn’t require training but encourages it through its Medical Cannabis Commission website––a policy also followed in some other states.

Physicians appear to welcome such direction, KHN says. A 2013 study in Colorado, for instance, found that more than 80% of family doctors thought physicians needed medical training before recommending marijuana.

Education is essential, given the complexity of how marijuana interacts with the body and how little physicians know, said Dr. Stephen Corn, an associate professor of anesthesiology and pain medicine at Harvard Medical School.

“You need a multihour course to learn where the medical cannabis works within the body,” Corn said. “As a patient, would you want a doctor blindly recommending something without knowing how it’s going to interact with your other medications? What to expect from it? What not to expect?”

But many say the current science is too weak to answer those questions, according to the KHN article. One reason: the federal Drug Enforcement Agency classifies marijuana as a schedule I drug, the same level as heroin. This classification makes it difficult for researchers to gain access to the drug and to obtain approval for human subjects to participate in studies. The White House rejected a petition last week to reclassify marijuana in a less-strict category, although federal authorities say they will start letting more facilities grow the plants for the purpose of research. (Currently, only the University of Mississippi can produce it, which advocates say limits study efforts.)

Source: Kaiser Health News; August 15, 2016.