The use of marijuana (cannabis) for medical purposes has been steadily increasing over the past few years and is becoming more widely accepted in the medical community. Polls show the public is largely accepting of marijuana use and research studies indicate that it has potential medical benefit.

Marijuana is a term for the cannabis plant, which contains high levels of tetrahydrocannabinol (THC), a compound that produces the “high” from marijuana. Cannabis plants with lower levels of THC are known as hemp.

So, What’s Legal?
The federal government classifies cannabis as a Schedule I controlled drug and as such, no healthcare practitioner is permitted to prescribe it to patients. As of May 2023, 38 states, plus the District of Columbia, Puerto Rico, Guam, and the Virgin Islands permit the medical use of marijuana. Nine states permit the use of marijuana for specific medical conditions. Three states (Kansas, Nebraska, and North Carolina) have prohibited all marijuana products. 

The Federation of State Medical Boards has a State-by-State Overview of Medical Marijuana Laws that you can review.

Individual state laws vary vastly in many aspects of medical marijuana – the type of healthcare provider that is qualified to recommend medical marijuana and certify patients for its use, illnesses that qualify for use of medical marijuana, how much medical marijuana a person is allowed to possess, continuing education requirements, etc.

Side Effects and Cautions
While medical marijuana may be beneficial for the treatment of many conditions and symptoms, it is not without potential side effects. Some of the most common side effects of marijuana include:

• Changes in blood pressure and increases in heart rate.
• Dizziness or drowsiness.
• Facial flushing.
• A false sense of well-being or a feeling of being “high.”
• Gastrointestinal disturbances.
• Impairment in respiratory function.
• Short-term impairment in learning, memory, and attention. Possible long-term impairment in mental skills with chronic use.
• Tiredness/fatigue.
• Prolonged use can lead to dependence.

Additionally, babies born to mothers who have smoked marijuana are more likely to be born prematurely, be underweight, or need intensive care.

Risk Mitigation for Healthcare Providers
As a healthcare provider discussing the use of medical marijuana with a patient, consider the following risk mitigation strategies before recommending:

1. Know your state laws. Avoid legal and regulatory liability by becoming familiar with and abiding by your state laws regarding medical marijuana.
2. Patient education. Provide patients with accurate and evidence-based information including its effects, potential risks, and potential interactions with other medications or conditions. Advise patients to use THC in moderation and avoid excessive or prolonged use. Educate patients about the impairing effects of THC on cognitive and motor functions. Advise against driving or operating heavy machinery while under the influence of TCH.
3. Dosage and administration. Different individuals may have different sensitivities, so it is important to find the optimal dosage for each patient. Advise patients to start with low doses and gradually increase if needed.
4. Medical history review. Thoroughly assess a patient’s medical history, including any existing medical conditions or medications they may be taking. THC may interact with certain medications or exacerbate certain conditions.
5. Patient monitoring. Monitor patients who are using medical marijuana regularly to assess the effectiveness of treatment, identify any adverse effects, and make necessary adjustments. Encourage patients to report new or worsening symptoms promptly.
6. Safety. Educate patients about the impairing effects of THC on cognitive and motor functions. Advise against driving or operating heavy machinery while under the influence of TCH. Also educate patients about the importance of storing THC products securely and out of the reach of children. THC-infused edibles can resemble regular food items, so extra caution is needed to prevent accidental ingestion by children.

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Sources:

• Centers for Disease Control and Prevention. CBD: What you Need to Know. CBD: What You Need to Know (cdc.gov)
• Harvard Health Publishing. Cannabidiol (CBD): What we know and what we don’t. September 24, 2021. Cannabidiol (CBD): What we know and what we don't - Harvard Health
• U.S. Food and Drug Administration. What You Need to Know (And What We’re Working to Find Out) About Products Containing Cannabis or Cannabis-derived Compounds, Including CBD. What You Need to Know (And What We’re Working to Find Out) About Products Containing Cannabis or Cannabis-derived Compounds, Including CBD | FDA
• National Conference of State Legislatures. State Medical Cannabis Laws. State Medical Cannabis Laws (ncsl.org)
• Federation of State Medical Boards. Medical Marijuana State-by-State Overview. medical-marijuana-requirements-by-state.pdf (fsmb.org)

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