Thanks to federal prohibition, new doctors are entering the field with almost no education on how to talk to their patients about cannabis use.
Despite the fact that 29 states and the District of Columbia have some sort of medical marijuana program — with a variety of qualifying conditions including chronic pain, post-traumatic stress disorder, ALS, MS, anxiety, epilepsy, arthritis and more — it can still be difficult in several areas to get a doctor to prescribe the plant.
Nearly three-quarters of medical professionals support medicinal cannabis (at least for certain illnesses), yet many are still uneducated about the potential benefits. But newer doctors and medical school students should almost certainly be learning more about prescribing medical cannabis, right? According to a recent study published in Drug and Alcohol Dependence, they aren’t.
Researchers at the University of Washington in St. Louis sent surveys to 172 medical schools and received over 100 replies from medical school curriculum deans. Two-thirds of respondents stated that their graduates were not prepared to prescribe medical marijuana. A quarter of deans said their trainees weren’t even equipped to answer questions about medical marijuana.
The students themselves were even less confident in their abilities. Around 250 medical residents and fellows at Washington University School of Medicine were also surveyed as part of the study, with the vast majority of respondents (89.5 percent) reporting they felt they weren’t prepared to prescribe cannabis. More than 35 percent reported that they felt not at all prepared to answer patients’ questions.
“As a future physician, it worries me,” said Anastasia B. Evanoff, lead author of the study and a third-year medical student, in a statement.
“We need to know how to answer questions about medical marijuana’s risks and benefits,” said Evanoff, “but there is a fundamental mismatch between state laws involving marijuana and the education physicians-in-training receive at medical schools throughout the country.”
One of the major roadblocks to medical cannabis curriculum is the lack of peer-reviewed data on the subject, due to marijuana’s federal status as a Schedule I narcotic. Additionally, current research is often anecdotal and/or contradicting, making it even more difficult to develop courses around the subject.
“You address the controversy,” added co-investigator Carolyn Dufault, PhD, assistant dean for education at Washington University and an instructor in medicine, in the statement. “You say, ‘This is what we know,’ and you guide students to the points of controversy. You also point out where there may be research opportunities.”
The research team argues that as more and more states legalize cannabis, it is vital that doctors are able to at least discuss the medicine with their patients.
“Medical education needs to catch up to marijuana legislation,” said senior author Laura Jean Bierut, MD, the Alumni Endowed Professor of Psychiatry at Washington University and a member of the National Advisory Council on Drug Abuse. “Physicians in training need to know the benefits and drawbacks associated with medical marijuana so they know when or if, and to whom, to prescribe the drug.”
Medical schools might also be discouraged from educating their students for fear of federal government punishment. Because of the Controlled Substances Act, universities can lose federal funding if they allow for the use or study of cannabis on campus. But this regulation does not prohibit schools from simply examining the research that has already been conducted, or teaching students how to help patients that are already navigating state medical marijuana programs.
Evanoff highlighted the fact that many medical schools have adjusted to the times and have begun to educate their students on the opioid crisis — in stark contrast to marijuana.
“More medical students are now getting better training about opioids, for example,” said Evanoff. “We talk about how those drugs can affect every organ system in the body, and we learn how to discuss the risks and benefits with patients. But if a patient were to ask about medical marijuana, most medical students wouldn’t know what to say.”
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