How to talk to your patients about marijuana

Medical and recreational marijuana use is expanding across the country. It’s no surprise, as many patients may find benefits for a variety of health conditions. As a result, the pharmacist’s role is evolving with an increased need for patient counseling and talking to patients about marijuana. 

Whether in dedicated dispensaries or retail and hospital settings, pharmacists may face a situation in which a patient is interested or already using medical marijuana. Some patients may even be using related products, such as CBD oil, which can now be found on some retail pharmacy shelves. Continue reading to learn more about how to talk to patients about medical marijuana.

Understanding the endocannabinoid system

Many pharmacists may be apprehensive about cannabis simply because they don’t know enough about it. Often, pharmacy schools gloss over medical marijuana use, which can lead to a poor understanding of how cannabis is used. In recent years though, with the legalization of medical marijuana, some pharmacy programs have added courses to help students build a better foundation. Continuing education (CE) courses on medical cannabis are also available for pharmacists through different organizations, such as the American Society of Health-System Pharmacists (ASHP). Pharmacists that have some knowledge on this topic can make more informed clinical decisions. 

Marijuana contains over 400 different chemical compounds, such as flavonoids, cannabinoids, and terpenoids. The active components of marijuana are cannabinoids, which have a range of effects on the human body. Through the endocannabinoid system, cannabinoids can affect blood pressure, metabolism, pain control, and other functions of the body. Cannabinoids are believed to work on the cannabinoid receptors (CB1 and CB2 receptors) found throughout the body. 

Educating patients about marijuana

As the research and use of medical cannabis continue to grow, pharmacists can play an important role in educating patients. Pharmacists can help drive patient-centered care with cannabis by being non-judgmental and open-minded. In addition, active listening can be a useful way to get the patient to open up about cannabis use and counsel them accordingly. 

Uses of medical marijuana

Medical marijuana programs may differ by state in the qualifying health conditions that would make a patient eligible to receive treatment. Medical marijuana can be used to help relieve symptoms of various conditions. For example, healthcare providers may prescribe it to help relieve pain, manage nausea and vomiting, or improve appetite. Research suggests that medical marijuana can be prescribed for certain conditions, including:

• Cancer
• Epilepsy
• HIV/AIDS
• Glaucoma
• Crohn’s disease
• Multiple sclerosis
• Inflammatory bowel disease
• Parkinson’s disease
• Chronic pain
• Tourette syndrome
• Anxiety disorders
• Sleep disorders
• Post-traumatic stress disorder (PTSD)

Currently, the FDA has only approved analogs of marijuana for certain conditions. For example, a cannabidiol oral solution is approved to treat Lennox-Gastaut syndrome, Dravet syndrome, and tuberous sclerosis. In addition, dronabinol can help treat anorexia in patients with AIDS-related weight loss, and nabilone is approved to treat nausea and vomiting caused by chemotherapy. 

It is important for patients to use medical marijuana as prescribed by a healthcare provider. After a complete evaluation of the patient, a healthcare provider may prescribe medical marijuana if the benefits outweigh any potential risks. 

Forms and dosage of medical marijuana

Medical marijuana can be administered through different formulations. It is commonly inhaled through smoking or administered orally as an edible. Marijuana is also available topically and sublingually. Dosage forms may include: 

• Lozenges
• Tinctures
• Resin
• Skin patches
• Creams or lotions
• Suppositories
• Sublingual tablets 

Marijuana products can vary in the amount of cannabinoids they contain, which can complicate dosing. For example, CBD products come in certain types, such as full spectrum, broad spectrum, and isolate. Full-spectrum CBD typically contains up to 0.3% THC, while broad-spectrum and isolate products do not contain any THC. 

Because the adoption of medical marijuana is still relatively new, there is also a lack of clinical guidelines that outline the right dosage for patients. When it comes to medical marijuana, patients should be advised to follow their healthcare provider’s instruction, which generally involves starting at a low dose. Patients should then log how they respond to treatment with marijuana, including any adverse effects they experience. 

The onset of effects of smoking marijuana is within minutes. With edibles, however, the onset of action is much longer and more variable. For instance, it could take anywhere from 30 minutes to three hours or more for edibles to start producing effects. Depending on the dosage form prescribed, patients should be counseled on the onset of action and how to administer the dosage form to prevent potential problems or side effects. 

Medical marijuana rules and regulations 

The intricacies surrounding the legal concerns with dispensing marijuana can sway many pharmacists away from dealing with marijuana in their patients. However, pharmacists are an important part of ensuring safe and effective treatment plans for patients who may be using medical marijuana. 

Currently, 37 states permit the use of medical marijuana, including New York, Connecticut, and Florida. Every state may have its own laws in regard to the growing, processing, dispensing, and use of marijuana. They may also have their own medical marijuana programs to authorize prescribing medical marijuana and assist patients who could benefit.

On a federal level, hemp-derived CBD products with 0.3% or less THC content are legal, while products derived from marijuana or those with 0.3% or more THC remain illegal. It’s important for pharmacists to know state rules and regulations to have a clear understanding of how to counsel patients. 

Pharmacists may also be required in dispensaries before medical marijuana can be given to a patient. In New York, a licensed pharmacist is required to be available to educate patients on medical cannabis use. A weed pharmacist (marijuana pharmacist) is a pharmacist that is employed by a dispensary.

Side effects, drug interactions, and other safety concerns

The use of medical cannabis does not come without the risk of side effects and drug interactions. The most common side effects of marijuana include dizziness, dry mouth, nausea, confusion, sedation, and increased heart rate. 

In serious cases, marijuana may cause panic attacks and psychosis. Marijuana has also been associated with new psychosis cases in adolescents. 

For patients with existing lung conditions or breathing problems, an edible form of marijuana may be more appropriate. Patients at risk of lung problems who smoke marijuana are more likely to experience wheezing and cough.

Marijuana is a controlled substance that may carry an increased risk of dependence. Due to its potential habit-forming nature, marijuana should be used under the guidance of a healthcare provider with regular follow-up visits. Discontinuing long-term use of marijuana may lead to withdrawal effects, including restlessness, sleep disturbances, irritability, and changes in appetite. 

Potential drug interactions

CBD and THC are metabolized in the liver by the CYP3A4 and CYP2C9 enzymes. Drugs that act as inhibitors of these enzymes may interact with CBD and THC, increasing the risk of adverse effects. In addition, combining certain drugs, such as CNS depressants, sympathomimetic drugs, and anticholinergics, may lead to side effects that overlap with those of marijuana. It’s important to be aware of potential drug interactions and caution patients to avoid or monitor their use of marijuana while taking certain medications. 

Contraindications

Certain patients are not good candidates for treatment with medical cannabis. These patients may include those with psychotic disorders, heart disease, arrhythmias, uncontrolled hypertension, heart failure, and children. In addition, patients who are pregnant or breastfeeding should avoid the use of medical marijuana. 

Pharmacists and the future of medical marijuana

Pharmacists can make a meaningful impact on the health of patients who use medical marijuana in a number of ways. Knowing the state and federal marijuana laws, understanding the potential uses of marijuana and related products, and assessing potential safety concerns can be useful for counseling patients interested in or using medical marijuana.