As medical cannabis becomes more integrated into healthcare, it’s essential for providers to understand how to navigate its therapeutic uses, legal complexities, and potential benefits (and risks) for patients. From the different cannabinoids and strains to state regulations and patient education, there’s a vast amount of information healthcare professionals need to know to prescribe it responsibly.
The more providers understand about medical cannabis, the more likely they can ensure safe and informed treatment plans. Read on for an in-depth introduction to the intricacies of medical cannabis and the importance of patient education.
Medical cannabis refers to the use of the cannabis plant for therapeutic purposes — specifically, its active chemical compounds, known as cannabinoids. “Cannabis” is the name of the flower from which the drug marijuana is derived.
In a medical context, cannabis is used to help manage a variety of conditions and symptoms, including chronic pain, epilepsy, chemotherapy side effects, and anxiety. It can be administered in several forms, which offers flexibility to suit varying patient needs and preferences. Methods and formats include oils, tinctures, capsules, edibles, topical creams, and through inhalation. Each method carries different absorption rates and durations, which enables healthcare providers to tailor treatment to individual patient requirements.
Research into medical cannabis is ongoing, and regulations governing its usage are changing constantly. It also carries significant stigma due to its association with recreational drug use; as such, many healthcare providers and patients alike campaign for expanded education and legislation regarding its medical applications.
Cannabinoids are naturally occurring compounds found in the cannabis plant. They interact with the body’s endocannabinoid system (ECS), which plays a key role in regulating physiological processes like mood, pain, appetite, and immune response. While they are most commonly associated with cannabis, cannabinoids can also be synthetically produced or found in other plants, including echinacea, liverwort, and some fungi. Medical cannabis contains over 100 cannabinoids, with THC (tetrahydrocannabinol) and CBD (cannabidiol) being the most studied.
THC is the psychoactive compound responsible for the “high” associated with recreational cannabis use. In healthcare, it is primarily known for its pain-relieving and anti-nausea properties. CBD, on the other hand, is non-psychoactive and widely studied for its anti-inflammatory, anti-anxiety, and seizure-reducing effects.
Other, less-well-known cannabinoids such as CBN (cannabinol) show sedative properties and potential in sleep disorder treatment, while CBG (cannabigerol) has antibacterial properties and is being researched for neuroprotective applications.
Medical cannabis is legal in many U.S. states, but it remains illegal at the federal level. Cannabis is classified as a Schedule I controlled substance by the Controlled Substances Act (CSA), meaning it is considered to have a high potential for abuse and no accepted medical use. However, the federal government has largely taken a hands-off approach to states that have legalized and currently regulate medical cannabis programs, following the guidelines of the 2013 Cole Memorandum (which has since been rescinded, but still informs state-level enforcement).
Currently, medical cannabis is legal in 47 states, the District of Columbia, and three U.S. territories (Guam, Puerto Rico, U.S. Virgin Islands). Each state operates its own medical cannabis program, which includes rules on qualifying conditions, patient registration, and product access. While qualifying conditions vary, common examples approved for cannabis treatment therapies include chronic pain, epilepsy, cancer, and multiple sclerosis.
Although the federal government does not generally prosecute state-regulated medical cannabis activities, federal authorities could, in theory, still prosecute healthcare providers who prescribe or recommend it. Prescribing cannabis could also potentially jeopardize a provider’s medical license if they work in a federally funded institution like a Veterans’ Affairs (VA) hospital.
In 2018, the Farm Bill legalized hemp-derived products containing less than 0.3% THC, allowing some forms of CBD to be used medically, even under federal law.
The Food and Drug Administration (FDA), a federal agency, approves the use of cannabis for a handful of chronic or terminal conditions. Traditional treatments for these conditions tend to be detrimental to patient well-being, so cannabis is often introduced as a less disruptive alternative.
Pain management
Medical cannabis has proven effective for chronic pain, neuropathic pain, and pain associated with conditions such as arthritis, multiple sclerosis, and fibromyalgia. The use of cannabis in this context has been supported by the National Academies of Sciences, Engineering, and Medicine (NASEM).
