Full length articlePhysicians-in-training are not prepared to prescribe medical marijuana
Introduction
Medical marijuana has increasingly gained popularity as a treatment for diverse medical conditions including epilepsy, glaucoma, multiple sclerosis, post-traumatic stress disorder, and Crohn’s Disease, as well as an alternative to opioids for treatment of pain (Federation of State Medical Boards, 2016, National Academies of Sciences, Engineering, and Medicine, 2017). Although federal law prohibits physicians from prescribing marijuana because of its classification as a Schedule 1 substance by the U.S. Drug Enforcement Administration, and thus defined as having no currently acceptable medical use and a high potential for abuse, marijuana has been legalized for medicinal purposes in 29 states and the District of Columbia, with additional states poised to make this change (National Academies of Sciences, Engineering, and Medicine, 2017, National Conference of State Legislatures, 2017, U.S. Food and Drug Administration, 2009). In most states where medical marijuana is legalized, medicinal users are required to have documentation from a physician “prescribing” marijuana treatment for their medical condition. Because marijuana is prohibited to be prescribed on the federal level, these “prescriptions” are often called “recommendations” (National Conference of State Legislatures, 2017). We asked whether current training prepares physicians to answer questions and prescribe medical marijuana to their patients.
Section snippets
Measures
We analyzed three data sources: (1) survey of curriculum deans at United States medical schools; (2) survey of residents and fellows at Washington University in St. Louis School of Medicine; and (3) search of medical school curricula through the, Curriculum Inventory.
Dean survey
101 curriculum deans responded to the survey (58.7% response rate), representing 82 allopathic and 19 osteopathic medical schools from 37 states and Puerto Rico. Twenty-five percent of deans reported that their graduates were not at all prepared to answer questions about medical marijuana, while 51.0% felt that their graduates were slightly prepared, and only 24.0% felt their graduates were moderately, very, or extremely prepared to answer questions (Table 1). Furthermore, most deans (66.7%)
Discussion
This study is the first to examine the preparation of physicians-in-training to prescribe medical marijuana. We examined this question through multiple channels − a survey of curriculum deans at U.S. medical schools, a survey of residents and fellows at our institution, and a search of medical school curricula through the Association of American Medical Colleges (AAMC) Curriculum Inventory. All three sources converge on a similar finding: although medical marijuana use is now legal in 29 U.S.
Conclusions
In summary, our study highlights a fundamental and potentially growing mismatch between the legalization of medical marijuana at a state level and the ability of physicians to properly address patients’ questions about medical marijuana or to appropriately prescribe it. This change in policy reflects the increasing evidence of potential positive health effects from medical marijuana. The recent National Academy of Medicine report on “The Health Effects of Cannabis and Cannabinoids” documents
Contributors
LJB, ABE and TQ conceived the study, acquired, analyzed and interpreted the data, and drafted the paper. CD and MA made substantial contributions to the study design and interpretation of data, and they provided critical review of the paper for important intellectual content. All authors approved the final manuscript for publication and have agreed to be accountable for all aspects of the work in ensuring that questions related the accuracy or integrity of any part of it are appropriately
Role of funding source
This work was supported by the Washington University Institute of Clinical and Translational Sciences grant UL1TR000448 from the National Center for Advancing Translational Sciences (NCATS) of the National Institutes of Health (NIH). The content is solely the responsibility of the authors and does not necessarily represent the official view of the NIH.
Conflicts of interest
No conflicts declared.
Acknowledgements
The authors would like to acknowledge Sherri Fisher for her work in preparing the surveys for Institutional Review Board approval. They would also like to acknowledge Dr. Rebecca McAlister, the Associate Dean for Graduate Medical Education at Washington University in St. Louis, for her help with surveying the residents and fellows, and the Office of the Associate Dean for Graduate Medical Education for their hard work implementing the survey.
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Colorado medical students’ attitudes and beliefs about marijuana
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(2017) Model Guidelines for the Recommendation of Marijuana in Patient Care
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