Patients Hesitant to Discuss Cannabis With PCPs

Lori Ann Reese

Posted by Lori Ann Reese on 03/13/2021 in Medical Marijuana

Medical Marijuana Use

A new study was published in the Journal of Cannabis Research that presents some interesting but unsurprising insights. The “Communication between healthcare providers and medical cannabis patients regarding referral and medication substitution” was published by the University of Michigan Medical School. It evaluated how comfortable patients were discussing medical cannabis with primary care providers (PCPs).

The study interviewed 275 medical cannabis patients living in the state of Michigan. A small sample, but with some very relevant facts that make sense. Not only are patients hesitant to share their use of medical cannabis with primary care providers (PCPs), but they fear divulging marijuana use. Not only that, but patients felt that talking to their physician about medical cannabis was pointless; they didn’t think the physician would have adequate training or knowledge that could help them.

The findings of the survey highlight some critical concerns about medical care. Now that thirty-six states have legalized medical cannabis, are physicians getting their patients’ whole-health picture? Are they making recommendations to treat health conditions without critical information that could improve their patients’ health outcomes? 

If the survey is representative statistically, there is another problem or breakdown in communication between physicians and their patients. And some of the decisions that physicians are making regarding health care can be detrimental to the patient’s health. 

In the survey, 86% of patients said that they sometimes substitute cannabis in place of prescription medications. And those patients did not inform their doctor that they were replacing medications with alternative medicine—specifically, medical marijuana.

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Why Are Patients Concerned About Discussing Medical Marijuana With Their Family Doctor?

After a lifetime of being ‘worried’ about the illegal use of cannabis, it’s a little hard to change perceptions. The culture of cannabis use in the United States has been covert (for legal reasons) and celebrated as a lifestyle. But only within the confines of the cannabis community, where people felt safe to discuss their use of the healing herb. For medical or recreational purposes.

There is still a lot of fear and apprehension surrounding marijuana use. It’s not hard to understand when you look at the contradiction between state and federal laws. Is it okay to use marijuana? It depends on where you live. And even in legalized states, there can be community bylaws that contradict state laws. Confusing? You bet!

Patients worry about social justice. How comfortable are you discussing medical marijuana with your doctor? Some people may have been using cannabis to manage health symptoms for decades. On the down-low, for fear of legal reprisal. Unless the PCP (primary care provider) has a reason to drug-screen, cannabis is not tested for routine annual health checks. 

Many studies support that Americans have been using cannabis medicinally and covertly because it helps. But many patients still feel extreme legal and social apprehension when it comes to discussing the use of cannabis with their doctors. 

What Consequences of Disclosure to PCPs Are Patients Concerned About?

The survey revealed that even people who live in legalized states hesitate to talk about medical marijuana with their family doctor. Eliminating the legal concerns about breaking the law using cannabis, there are still some legitimate reasons people hesitate. Or even fear disclosing their use of cannabis to a physician.

If a patient has other underlying health conditions, they may understand that it is important to talk about the personal use of cannabis with a doctor. Still, patients face many concerns and questions when they consider being honest with their physicians.

  • Will the doctor report it to law enforcement?
  • Will the doctor stop prescribing certain medications the patient needs if cannabis use is disclosed?
  • Will the doctor/patient relationship change when the physician knows that their patient uses cannabis?
  • Will other people find out (including friends, family, or employers) if the patient is honest about cannabis use?

 Could cannabis use be disclosed to insurance companies? Using marijuana could (with current legislation in most states) impact health insurance rates and life insurance eligibility. Individuals who need to be bondable for employment purposes may also have legitimate concerns about their information privacy.

The biggest source of concern is a lack of understanding about healthcare privacy laws. Many American’s do not understand how the Health Insurance Portability and Accountability Act of 1996 (HIPAA) protects health record privacy.

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Can PCPs Report Marijuana Use to Law Enforcement?

Health privacy laws and HIPAA bind physicians. A doctor cannot decide to disclose illicit drug use unless they are subpoenaed to do so if a patient may have been charged with criminal activity. And even then, access to health information is very protected in the United States.

But patients aren’t confident about what would happen if they disclosed marijuana use to their doctor. Is there a ‘right to report’ when a physician knows a patient may be breaking the law? Under what circumstances can a doctor report drug use?

When patients are hospitalized for care, diagnostic testing (including drug testing) is standard. This is critical for all patients that are admitted. So, the results of the blood tests are reviewed by the care provider. But unless the patient has indicated a history or intention of self-harm or their drug use may put someone else in harm (such as a minor), physicians have no legal responsibility to report to the authorities.

However, PCPs concerned about a patient who may be at risk of health complications due to drug use can resign the patient. There are codes of ethics that physicians must follow to provide the best patient care. And when a patient refuses to change lifestyle habits that may put them at risk, the physician can terminate the doctor/patient relationship. This is what can happen if your physician disagrees with the use of medical cannabis.

Physicians May Not Know Patient’s Combine Cannabis With Prescription Medications

Even if your physician feels that your use of recreational or medicinal cannabis may cause harm to your health, they cannot report it to the authorities. A physician or practitioner knows that cannabis use may be contraindicated (or conflicting) with medications and health conditions. And the next step is for them to inform you (the patient) of the potential risks.

There are no cases worldwide of a cannabis overdose, where cannabis is the single drug of use. However, there are some prescription medications that can conflict with cannabis. For example, did you know that certain pain medications can be affected? If you have chronic pain that is not being managed well, the dose of prescription pain medications can be adjusted. But the effects of pain medications can be significantly reduced when a patient uses cannabis on a daily basis.

One of the risks of this contraindication between pain medications and cannabis is the potential for opioid or NSAID overdose. For example, a physician may disproportionately increase pain medication potency, as the patient reports it is ‘not working.’ Not knowing that cannabis presents a medication conflict. If the dose is increased and the patient lowers or eliminates their use of medical cannabis, the opioid or NSAID potency may be higher than safe levels.

PCPs (primary care providers) need to know all supplements and lifestyle drugs that can affect medication doses. When patients are not forthcoming about the use of therapeutic cannabis, it can present a health risk and increase overdose potential.

Read: “Questions to Ask Your Doctor About Medical Marijuana.”

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