Neurological disorders
Cannabis is an FDA-approved treatment for epilepsy (especially in resistant forms like Dravet Syndrome) via the CBD-based drug Epidiolex. Although not officially approved (but widely accepted), cannabis also shows promise in treating Parkinson’s Disease, Alzheimer’s Disease, and multiple sclerosis symptoms such as spasticity and tremors.
Cancer
Though cannabis is not approved for direct cancer treatment, it is used as an adjunct treatment for cancer-related symptoms, including nausea, vomiting, and appetite stimulation during chemotherapy.
Cannabis is not a federally-approved treatment for most medical conditions; however, many patients and medical professionals have used or prescribed medical cannabis to positive effect.
Inflammatory and autoimmune diseases
The anti-inflammatory effects of cannabis can help mitigate the symptoms of conditions such as Crohn’s disease, ulcerative colitis, and rheumatoid arthritis.
Sleep disorders
Cannabis, especially CBN and THC, can assist in improving insomnia and sleep apnea due to its sedative properties.
Glaucoma
Cannabis has historically been used to lower intraocular pressure — the pressure of fluid inside the eye — though other glaucoma treatments are more effective.
There are no official approvals for cannabis as a direct cancer treatment, though THC and CBD show potential anti-tumor effects in preclinical studies.
Mental health disorders
CBD is currently being researched for treatment of anxiety, PTSD, and depression; however, THC is discouraged for mental health treatment due to its (potentially damaging) psychoactive effects.
One major benefit of medical cannabis is its wide range of administration methods. Patients seeking cannabis-based treatments are often able to choose a method that best suits their needs or preferences.
Inhalation
The cannabis flower is smoked or vaporized, delivering cannabinoids directly to the lungs. The effects materialize very quickly, within one to five minutes, though they only last about two to four hours. Inhalation is recommended for immediate relief of symptoms such as pain or nausea. Since smoking is associated with respiratory risks due to carcinogens, vaporization is generally recommended as the safer method.
Oral
Cannabis can be ingested through food, capsules, or liquid drops (tinctures) added to beverages or placed under the tongue. Digestion causes a delayed release, meaning that the patient may not feel the effects until 30 minutes (or up to two hours) following administration. The effects last much longer, up to eight hours or more, which makes this method suitable for long-term relief of pain or insomnia. However, it is difficult to dose oral forms of medical cannabis, and the effects may vary greatly based on metabolism.
Sublingual
Liquid cannabis extract (usually in an oil- or alcohol-based tincture or spray) is placed under the tongue for absorption. The onset takes only 15 to 30 minutes, with the effects lasting for four to six hours. Sublingual administration is ideal for patients who need faster relief, but who prefer not to smoke or vaporize. It is also easier to dose than edibles.
Topical
Cannabis-infused creams, balms, or transdermal patches can be applied to the skin to achieve localized relief within 15 to 60 minutes. Topical applications can treat localized pain, inflammation, and skin conditions for several hours at a time and are easy to re-apply. This method does not produce psychoactive effects, as cannabinoids typically don’t enter the bloodstream.
Suppositories
Cannabis-infused suppositories can be inserted into the rectum or vagina for fast absorption, taking about 10 to 20 minutes to produce results that can last for four to eight hours. This method is intended for patients who cannot tolerate oral or inhaled treatments. Suppositories are often prescribed for more localized issues or to patients seeking non-psychoactive relief.
Transdermal patches
Patches infused with cannabinoids are applied to the skin for slow, controlled release of cannabinoids into the bloodstream. The slow onset (one to two hours) yields long-lasting effects, up to 12 hours or more. Patches provide sustained relief and consistent dosing for chronic conditions such as pain and inflammation, and are an ideal alternative to oral methods.
Since there are so many methods of administration for medical cannabis, healthcare providers must carefully assess their patients’ specific needs, preferences, tolerance level, and medical history to determine which method is most appropriate.
