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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Force UPST. Screening and Behavioral Counseling Interventions to Reduce Unhealthy Alcohol Use in Adolescents and Adults: US Preventive Services Task Force Recommendation StatementUSPSTF Recommendation: Screening and Interventions for Unhealthy Alcohol UseUSPSTF Recommendation: Screening and Interventions for Unhealthy Alcohol Use. Jama. 2018;320(18):1899–1909.
Counseling and interventions to prevent tobacco use and tobacco-caused disease in adults and pregnant women: U.S. Preventive Services Task Force reaffirmation recommendation statement. Annals of internal medicine. 2009;150(8):551–555.
Han B, Compton WM, Blanco C, Jones CM. Trends in and correlates of medical marijuana use among adults in the United States. Drug Alcohol Depend 2018;186:120–129.
Aaronson NK, Ahmedzai S, Bergman B, et al. The European Organization for Research and Treatment of Cancer QLQ-C30: a quality-of-life instrument for use in international clinical trials in oncology. JNCI 1993;85(5):365–376.
Pope HG, Jr., Gruber AJ, Hudson JI, Huestis MA, Yurgelun-Todd D. Neuropsychological performance in long-term cannabis users. Arch Gen Psychiatry 2001;58(10):909–915.
Volkow ND, Baler RD, Compton WM, Weiss SRB. Adverse health effects of marijuana use. N Engl J Med 2014;370(23):2219–2227.
Cavazos-Rehg PA, Krauss MJ, Cahn E, et al. Marijuana Promotion Online: an Investigation of Dispensary Practices. Prev Sci 2019;20(2):280–290.
Devinsky O, Cross JH, Laux L, et al. Trial of Cannabidiol for Drug-Resistant Seizures in the Dravet Syndrome. N Engl J Med 2017;376(21):2011–2020.
Devinsky O, Marsh E, Friedman D, et al. Cannabidiol in patients with treatment-resistant epilepsy: an open-label interventional trial. Lancet Neurol 2016;15(3):270–278.
National Academies of Sciences E, Medicine. The health effects of cannabis and cannabinoids: The current state of evidence and recommendations for research. National Academies Press; 2017.
Whiting PF, Wolff RF, Deshpande S, et al. Cannabinoids for medical use: a systematic review and meta-analysis. Jama. 2015;313(24):2456–2473.
Vickers AJ, Cronin AM, Maschino AC, et al. Acupuncture for Chronic Pain: Individual Patient Data Meta-analysis. JAMA Intern Med 2012;172(19):1444–1453.
Bradford AC, Bradford WD, Abraham A, Adams GB. Association between US state medical cannabis laws and opioid prescribing in the Medicare Part D population. JAMA Intern Med 2018;178(5):667–672.
Wen H, Hockenberry JM. Association of medical and adult-use marijuana laws with opioid prescribing for Medicaid enrollees. JAMA Intern Med 2018;178(5):673–679.
Bachhuber MA, Saloner B, Cunningham CO, Barry CL. Medical cannabis laws and opioid analgesic overdose mortality in the United States, 1999-2010. JAMA Intern Med 2014;174(10):1668–1673.
Powell D, Pacula RL, Jacobson M. Do medical marijuana laws reduce addictions and deaths related to pain killers? J Health Econ 2018;58:29–42.
Shover CL, Davis CS, Gordon SC, Humphreys K. Association between medical cannabis laws and opioid overdose mortality has reversed over time. Proc Natl Acad Sci U S A 2019;116(26):12624–12626.
Bachhuber MA, Arnsten JH, Cunningham CO, Sohler N. Does Medical Cannabis Use Increase or Decrease the Use of Opioid Analgesics and Other Prescription Drugs? J Addict Med 2018;12(4):259–261.
Livne O, Shmulewitz D, Lev-Ran S, Hasin DS. DSM-5 cannabis withdrawal syndrome: Demographic and clinical correlates in U.S. adults. Drug Alcohol Depend 2019;195:170–177.
Compton WM, Han B, Jones CM, Blanco C. Cannabis use disorders among adults in the United States during a time of increasing use of cannabis. Drug Alcohol Depend 2019;204:107468.
ElSohly MA, Mehmedic Z, Foster S, Gon C, Chandra S, Church JC. Changes in Cannabis Potency Over the Last 2 Decades (1995-2014): Analysis of Current Data in the United States. Biol Psychiatry 2016;79(7):613–619.
Di Forti M, Quattrone D, Freeman TP, et al. The contribution of cannabis use to variation in the incidence of psychotic disorder across Europe (EU-GEI): a multicentre case-control study. Lancet Psychiatry 2019;6(5):427–436.
Dickson B, Mansfield C, Guiahi M, et al. Recommendations From Cannabis Dispensaries About First-Trimester Cannabis Use. Obstet Gynecol 2018;131(6):1031–1038.
Metz TD, Allshouse AA, Hogue CJ, et al. Maternal marijuana use, adverse pregnancy outcomes, and neonatal morbidity. Am J Obstet Gynecol. 2017;217(4):478.e471–478.e478.
Monte AA, Shelton SK, Mills E, et al. Acute Illness Associated With Cannabis Use, by Route of Exposure: An Observational Study. Ann Intern Med 2019;170(8):531–537.
Adamson SJ, Kay-Lambkin FJ, Baker AL, et al. An improved brief measure of cannabis misuse: the Cannabis Use Disorders Identification Test-Revised (CUDIT-R). Drug Alcohol Depend 2010;110(1–2):137–143.
Dr. Calcaterra would like to acknowledge Drs. Toby and Mort Mower for their generous support of her research efforts.
Conflict of Interest
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). https://doi.org/10.1007/s11606-019-05612-4