By DOUGLAS BRUCE, PhD
On January 1, 2020, recreational cannabis use became legal in Illinois. More than 80,000 people in Illinois are registered in the state’s medical cannabis program. Surprisingly, many of their doctors don’t know how to talk with them about their medical cannabis use.
As a health sciences researcher, I have a recommendation that is both practical and profound: Physicians can learn first-hand from their own patients how and why they use medical cannabis, and the legalization of recreational cannabis may make them more comfortable discussing its usage overall.
Nationwide, physicians too rarely discuss cannabis use with their patients living with chronic conditions, such as chronic pain, cancer, multiple sclerosis, epilepsy, fibromyalgia, and Crohn’s disease—all conditions with symptoms that evidence shows cannabis may effectively treat. Why don’t physicians talk with their patients about cannabis use? Research from states with longer histories of legalized medical cannabis shows that many physicians do not communicate with patients regarding their medical cannabis use for a variety of reasons.
First, physicians aren’t well trained in cannabis’ medical applications. Unlike the endocrine or cardiovascular systems, the endocannabinoid system—comprised of receptors which bond with the compounds THC and CBD found in cannabis—is not taught in medical school.
Second, federal drug policy classifying cannabis as a Schedule I substance has severely limited the degree to which it can be investigated in clinical trials involving patients in the U.S., so clinical trial data on cannabis products is scant.
Third, because clinical trials largely determine the “evidence base” from which treatment guidelines are generated for new pharmaceutical agents that come to market, existing guidelines for cannabis use within clinical practice are few.
Understandably, then, the lack of treatment guidelines on cannabis products gives many physicians pause when considering medical cannabis as an option for their patients.
In the absence of physician guidance on medical cannabis products, patients often seek out information on their own, turning to websites like Leafly.com, and online patient communities to investigate which products, administration methods, and dosings may help with their particular symptoms. But this process is not optimal, and usually involves patients experimenting with a range of products and dosings before finding a regimen that works for them.
With minimal clinical trial data and no established physician guidelines, observational research based on patient knowledge can fill a gap. My colleagues and I—and other researchers like us—are attempting to do just that. Our research illustrates how persons living with chronic conditions may discontinue prescription medications and use cannabis as an alternative due to perceived improved symptom management, longer lasting effects, fewer side effects and toxicities, and less risk of addiction. They may also use cannabis as a complementary therapy to existing pharmaceutical regimens.
A 65-year old woman living with chronic regional pain syndrome told us, “The topical cannabis relieves [pain] in a way that none of the narcotic medications do – and I was given a topical narcotic, too, two years ago that helped a little but not like this does. This is a dramatic and very quick release.” Patients describe using cannabis to address multiple symptoms that may mutually reinforce one another, such as pain, anxiety, and insomnia. A 33-year old woman living with multiple sclerosis told us, “Cannabis is very helpful in managing my sleep. And it also helps with my neuropathy, and my spasticity. Specifically to MS, the pain can be so unbearable that I cannot sleep. So the cannabis really does help ease the pain, and helps me go to sleep…. The previous medicine made me feel like a zombie.”
Indeed, results from our 2017 survey of medical cannabis users in Illinois show persons with such co-occurring symptoms rate the efficacy of cannabis to multiple symptoms as higher than persons only intending to treat a single symptom.
This is data physicians need to know. Until the federal prohibition on research on medical cannabis in the U.S is lifted, patient-centered perspectives on medical cannabis utilization and outcomes can inform policy and public views.
With the rollout of recreational cannabis use in Illinois, physicians have a unique opportunity to change a pattern. Although cannabis remains illegal at the federal level, new state laws may remove some of the stigma that keeps cannabis from being discussed openly in patient-physician conversations. Physicians can listen to their patients’ experiences. They can learn from patients about alternative strategies for symptoms management. They can broaden their understanding of opportunities to effectively manage chronic conditions and be less reliant on prescriptions medications with higher toxicities and risks for addiction.
Ultimately, they can learn from their patients and break the silence in medical culture that has shrouded medical cannabis use for far too long.
Douglas Bruce is Associate Professor and Chair, Department of Health Sciences, DePaul University, Chicago. He is a Public Voices fellow with the OpEd Project.
this could be useful
A summary of the ECS can be found at
I wonder what the natural agonists for these receptors are and what tissues produce these agonists and the physiologic reasons for their existence. In other words, why do we have these receptors?
The science is emerging, but CB1 receptors are found most frequently in the brain and peripheral nervous system whereas CB2 receptors are located chiefly in the immune system. Endocannabinoids are lipids that serve as agonists for the CB receptors, and they appear to play a role in metabolic processes, mood, memory, and brain reward systems. A summary of the ECS can be found at