Maryland, home to the FDA, is one of 38 US states, along with three territories and the District of Columbia, that have legalized cannabis for medical purposes. This legal sea change has generated increasing interest in and use of cannabis and cannabis products, yet most health care practitioners and students feel underprepared to counsel patients on medical cannabis, according to a new paper co-authored by a University of Maryland School of Medicine (UMSOM) faculty member and published in JAMA Network Open.
The paper suggests key content that should be incorporated into medical school curricula so that students will have the tools they need to serve patients in a landscape of increasing legal medical cannabis use, according to study co-author David Gorelick, MD, PhD, Clinical Professor of Psychiatry at the Maryland Psychiatric Research Center.
“This paper outlines the core competencies that physicians should possess to deal appropriately with their patients regarding medical cannabis,” Dr. Gorelick said. “The goal is to spur medical schools and residency programs to incorporate these competencies into their curricula.”
When I interviewed Dr. Raphael Mechoulam in the past, and also Dr. Alan Shackelford, both medical cannabis pioneers in their right, they both understood that dosing is key. How to find it may depend on the individual’s response to finely tuned concentrations of CBD and THC and other cannabis active compounds.
The core competencies could also help clinicians address a concurrently increasing amount of legal non-medical cannabis use, Dr. Gorelick added, as 24 states, including Maryland, now allow for adult recreational sale and use of cannabis products.
In collaboration with more than 20 co-authors across 26 institutions, Dr. Gorelick and his colleagues characterized the gap between patient and clinician needs and the current medical school curriculum. They cited past studies showing that only 8 percent of medical school curricula mentioned medical cannabis in the 2015-2016 academic year, and that 66.7 percent of surveyed medical school curriculum deans felt their students graduated without adequate preparation for prescribing medical cannabis.
At the same time, the need for cannabis-informed physicians is increasing as more people are using cannabis with or without medical supervision — UMSOM researchers studying cannabis use among pregnant women found that use increased 170 percent between 2009 and 2016, for instance.
When I asked cancer researchers at Princess Margaret Hospital in Toronto, treating my dad for cancer, and one of the leading cancer clinical hospitals in the world, they were stumped and said I couldn’t access any treatments inside the hospital. The concept was out of bounds.
To better meet the needs of patients and clinicians, the authors assembled 23 clinical and scientific experts with varied backgrounds to achieve a consensus on what medical students need to know about cannabis before entering practice. The process resulted in a recommendation of six core competencies addressing the clinical utility, risks, legal landscape, and scientific evidence around medical cannabis.
The six core competencies are:
- Understand the basics of the endocannabinoid system.
- Describe the main components of the cannabis plant and their biological effects.
- Review the legal and regulatory landscape of cannabis in the US.
- Describe the evidence base for health conditions that are commonly managed with cannabis.
- Understand the potential risks of medical cannabis use.
- Understand basic clinical management with medical cannabis.
”It’s important that medical students be exposed to this information, and we currently provide lectures that cover cannabis fairly robustly in our pre-clerkship curriculum in the first two years of medical school,” said Dr. Joseph Martinez, MD, UMSOM Professor of Emergency Medicine and the school’s Associate Dean for Medical Education and Student Experience.
Students also gain hands-on experience in caring for patients using cannabis, as well as any other medications and illicit substances, after they begin their clinical rotations, he added.
“I’m pleased to say that the UMSOM medical student curriculum appears to incorporate most of the topics recommended in the JAMA Network Open article,” Dr. Gorelick said. “I hope that further progress will be made in including cannabis-related material in the curricula for clinical clerkships and residencies. This will help ensure that future physicians have the knowledge and expertise they need to work with patients who are using or considering using cannabis products.”
