What doctors should know about the latest cannabis trends

By Jules Murtha | Fact-checked by Barbara Bekiesz
Published August 10, 2022

Key Takeaways

  • According to research, medical and recreational cannabis use is more prevalent as it becomes increasingly legalized in the US.

  • The most common patient-reported qualifying condition for medical cannabis in 2020 was chronic pain, followed by post-traumatic stress disorder.

  • Primary care physicians who are new to medical cannabis may benefit from familiarization with its uses, risks, and adverse events.

Cannabis use is rising among the US population, in synch with growing rates of legalization across the country. Clinicians, in turn, may encounter a growing number of patients who want to know more about the once-taboo drug and its uses.

Findings from recent studies detail emerging trends related to cannabis use that could inform clinical policies moving forward. Regardless of current legislation surrounding cannabis, doctors can empower themselves by getting to know what it has to offer (as well as the risks it poses) to patients.

Patient-reported qualifying conditions

As medical cannabis grows in popularity, current research seeks to clarify who is using it, where they’re using it, and their reasons for doing so.

The Annals of Internal Medicine published a 2022 observational study that looks at the latest medical cannabis trends in applicable states.[] To obtain this information, researchers used data from 2016–2020 state reports and data requests on medical cannabis licensure.

In 2020, 26 states and Washington, DC, reported numbers pertaining to patient use. Of those states, 19 provided patient-reported qualifying conditions. The 2020 numbers showed a significant spike in patient enrollment at 2,974,433—a 4.5-fold increase from 678,408 in 2016.

Data also showed that patient enrollment increased in medical-only states, while the opposite occurred in recreational states over the 4-year period.

Regarding 2020 use trends, 60.6% of patients reported chronic pain as their reason for using medical cannabis, making it the most popular patient-reported qualifying condition. Second most common was post-traumatic stress disorder (PTSD), reported by 10.6% of patients.

Interestingly, the proportion of patient-reported qualifying conditions for which there was substantial evidence of cannabis’s therapeutic value decreased during the time of the study. The percentages were 84.6% for 2016 and 68.2% for 2020.

These findings may influence future cannabis policy. But for now, regardless of the legislature, you may want to know the answers to cannabis-related-FAQs.

The basics on medical cannabis

If you’re a primary care physician in a state where medical cannabis is legal, you may be fielding more and more cannabis-related inquiries from patients.

An article published by the Journal of Primary Care and Community Health suggested it’s important that primary care physicians understand the basic pharmacology of cannabis.[]

Cannabis refers to a family of plants with marijuana features, primarily Cannabis sativa, Cannabis indica, and hemp. These plants produce over 100 cannabinoids and terpenes, of which Δ9-tetrahydrocannabinol (THC) and cannabidiol (CBD) are among the most well-studied.

Cannabis products are endogenous to the plants or can be synthesized. Patients can ingest, smoke, and vape them. Topical and oromucosal products are also available.

According to the authors, the route of administration of medical cannabis determines its clinical effects.

"Peak THC blood levels are reached within 30 minutes and subside within 1 to 3.5 hours when cannabis is smoked."

Slawek, et al.

“In contrast, peak THC levels are reached within 30 minutes to 2 hours when ingested and can last 5 to 8 hours,” they explain. “Sublingual and oromucosal THC and CBD avoid first-pass metabolism in the liver, but peak serum THC and CBD concentrations are reached 1 to 8 hours after administration.”

Patients may use cannabis to manage a number of symptoms. As noted in a 2022 study published by JAMA Network Open, evidence suggests that cannabis may be used to help patients with neuropathic pain, appetite struggles, nausea and vomiting, spasticity, and sleeping issues, among other symptoms.[]

Potential risks

Along with its benefits, however, doctors may also want to know the risks associated with cannabis.

Cannabis use disorder (CUD), for example, is a disorder characterized by “use leading to negative social, occupational, psychological, and physical consequences,” according to the Journal of Primary Care & Community Health article. All patients who use cannabis may be subject to screenings for CUD.

Finally, you may want to monitor your patients and taper existing medications they may be taking for anxiety or pain, to prevent harmful drug interactions if they’re also using cannabis.

What this means for you

More individuals are using cannabis both medicinally and recreationally as a result of recent policy changes in the US. Chronic pain, followed by PTSD, are the most common conditions for which patients seek—and quality for—use of medical cannabis. Cannabis can also help patients manage a range of symptoms, including stress, anxiety, and sleep issues. Physicians may want to become familiar with the uses and risks of medical cannabis as more patients explore its medicinal properties.

Read Next: The link between mood disorders and cannabis use disorder in families
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