The educational gap between healthcare professionals and cannabinoid therapeutics is significant.
Despite the discovery of the endocannabinoid system (ECS) in 1988, less than 10% of medical schools include any education on it.1 For example, Guyton’s textbook on Medical Physiology (14th edition) still omits mention of the ECS, even though it plays a crucial role in the body.2 Patients are already using cannabis products, and many know more about cannabinoids than their doctors.
Understanding best practices in cannabinoid therapeutics is essential for patient safety and improved outcomes. Additionally, discussing cannabinoids openly with patients fosters trust and allows for accurate diagnosis and treatment. Educating practitioners on contraindications and risks associated with cannabinoid use can help avoid malpractice concerns. Read on for why DCs need cannabinoid therapy education.
Cannabinoid therapy education: The gap between DCs and cannabinoid therapeutics
Many physicians are unaware of the presence of the second largest regulatory system in the body called the endocannabinoid system. The endocannabinoid system was first identified back in 1988 with the discovery of the CB1 cannabinoid receptor. This discovery established the endocannabinoid system within the body yet less than 10% of medical schools include any type of education on the endocannabinoid system.1
A great example the omission of the endocannabinoid system in the 14th edition of Guyton’s medical physiology textbook that was updated as recently as 2020.2 They still chose not to include mention of the endocannabinoid system despite its discovery back in 1988. The circadian clock even made it into the book, but the endocannabinoid system did not. This all contributes to the educational gap between healthcare professionals and cannabinoid therapeutics. Understanding the basics of cannabinoid therapeutics is the first step in bridging that educational gap.
Patients are already using cannabis products whether physicians agree or endorse their use
Patients are already exploring the benefits of cannabinoid therapeutics and they are not asking for your endorsement or recommendation. It highlights the need for the doctors to pursue cannabinoid therapy education so they understand cannabinoid basics to recognize red flags, drug-drug interactions and/or contraindications of use. In Florida for instance, there are nearly 900K medical marijuana patients exploring cannabinoid therapeutics.3 As of 2022, 26% of Americans were using CBD products, and that number has gone up dramatically since then.4
What that means is many patients are coming into chiropractic offices likely knowing more about the endocannabinoid system, including how it interacts with CBD, THC and the other cannabinoids. Although they could know more about cannabinoids than their doctors, their information is not always accurate. Understanding best practices in cannabinoid therapeutics could provide a trusted resource for patient safety with improved outcomes in one of America’s fastest-growing healthcare trends.
Enhanced doctor-patient interaction
When the physician is comfortable talking to their patients about cannabinoids, it opens dialogue between doctors and patients with less cannabis stigma. Being comfortable confiding cannabis use to the doctor establishes a relationship of trust that could lead to more accurate diagnosis/treatment. For example, if a patient mentioned feeling “woozy when standing up,” it could be an upper cervical condition, a vascular issue or even a neurological condition. Knowing that the “woozy symptoms” typically occur after THC use would be helpful in ruling out more complicated conditions. It provides a more accurate treatment plan as well as prognosis. It also allows for monitoring of potential risks, contraindications or any other red flags associated with patient cannabinoid use.
Cannabinoid therapy education diminishes malpractice concerns
The threat of malpractice lawsuits is another reason for needing cannabinoid therapy education because it could help avoid liability pitfalls. This is especially true in multidiscipline chiropractic offices where there could be drug-drug interactions that the practitioner should make the patient aware of (if the patient feels comfortable enough to disclose cannabinoid use). There are also certain delivery methods, which are contraindicated for particular patients. One example is patients with COPD should not inhale cannabis. Recognizing and educating on contraindication of use when the patient discloses an inappropriate delivery method should be documented and risks discussed. It is unlikely most DCs could recognize red flags or even know what they are in the first place, much less understand how to accurately document them to minimize liability risks.
Help navigate product selection
Lastly, cannabinoid therapy education for DCs could help navigate product selection because choosing the wrong product to sell in the office could end up costing the doctor more than just lost profits. Moreover, there are distinct parameters DCs must stay within to remain compliant federally as well as at the state level.
For example, there are advertising parameters, such as avoiding the use of false medical claims and avoiding packaging that appeals to children. There are product selection guidelines to ensure compliance, such as having a QR code on the label of any product containing CBD in it. In addition, regarding product selection, due diligence is required when vetting the products to ensure the federal THC threshold of <0.3% (dry weight) or else it is federally illegal.
The evolving legal landscape surrounding cannabinoids could significantly impact ethical considerations. Legalities of the alternate cannabinoids, also known as “delta cannabinoids,” are determined by each state and the legal status could change via state legislation. Some states allow them. Others outlaw them. It requires DCs to adhere to their own state law. Therefore, even if practicing in a “legal state” for alternate cannabinoids, the alternate cannabinoid market is less regulated than the CBD market and has the least evidence-based research available for its efficacy. Those ethical gray areas should be considered when discussing the appropriateness of their use and inclusion in the recommended chiropractic treatment plan.
Final thoughts on cannabinoid therapy education
Ensuring you have a reliable source for cannabinoid therapy education is crucial to prevent costly errors in the future. As regulations change and new information emerges, staying informed ensures safe and effective practices.
MISTY GREEN, DC, MS, is a cannabis educator for physicians after completing the first graduate-level cannabis program in the country, obtaining her master’s degree in medical cannabis science and therapeutics through the University of Maryland, School of Pharmacy. She has combined her decades of clinical practice with her fascination with all things cannabis to pivot into the cannabis space, helping bridge the gap between healthcare workers and much-needed cannabis education through lectures and cannabis curriculum production. She can be reached at drmistydc@hotmail.com.
References
- Evanoff AB, et al. (2017). Physicians-in-training are not prepared to prescribe medical marijuana. Drug and Alcohol Dependence. 2017;180:151-155. PubMed. https://pubmed.ncbi.nlm.nih.gov/28892720/. Accessed August 14, 2024.
- Hall JE, Hall ME. Guyton and Hall Textbook of Medical Physiology. 14th Edition. Elsevier. June 2020.
- Office of Medical Marijuana Use (OMMU) Weekly Update. August 9, 2024. https://knowthefactsmmj.com/wp-content/uploads/ommu_updates/2024/080924-OMMU-Update.pdf. Accessed August 14, 2024.
- Conway J. (2019a). Annual CBD usage rate in the United States from 2018 to 2024. Statista. https://cfah.org/cbd-statistics/. Accessed August 14, 2024.