His goal is to provide evidence-based information that he hopes will empower clinicians to feel more comfortable talking to their patients about cannabis use and answering questions that patients may have.
A new website created by an Oregon doctor aims to make it easier for healthcare providers to talk with their patients about the health effects of cannabis.
Devan Kansagara: This is a project funded by the VA Office of Rural Health, and it’s a collaboration of excellent teams here at the VA and at the Center for Evidence-Based Policy at OHSU and our goals are really to help clinicians feel empowered to have evidence informed discussions about cannabis with their patients.
Caller: My name is Janet Garland and I am 67 years old and I have smoked weed off and on since, oh gosh, I don’t know, like 1975 and I have to tell you that I will never admit to a doctor that I smoke weed because the reactions that I get at 67 is really kind of ridiculous, considering all the other drugs that are out there.
But let’s start with the research one because, as you noted, one of the big ideas behind this effort is to be a kind of clearinghouse for quality studies about cannabis.
Kansagara:There’s a growing amount of data, but I think everybody – patients, clinicians, researchers – everybody would agree that we need more and better research.
Miller: The broader point that Janet was making is she’s used cannabis for, her estimate is what, 45 years or something.
So I think part of it is about normalizing the discussion and just as a patient might expect to go to the doctor and have these routine sorts of questions asked, we can do that for cannabis as well.
Obviously it’s not true 100% of the time, but again, I think it has partially to do with how we ask the questions and whether or not it’s kind of a routine part of care.
I have talked to every single doctor that takes care of me about using cannabis, and they are all 150% supportive.
I mentioned to my doctors over many years when I go see them that I use cannabis for pain treatment and treatment of anxiety and I don’t ever get any pushback.
And I’ll say the next generation of doctors is extremely curious and engaged in this question, often having read a lot about it and you know, coming to the table with a lot of knowledge.
As part of the screening process, the psychiatrist asked him if he had ever used marijuana and my husband quite honestly replied that he had recently used some cannabis CBD on some skin issues he was having.
Miller: Somebody tweeted at us on Twitter, ‘I have asked my Kaiser Permanente doctors about treating arthritis, aches and pains with CBD oil.
I would say even if you’re a healthcare provider who works for an organization that doesn’t allow you to sign a medical marijuana card, there’s still a lot you can do in terms of informing patients about what the evidence says and doesn’t say about the health effects that you know wouldn’t violate some of these policies.
Caller: This is Sarah Holt, I am a nurse midwife here in Portland and we do need to counsel patients about cannabis use particularly during pregnancy.
Miller: Cannabis use in pregnancy is actually one of the topics that you address under the evidence synthesis tabs on this new website.
Then, as with any clinical encounter, I think engaging the patient, hearing their thoughts, hearing where they’re coming from and then kind of presenting the information we have and taking a shared decision making approach, I think goes a long way.
So I think there’s a lot of interest in CBD and I think that’s one area where there’s the biggest disconnect between interest and the evidence we have.
But certainly there’s a big distance between having the biologic plausibility and knowing whether or not this works in the human body and what the doses are, that would work and how often you need to take it and so on and so forth, and we just don’t have that work done yet.
But you’re right, I think many people would think, you know, evidence-based medicine as opposed to what? So in this context, we mean that part of what we’re doing is taking a broad look at what’s out there, and trying to tell you if there’s 10 studies on this particular topic, are they all saying the same thing? Did one find a benefit and nine didn’t? So it’s kind of important to look at the landscape of information out there and part of that is also looking at the quality of the studies that are being done – not all studies are created equal.
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