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The Void in Clinician Counseling of Cannabis Use


As more states legalize cannabis for medical use, people increasingly use cannabis to treat medical conditions. Well-documented harms of cannabis use include increased risk of fatal auto accidents, neurocognitive deficits, and increased risk of addiction. Observational data supports the use of cannabis for pain, nausea and vomiting related to chemotherapy, and multiple sclerosis spasticity symptoms. Given potential harms versus benefits of cannabis use, how should physicians counsel patients regarding their cannabis use? This paper briefly reviews the evidence supporting medical cannabis use for pain. We consider cannabis use as a harm reduction strategy for pain management. We encourage routine, longitudinal assessments of cannabis use among patients. We discuss the commercialization of cannabis for financial gain, contributing to potent and addictive cannabis. We highlight the concerning phenomena of cannabis dispensary workers as proxy clinicians. Finally, we present three strategies to reduce public harms associated with potent cannabis use including required testing and reporting of tetrahydrocannabinol/cannabidiol concentrations, rigorous study of high-potency cannabis available for purchase in dispensaries across the USA, and large-scale efforts to measure cannabis consumption in medical records so prospective, longitudinal studies can be conducted to correlate consumption measures with medical and psychiatric outcomes.

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Dr. Calcaterra would like to acknowledge Drs. Toby and Mort Mower for their generous support of her research efforts.


Dr. Cunningham is supported by federal grants R01DA032110 and K24DA036955. Dr. Hopfer is supported by federal grants DA032555, DA035804, and DA042755.

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Correspondence to Susan L. Calcaterra MD, MPH, MS.

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Dr. Calcaterra, Dr. Cunningham, and Dr. Hopfer report no conflict of interest.

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Calcaterra, S.L., Cunningham, C.O. & Hopfer, C.J. The Void in Clinician Counseling of Cannabis Use. J GEN INTERN MED (2020).

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