Medical Cannabis: A Physician Survey

If you are looking for them, medical marijuana conventions aren’t hard to find. A quick google query turned up a series of, well, smokin’ events all over the country. (Sorry, but tickets to the second annual National Marijuana Business Convention are sold out.)

Marijuana is big business. One report cites the weed as the top cash crop in 12 states and among the top 3 cash crops in 30. A study estimates that marijuana production, at a value of $35.8 billion, exceeds the combined value of corn ($23.3 billion) and wheat ($7.5 billion).

Medical cannabis is now legal in 20 states and in Washington DC.

But what do physicians think about medical cannabis?

Consultantlive recently conducted a survey to find out answers to this and other questions about clinical use of cannabis. We got 528 responses-271 from physicians. The comments and graphs you see here summarize the responses from those physicians.

Our respondents said they practice family medicine (38%); 20% are internists; 10% list themselves as general practitioners; 28% as “other”; and 3% practice psychiatry. About 32% are 51 to 60 years old; 24% are 41 to 50; 19% are 61-70; 14% are 31 to 40; 8% are over 70; and 3% are 20 to 30. A significant majority - 59% - live in a state where medical cannabis is illegal.

What is your opinion of medical marijuana?We got 259 responses. Fifty four (21%) said they would never prescribe medical cannabis; 138 (53%) said they would consider prescribing under some circumstances; and 41 (16%) said they would consider prescribing, but only in pill form.

Here’s a sampling of the some of the widely divergent opinions:

“I would definitely prescribe medical marijuana, without reservation. There are many more prescription drugs that are far more dangerous, habit forming and, without saying, with more deadly and permanent side effects, that I prescribe, than marijuana. It’s tobacco/cigarettes, 'dip' and 'chew' that should be against the law to grow and manufacture.”

“I am in favor of it being totally legal.”

“Hospice patients only and in pill form.”

“I would prescribe, but only if legal at the Federal level.”

“This reminds me of the prohibition era, when alcohol was like cannabis is now, and look what happened: gangsters took over. Is the same going to happen with marijuana?”

“I would prescribe medical marijuana only if it was legal and other forms such as oil or pill. I would only prescribe for certain diseases such as cancer, AIDS, Crohns and other diagnoses that have been shown to improve the outcome of the disease.”

“If it could be dosed, it is a viable option. Without dosing, I'm required to withhold all other controlled substances if it is used.”

“I absolutely would prescribe it! It is a drug, no more so or less than any other prescription drug. I strongly believe it has greater efficacy with far fewer side effects and less risk than many psychotropic medications we use on a daily basis. Could it be abused? Sure, but it is no different than benzodiazepines in that regard.”

“No medical marijuana.”

“Terminal illness distress or pain.”

"Cannabidiol (CBD) is one of at least 85 cannabinoids found in cannabis. It is a major constituent of the plant, second to THC. . . Compared with THC, CBD is non-psychoactive, and is considered to have a wider scope of medical applications, including epilepsy, MS spasms, anxiety disorders, schizophrenia, nausea, convulsion, and inflammation, as well as inhibiting cancer cell growth. CBD may decrease the rate of THC clearance from the body, perhaps by interfering with the metabolism of THC in the liver. Cannabidiol has displayed sedative effects in animal tests. Other research indicates that CBD increases alertness. CBD has been shown to reduce growth of aggressive human breast cancer cells in vitro and to reduce their invasiveness. I am using it on my patients with excellent results.”

For what conditions would you be willing to prescribe medical marijuana?We got 195 answers to this question: responses were fairly consistent. Aside from a few who wrote “none,” these were the most frequent responses.

“Chronic pain, some mental health disorders, insomnia, glaucoma”

“Extreme nausea unresponsive to traditional treatments, chemotherapy adjunct, chronic or terminal illness pain unresponsive to several conventional treatments”

“Pain management; Anxiety”

“Cancer, malnutrition secondary to a disease”

“MS, chronic pain, lupus, and then only if the patient followed up with a specialist”

“Pediatric muscular dystrophy and pediatric seizure disorders”

If your patient was receiving medical marijuana from another prescriber, would you continue to treat his/his illness?57% said yes; 26% said no- the remainder voted "other" and left comments, among which were these:

“It depends on the circumstances!”
“Only for terminal care.”

“Depends on what the condition is. If it was for chronic pain, probably not.”

“Only if the other prescriber had prescribed for an appropriate reason, followed guidelines, and had done the appropriate work up and monitoring.”

Would you approach medication management differently if your patient was using marijuana illicitly or medically?

Of the 247 who responded, the majority (58%) answered yes. Among the comments:

“I would be more likely to limit the use of narcotics.”

“If used illicitly. I could not account for how much medical marijuana the patient uses; therefore it would be challenging to determine how much benefit the patient is receiving from cannabis.”

“When prescribing medications, all medications (OTC or otherwise), taken by a patient need to be taken into consideration.”

“Alternative medicine and conventional medicine can be made to work symmetrically, in a parallel manner, if they are not in contradiction.”

“If the patient were using it illicitly I would have to fire him/her from my practice.”

“I view recreational use of marijuana as being no better and no worse than using alcohol, cigarettes, or any other recreational drug.”

“It would make me more suspicious of pain medication abuse and I would not increase dosages on request.”

“The state I practice in does not support medical marijuana as of yet. Many of my patients use it illicitly and it has not interfered with other medications. I have personally witnessed little to no negative effect during treatment. Counseling the patient on past use compared to using marijuana medicinally is a concern.”

“Many people are forced to use this medicine ‘illicitly’ due to lack of safe access.

We would like to thank all those who took time to complete this survey.* We would also call your attention to a survey recently conducted by The New England Journal of Medicine in which physicians across various specialties were asked their views about medicinal use of marijuana.¹Reference

1. Adler JN, Colbert JA. Clinical decisions. Medicinal use of marijuana-polling results. N Engl J Med. 2013;368:e30.

*Among those who also completed this survey were 79 nurse practitioners, 35 physician assistants, 22 nurses, and 4 pharmacists. Thanks to all of you.