By Dr. Demetria Bates, DNP, FNP-BC, CCE, and Health Coach

Cannabis, often referred to as marijuana, is a topic that has a long history in controversy and negative stigma, especially within the scope of healthcare. Despite the growing acceptance and legalization of Cannabis globally, healthcare providers still face significant challenges to understanding and integrating Cannabis into practice. Cannabis is currently gaining recognition for its therapeutic potential, but there is still much work to be done in changing the stigma surrounding it. In this article, we will discuss the negative stigma surrounding Cannabis in healthcare, healthcare providers, and medical Cannabis, and the profound impact it has on patient care.

Understanding Medical Cannabis

Medical Cannabis refers to the use of the natural plant Cannabis for medicinal and therapeutic purposes, treating a wide range of medical conditions and symptoms such as anxiety, chronic pain, and sleep disorders (1). Furthermore, some states have legalized Cannabis for medicinal and recreational use, yet the federal government still classifies Cannabis as a Schedule I controlled substance. This discrepancy produces confusion and fear within the healthcare community which creates a complex environment for both medical Cannabis patients and healthcare providers.

The Negative Stigma Surrounding Medical Cannabis

Historically, Cannabis has been saturated in negative stereotypes and misconceptions. Cannabis was demonized in the United States due to various factors (2), including cultural biases, racial prejudice, and unfounded fears about its effects. The media portrayal of Cannabis has also played a significant role in perpetuating negative stigma. Popular culture often depicts Cannabis users as lazy, irresponsible, or even criminal which further stigmatizes its use and hinders open discussions. These false impressions have left a lasting imprint on how society views Cannabis today, which influences the attitudes and beliefs of both medical Cannabis patients and healthcare providers.

Health Care Providers' Challenges and Concerns with Medical Cannabis

Healthcare providers play a significant role in providing high-quality care for patients with varying medical conditions and diseases. Moreover, healthcare providers have an ethical obligation to prioritize the well-being of their patients, and this includes advocating for effective, evidence-based treatments, which should include medical Cannabis. However, research (3) shows that healthcare providers in Canada lack Cannabis education. A more recent survey study (4) in 2022 revealed that US healthcare providers receive minimal training on medical Cannabis, giving evidence-based recommendations, or understanding how the endocannabinoid system works, which indicates insufficient education in medical schools, thus creating a barrier to making patient recommendations. Medical and nursing schools offer little to no curriculum on Cannabis, leaving future healthcare providers without the proper education to manage Cannabis-based treatments. However, healthcare providers are responsible for staying up-to-date on pertinent research.

Other barriers healthcare providers face are the legal restrictions in prohibition states, the ingrained societal biases, and the federal classification of Cannabis as a Schedule I substance. Substances listed in Schedule I are defined as drugs that have no medical use (5) with a high potential risk for abuse. Hospitals and other health care settings that receive federal funding such as Medicare reimbursement or federal grants limit medical providers from considering incorporating Cannabis into practice due to the risk (6) of jeopardizing reimbursements and funding. Healthcare providers that are registered to certify patients for legal medicinal Cannabis programs also have concerns about jeopardizing their federal DEA (Drug Enforcement Agency) license, Medicare reimbursements, and prescribing other controlled substances. These limitations hinder healthcare providers' ability to make informed decisions regarding Cannabis-based treatments. These challenges, in turn, have direct consequences for patient care, creating a significant gap between the patient-provider relationship, the potential benefits of medical Cannabis, and its actual use in health care as medicine.

Impact on Patient Care

The patients themselves most deeply feel the impact of changing the stigma around medical Cannabis. The fact is, that patients are using Cannabis without medical supervision because healthcare providers are not properly trained and/or display judgment. Many patients hesitate to discuss their Cannabis use with healthcare providers, fearing judgment or even legal repercussions. This hesitancy and prejudice can lead to delayed diagnoses and treatment plans that may not fully address the patient’s needs.

The biased attitude within the healthcare community is interrupting the patient-provider relationship which forces patients to mistrust and undermine the quality of care they receive by healthcare providers. Participants in a qualitative study (7) in Canada reported that keeping medical Cannabis use undercover, educating others about the benefits of medical Cannabis, responsible Cannabis use, and defending their right to choose their medicines as strategies to manage negative stigma. Medical Cannabis patients should not have to hide their consumption from healthcare providers. This type of behavior increases the risk of potential side effects or unwanted interactions that can be avoided if healthcare providers implement nonjudgmental care and receive proper training. Patients who discuss medical Cannabis with their medical provider would have the potential to receive informed guidance and overall improved patient care.

