Cannabis in Healthcare: What Clinicians Must Know

Cannabis consumption has a history of use that goes back thousands of years. Originally noted for use in what is now China in 2800 BCE, its medicinal properties have been lauded by scribes across Asia and Africa for centuries. The first advances in the medical cannabis movement in the modern era can be attributed to Robert Randall and Alice O’Leary Randall in the mid 1970s. Medical cannabis was first legalized in California in 1996, and adult use was first legalized in Colorado and Washington in 2012. Since then, the medical and adult use of cannabis has been legalized in numerous states across the country, with many more states moving to do the same.

People around the world use cannabis to address symptoms from myriad ailments, but research on the plant in the U.S. has been limited by government restrictions. Research is primarily restricted because the Drug Enforcement Administration (DEA) lists cannabis as a Schedule I narcotic, considered by the government as a substance likely to be abused and lacking in any medical value. To study cannabis in the U.S., researchers require permission from the DEA, the Food and Drug Administration (FDA), and the National Institute on Drug Abuse (NIDA). Obtaining permission from these organizations remains difficult. To date, the FDA has approved cannabis plant-derived compounds for treatment of only three rare and severe forms of epilepsy: Dravet syndrome, Lennox-Gastaut syndrome, and tuberous sclerosis complex (TSC).

What We Know About Cannabis

Despite the roadblocks, researchers in the U.S. and abroad have been making progress in recent years. This research demonstrates that the cannabis plant contains over 100 different substances known as cannabinoids. Cannabinoids are the active chemicals in cannabis and are similar to compounds naturally produced in the body (which are called endocannabinoids) that influence pain awareness, movement, memory, appetite, sleep and other functions.

Each cannabinoid is understood to affect the body differently. Delta-9-tetrahydrocannabinol (THC) and cannabidiol (CBD) are the most well known and are the main cannabinoids found in legal cannabis products today. THC is most well known for its psychoactive properties.

The anecdotal reports of how cannabis can improve health or reduce debilitating symptoms from a variety of diseases and ailments are ubiquitous. People report that cannabis helps treat chronic pain, ease multiple sclerosis symptoms, and reduce nausea. It is commonly accepted—and the medical literature supports—that cannabis can help with the following:

More data are slowly emerging, but a massive disconnect exists between healthcare professionals and a working understanding of how cannabis can—and does—work in the context of health and wellness.

Reticence in the Medical Community

Due to the federal prohibition of cannabis and lingering stigma stemming from years of propaganda and misinformation, many healthcare professionals remain wary of discussing cannabis with their patients. Although there is a growing body of scientific information available, it remains somewhat difficult for many to separate cannabis facts from cannabis fiction. Additionally, in many jurisdictions, clinicians can still have their licenses revoked and lose their businesses simply for recommending medical cannabis to patients. This landscape is becoming more difficult for clinicians to navigate as growing numbers of patients seek to discuss cannabis as part of their healthcare regimen.

One aspect of cannabis that doesn’t align particularly well with traditional Western medical pedagogy is that cannabis is a plant, whereas the vast majority of FDA-approved prescription medications are lab-created pharmaceutical compounds (in fact, only two botanical products have been approved by the FDA as prescription drugs). Cannabis in its plant form is complex and does not have standard dosage parameters like pharmaceutical drugs do. There are also many different kinds of cannabis, and each unique cultivar (or strain) consists of a different combination of cannabinoids and terpenes, which can affect the body (and individuals) in very different ways. Because of these complexities and because most medical schools and professional organizations still do not offer cannabis education, this is understandably confusing territory for most healthcare providers to navigate. In fact, many clinicians end up getting much of their information about how cannabis can provide therapeutic assistance from their patients.

Patients have personal experiences they can share with their doctors or nurses that provide insight and data—albeit anecdotal. The patients also relay what they have learned from other sources, like dispensary staff, friends and family, or internet research.

Integrating Cannabis Into Healthcare

With a growing number of Americans seeking information about cannabis from their healthcare providers, cannabis education for clinicians is becoming increasingly important.

Despite the current obstacles for clinicians, there are definite signs that the outlook surrounding cannabis in the healthcare industry is changing. In 2018, the National Council of State Boards of Nursing (NCSBN) acknowledged the need for cannabis education and integration when it issued guidelines for the nursing care of patients using medical cannabis. The evidence-based nursing guidelines represent a significant step forward in understanding the importance of cannabis in healthcare. Still, many nurses remain unsure about how to discuss cannabis with patients or if it is even safe to do so in their company or organization. Confusion around legality and policies continues to block open discourse.

Providers cannot currently prescribe cannabis, but they can—and should—be able to advise patients on its use and how cannabis might impact other aspects of their health, like mental health conditions and drug interactions. While more research and clinical trials are needed so doctors and patients can be thoroughly advised on the safe and effective use of cannabis, there currently exists compelling research and evidence about which clinicians should be aware. And more research is currently underway to further study and confirm the value of medical cannabis for a number of conditions and symptoms, including:

Oncology is one particular field where a great deal of anecdotal evidence exists surrounding the potential benefits of cannabis. Many patients find cannabis helpful when undergoing chemotherapy; they report that it increases appetite, eases nausea, and reduces neuropathic pain. There is also early evidence suggesting cannabis compounds may inhibit the growth of cancerous tumors.

Hospice care is another setting where cannabis is becoming more relevant, with many patients seeking to use cannabis for pain relief because it does not have the debilitating side effects associated with opioids. The use of cannabis in the elderly population is on the rise and shows no sign of slowing down. Providers who are knowledgeable about cannabis are far better equipped to assist patients nearing the end of life in managing their other health issues and using cannabis in a manner that is comfortable for them.

Pediatricians and school nurses would also benefit from cannabis education. It is important that they know what to do if a child has consumed a cannabis edible and is experiencing symptoms. How cannabis might interact with other medications a child has taken is critical knowledge, as well.

Cannabis is also relevant to sleep medicine, with many patients reporting it can help with insomnia and other sleep issues. A substantial percentage of the population suffers from sleep disorders and would benefit from healthcare professionals who are knowledgeable about how cannabis can be integrated into treatment plans.

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Where Clinicians Can Find Cannabis Education

As legal cannabis continues to emerge across the country and stigma slowly subsides, the percentage of patients using cannabis and discussing it openly with their healthcare providers will grow. Practitioners must understand how they can help patients who use cannabis and how to correctly answer questions about cannabis use. As with any education, the institution where providers obtain cannabis health education matters greatly. In order to properly assist—and coach—their patients with their medical cannabis use, healthcare practitioners must learn about the medical science surrounding cannabis as well as the legal and regulatory landscapes.

The Importance of Accreditation

While several cannabis education certificate programs already exist out in the world, they are not offered by accredited institutions. The programs offered at Pacific College of Health and Science are credit-based—meaning they are transferable to other universities—and accredited at the institutional level by the WASC Senior College and University Commission (WSCUC). Pacific College takes advantage of its flexibility to engage with guest lecturers, expand faculty, and focus specifically on clinician education.

Some large state universities are creating cannabis education programs, but none of them are masters level or developed specifically for clinicians. The Pacific College Master of Science in Medical Cannabis Therapeutics program has been designed for healthcare professionals to ensure that graduates can apply foundational cannabis concepts to a clinical setting and feel confident and competent when they meet with cannabis patients. These graduates will play an integral role in bridging the gap between the rapidly expanding industry, evolving legislation, and advancing science.

Are you interested in cannabis in healthcare? Contact Pacific College of Health and Science to learn more about our programs and how we educate tomorrow’s cannabis-literate clinicians.

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