In his State of the Union address this year, President Biden said he had directed his Cabinet to review the federal classification of cannabis. This direction follows two other administration recommendations – including a letter sent by 12 senators, including Senate Majority Leader Chuck Summer, to the Drug Enforcement Administration (DEA) in January and the U.S. Department of Health and Human Services’ recommendation to the DEA in August last year to reschedule cannabis – could mean momentum is building for this much-needed change.
The dynamic gives me hope that we are moving forward from reclassifying cannabis from a Schedule I substance, reserved for the most dangerous controlled drugs including heroin and LSD, to a Schedule III substance, drugs with a moderate to low potential for physical and psychological dependence , have come one step closer. like ketamine, testosterone and Tylenol with codeine.
A new regulation of cannabis would mean significant changes to healthcare on several fronts:
- Above all, it would open the door to clinical research to provide scientific evidence of the medical benefits of cannabis.
- By reducing stigma and the risk of arrest, reclassifying cannabis would remove one of the biggest barriers preventing patients and their caregivers from speaking openly to mainstream medical professionals about their use.
- And it could reduce barriers to access for patients suffering from cancer pain and treatment-related symptoms, chronic pain and other serious illnesses.
Despite growing acceptance and legalization in 40 states, there is still a significant level of negative perception and misinformation about cannabis as a medical therapy because it is still classified as a Schedule I drug.
As a leader of supportive oncology services, I see firsthand how the confusion and distrust surrounding medical cannabis impacts my cancer patients and their families. Prior to establishing a need-blind, interprofessional cannabis clinic, most patients would use cannabis without medical guidance or feel comfortable discussing this interest with providers. We have seen over 1,000 cancer patients and survivors between the ages of 18 and 95 express interest in using cannabis to reduce their symptom burden. The question is universal: Help me understand what cannabis can help me with, where it can’t, and what I can safely consume.
Medical cannabis is not always accessible for many of my patients, as there are countless barriers to access, from digital literacy issues to the financial toxicity of cancer treatment. As a Schedule I substance, cannabis is not covered by health insurance; This is a deductible that cannot be paid with a credit card. As a result, some of my patients purchase street marijuana, which is not only illegal, but also leaves me in the dark about what they purchased, how they use it, and what effects it might have on their health.
My patients are just a microcosm of the problem. Currently, 40 to 50 percent of cancer patients in the United States use cannabis to treat cancer symptoms. Many say it is confusing and expensive and that there is no medical oversight. Many of these patients are alone and inadequately informed when they are most at risk.
The American Society of Clinical Oncology’s Journal of Clinical Oncology recently published guidelines for physicians, adults with cancer, caregivers, researchers, and oncology settings on the medical use of cannabis and cannabinoids, including synthetic cannabinoids and herbal cannabis derivatives. individual, purified cannabinoids; combinations of cannabis ingredients; and full-spectrum cannabis. They highlight the urgent need for more cannabis and/or cannabinoid research.
Cannabis as part of cancer treatment has been a topic of great interest for years. In fact, in 2019, the Journal of Palliative Medicine published a research study titled “Association of Cannabis Use with Patient-Reported Symptoms in Cancer Patients Seeking Supportive/Palliative Care.” The study concluded that patients seeking specific symptom management self-medicate with cannabis, despite a lack of high-quality evidence supporting its use in palliative care. Unauthorized consumption is likely to increase among cancer patients. Accurate information is urgently needed to meet patient expectations of use and improve understanding of risks and benefits.
Once cannabis is reclassified, the uncertainty and ambiguity will change. Clinical research will help us understand the benefits and risks of cannabis use. The well-established, conclusive, scientific evidence for the medical benefits of cannabis will be the main catalyst for changes in the medical community’s attitudes and practices regarding cannabis care. In addition, we can take two initiatives here to ensure more effective cannabis consumption for our patients – starting immediately:
- Meet the need for more education and training to make it easier for physicians to discuss the use of cannabis for medical purposes with their patients. While medical use of cannabis is increasing in the United States, medical education and physicians’ willingness to discuss cannabis for medical purposes have not kept pace. For example, according to a study I co-authored, of the 344 clinicians we surveyed in the state of Pennsylvania, only 51% reported having completed formal medical cannabis training. Compared to non-certified physicians (pharmacists, nurse practitioners, and physician assistants), physicians were significantly more comfortable with patients’ use of medical cannabis, saw fewer risks, more benefits, and felt more prepared to discuss its use with vulnerable populations. All clinicians noted significant limitations in their understanding of how medical cannabis can impact patients, and many expressed a desire for more research and training to address knowledge gaps.
- Open lines of communication between doctors and patients about the use of cannabis along with other drugs. When assessing polypharmacy, i.e. taking five or more medications, it is important to assess the use of medical cannabis in conjunction with other medications. However, while more patients are using cannabis, little is known about how often they use it with other medications. That needs to change. It is best to continually survey patients to assess their use of medical cannabis products, as the products people use during different time periods vary greatly.
I believe that if we work together, these initiatives, along with others being studied, can be established as best practices that make medical cannabis safer and more effective for patients suffering from cancer symptoms, chronic pain, insomnia and anxiety.
In a post-transformation world, all of us – providers, health insurers, employers, regulators, financial institutions and investors – must make it our mission to work together to begin building a responsible, regulated and structured industry using clinically managed medical cannabis Care is accessible and affordable for all.
The Drug Enforcement Agency’s decision to reclassify cannabis as a Schedule III drug would represent a turning point in the cannabis market, but it does not immediately resolve the lack of data, issues with equitable access, consistent quality, and adequate clinical and regulatory oversight. This is the first step in a long process to establish a new normal for medical cannabis supply. I am optimistic that together we have the resources necessary to integrate medical cannabis into mainstream healthcare.
Photo: Ivan Balvan, Getty Images
Dr. Brooke Worster is a pioneering palliative care physician and researcher and currently director of supportive oncology at Jefferson Health in Philadelphia. She is a graduate of Temple University School of Medicine and completed her fellowship in palliative care and pain management at the MGH Brigham and Dana Farber Cancer Center in Boston.