Addressing the Issue

Healthcare providers are uniquely positioned to change the narrative around medical Cannabis by adopting a proactive approach that involves open communication, education, and empathy. By providing evidence-based information and fostering a judgment-free environment, healthcare providers can challenge existing biases and shift the perception of medical Cannabis from a stigmatized substance to a legitimate medical treatment.

Colleges and universities should incorporate Cannabis into the medical curricula to increase the knowledge of future health care providers which will equip them to manage Cannabis-based treatment options. It is mandatory for healthcare providers to have a certain number of continuing education credits for licensure purposes. There are healthcare education programs that offer continuing medical education about Cannabis as medicine. Therefore, there is no excuse as to why providers can not learn about Cannabis. Cannabis education can empower healthcare providers with the knowledge and skills to navigate Cannabis-related discussions, reduce stigmatization, and enhance Cannabis patient care.

The evolving landscape of medical Cannabis holds great promise for patient care, but a significant obstacle remains in the form of stigma. This stigma affects patient care, access to effective treatments, and the overall patient-provider relationship. Health care providers are in a prime position to challenge and change this stigma by providing accurate evidence-based information, encouraging open communication, and adopting a non-judgmental attitude. It is imperative to incorporate Cannabis in the medical curricula to enhance the knowledge of health care providers which influences their ability to make informed decisions related to Cannabis-based treatments. Healthcare providers’ influence can reshape the perception of medical Cannabis and significantly improve patient outcomes. It is time to have open informed discussions about Cannabis in health care. Starting with healthcare providers who can reshape this stigma to improve patients' well-being with Cannabis-based treatments.

References

1. Bachhuber, Marcus et al. “Use of Cannabis to Relieve Pain and Promote Sleep by Customers at an Adult Use Dispensary.” Journal of psychoactive drugs vol. 51,5 (2019): 400-404. doi:10.1080/02791072.2019.1626953.

2. Solomon, Robert. “Racism and Its Effect on Cannabis Research.” Cannabis and cannabinoid research vol. 5,1 2-5. 27 Feb. 2020, doi:10.1089/can.2019.0063

3. Ziemianski, Daniel et al. “Cannabis in medicine: a national educational needs assessment among Canadian physicians.” BMC medical education vol. 15 52. 19 Mar. 2015, doi:10.1186/s12909-015-0335-0

4. Kruger, Daniel J et al. “Assessing Health Care Providers' Knowledge of Medical Cannabis.” Cannabis and cannabinoid research vol. 7,4 (2022): 501-507. doi:10.1089/can.2021.0032

5. Gregorio, Joseph. “Physicians, Medical Marijuana, and the Law.” Journal of Ethics | American Medical Association, American Medical Association, 1 Sept. 2014, journalofethics.ama-assn.org/article/physicians-medical-marijuana-and-law/2014-09.

6. Bridgeman, Mary Barna, and Daniel T Abazia. “Medicinal Cannabis: History, Pharmacology, And Implications for the Acute Care Setting.” P & T : a peer-reviewed journal for formulary management vol. 42,3 (2017): 180-188.

7. Bottorff, J.L., Bissell, L.J., Balneaves, L.G. et al. Perceptions of cannabis as a stigmatized medicine: a qualitative descriptive study. Harm Reduct J 10, 2 (2013). https://doi.org/10.1186/1477-7517-10-2.

About Dr. Demetria Bates, DNP, FNP-BC, CCE

Dr. Demetria Bates, DNP, FNP-BC, CCE, is a distinguished healthcare professional with a passion for bridging the gap between Cannabis medicine and Western medicine. She is the founder and CEO of Bates Virtual Health & Consultants, LLC which provides medical card services exclusively for Virginia residents. She works with individuals seeking to understand the integration of Cannabis medicine for health and wellness.  

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Effective Cannabis Newsletter is a platform to educate on the vital role of the Endocannabinoid System (ECS) in one's health. The information is not intended or implied to be a substitute for professional medical advice, diagnosis, or treatment. All content, including text, graphics, images, and information, contained in or available through this newsletter is for general information purposes only. It is not medical advice; it is health awareness.