Medical cannabis patients may not receive consistent guidance from clinicians, analysis shows

Medical cannabis patients may not receive consistent guidance from clinicians, analysis shows

Due to a lack of publicly available data, understanding which products medical cannabis patients use for various conditions has come primarily from survey responses. In a new study, researchers at the USC Schaeffer Center created a clearer picture by analyzing point-of-sale data from nearly 17,000 patients who made more than 80,000 purchases through New York State's medical cannabis program.

Researchers found significant variation in products selected for most conditions and high variability in reported THC doses.

Although the medical cannabis market is not new, there is still relatively little research into patient purchasing behavior. Unfortunately, our analysis suggests that patients may not receive consistent guidance from physicians and pharmacists, and clear clinical data on appropriate dosing appears to be lacking in many disease areas.”

Alexandra Kritikos, postdoctoral researcher at the USC Schaeffer Center and the USC Institute for Addiction Science

The findings, published in JAMA Network Open, are based on purchases made between 2016 and 2019, when cannabis flower and edibles could not be sold on the medical market. Cannabis cardholders could purchase vape cartridges and pens, capsules and tablets, tinctures, lotions and suppositories.

Medical cannabis users purchase a range of products with varying potencies

Since its inception in 2014, New York's medical cannabis program has grown to 150,000 participants, making it one of the largest in the United States.

Using data from an integrated single system of pharmacies, researchers found that the three most common conditions patients listed on their medical charts were chronic pain (52%), neuropathy (22%) and cancer (13%). In addition to a qualifying condition, patients also needed a qualifying symptom to enroll. The most common qualifying symptoms were severe pain (82%), severe muscle cramps (21%), and severe nausea (8%).

Vaporizers were the most popular product purchased (40%), followed by tinctures (38%) and tablets (22%). In terms of effectiveness, most products purchased (52%) were high THC and low CBD products. High THC products contained between 2 and 10 mg of THC per dose, depending on the product.

Given this variation, patients likely favored different dosages when choosing different products. For example, 41% of chronic pain patients preferred a high THC vaporizer that delivered 2 mg THC/0.1 mg CBD per dose, while 33% of chronic pain patients chose tinctures and 25% chose tablets that both delivered 10 mg THC per dose. Another quarter of chronic pain patients chose a product containing 5 mg of both THC and CBD.

In contrast, the majority of patients suffering from cancer, HIV/AIDS and epilepsy purchased the same product, suggesting similar dosage.

Physicians need to take a more active role with patients using medical cannabis products

Previous research found that electronic medical records often underreport the number of medical cannabis users. Combined with the results of the Schaeffer Center's new study, researchers suggest improving medical guidance and monitoring of dosage.

“We suspect that the lack of clinical guidelines on cannabinoid dosing for certain medical conditions has made physicians uncomfortable discussing their medical cannabis use with their patients,” says Rosalie Liccardo Pacula, senior author of both studies. “This change is imperative because interactions with other prescribed medications are likely but impossible to identify if medical cannabis use is not accounted for or recorded in the medical record.” Pacula is a senior fellow at the Schaeffer Center and the Elizabeth Garrett Chair in Health Policy, Economics & Law at the USC Price School of Public Policy.

Pacula and Kritikos hope their study provides a basis for conversations between providers and patients about cannabis use, including dosage levels.

Calls for caps on the recreational market will not limit access for medical cannabis patients

According to the reported dosage, none of the most popular products analyzed for any of the conditions had a dosage of more than 10 mg of THC, which policymakers should take into account, the researchers say.

“We have seen the industry and the media make the claim that limiting potency would limit access to necessary medications,” says Pacula. “But our research in New York state suggests that medical cannabis users are consuming products that are less potent than those taken by recreational users.”

A white paper released by the Schaeffer Center in July discussed how policymakers could legalize recreational cannabis while enacting regulations that prioritize public health.

Source:

University of Southern California

Reference:

Kritikos, AF & Pacula, RL, (2022) Characterization of cannabis products purchased for medical purposes in New York State. JAMA network opened. doi.org/10.1001/jamanetworkopen.2022.27735.

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