Provider should carefully consider the following:
With each passing year, researchers uncover more medical applications for cannabis, so the list of benefits is ever-growing. Though cannabis may not be legally approved to treat the majority of conditions or symptoms, research shows that it delivers a growing list of positive medical outcomes:
When administered properly, medical cannabis generally has a favorable side effect profile compared to certain traditional medications, with manageable side effects like dry mouth, dizziness, or drowsiness.
That said, patients should be made aware of the potential side effects so they are not caught off guard. Patients using cannabis for the first time should always start with low doses under medical supervision to monitor for adverse reactions, especially with THC-containing products.
Common side effects include:
There are a number of contraindications that may prevent a patient from using medical cannabis; healthcare providers use extra caution when considering cannabis-based medication for these patients, and may decline to prescribe it in favor of alternative treatments.
Medical cannabis remains federally illegal in the United States, despite state-level approval. In order to treat patients responsibly, healthcare providers must be aware of state-specific laws regarding the legality of medical cannabis in their specific region, since laws vary widely across jurisdictions.
Qualifying conditions are not the same from state to state, which can make it extremely confusing for healthcare providers to know whether they are technically allowed to prescribe cannabis for certain conditions. There are also varying reporting requirements between states, making it difficult for regulators to determine the actual number of patients or doctors who currently utilize cannabis as part of a treatment regimen, and whether lawmakers need to develop new regulation to accommodate new use cases.
To stay as compliant as possible, healthcare providers need to stay updated on evolving regulations and guidelines from the FDA, Drug Enforcement Administration (DEA), and other governing bodies. Careful documentation of patient assessments and treatment plans not only help providers understand proper dosing and outcomes, but it can also aid in legal investigations, if necessary. Legal experts and medical cannabis specialists can help healthcare facilities and practitioners navigate the complexities of prescribing cannabis and avoid any regulatory scrutiny.
The last decade or so has seen a massive shift in the public’s perception of cannabis. What was once viewed as an illicit substance with an unsavory reputation is now widely recognized as a natural, less disruptive alternative to many traditional medicines. Still, many patients who encounter medical cannabis for the first time may be skeptical, as its efficacy is still up for debate among clinical researchers.
If a healthcare provider believes that cannabis-based medicine is the best option for a patient’s case, it’s crucial to ensure the patient understands the benefits, side effects, and potential risks — whether they are initially supportive of the idea or not.
As the body of research grows and the perception of medical cannabis continues to evolve, it is critical for healthcare providers to stay informed through proper education and training. Understanding the therapeutic potential, proper administration, and regulatory considerations surrounding cannabis can enhance patient care and safety.
The Cannabis Healthcare & Medicine Certificate, offered by the University of San Diego’s School of Professional and Continuing Education, provides healthcare professionals with the knowledge and skills needed to navigate this emerging field and improve patient outcomes.
Enhance your professional credentials and improve your medical practice in just 24 weeks — explore this unique online certificate today.
Medical cannabis laws vary by state. You’ll need to check your state’s specific regulations, which may include qualifying conditions, patient registration requirements, and how cannabis can be legally accessed. Be sure to stay up to date with both state and federal laws.
Each state has its own list of qualifying conditions, commonly including chronic pain, epilepsy, multiple sclerosis, cancer-related symptoms, and more. Check your state’s medical cannabis program for the full list of approved conditions.
Common side effects include dizziness, dry mouth, increased heart rate, and appetite changes. THC may also cause psychoactive effects like euphoria or anxiety, while CBD is generally well-tolerated with fewer side effects.
Healthcare providers can stay informed through professional organizations, medical journals, and certifications in cannabis medicine. Attending conferences, following regulatory updates, and subscribing to cannabis-focused research publications can also help you stay updated.
Several professional development courses and certifications are available for healthcare providers, including programs offered by universities, such as the Cannabis Healthcare & Medicine Certificate from the University of San Diego.
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