More patients are using cannabis to self-treat chronic pain, nausea and seizures, and psychiatric conditions such as anxiety and depression despite the lack of data assessing its safety and efficacy. As with any substance, cannabis comes with health risks. It’s important for physicians to monitor and screen for potential harms, especially in adolescents and when patients are pregnant. New screening tools are making it easier to pinpoint signs of cannabis addiction.
Before the COVID-19 pandemic hit, the AMA adopted policy to create a cannabis task force that would develop and share scientific evidence to health care providers and the public. Since then, the AMA Cannabis Task Force has launched a CME podcast series on AMA Ed Hub™ that serves as a primer on cannabis products, their uses and potential health effects.
The series—presented as part of the “AMA Moving Medicine” podcast—addresses Food and Drug Administration-approved indications and the different cannabis products available for adult use, offering guidance to physicians on how to counsel patients. The seven episodes are moderated by the co-chairs of the AMA Cannabis Task Force:
- Jesse Ehrenfeld, MD, MPH, immediate past president of the AMA and anesthesiologist.
- Michael Suk, MD, JD, MPH, MBA, chair of the AMA Board of Trustees chair and an orthopaedic surgeon at the Geisinger health system.
Geisinger is a member of the AMA Health System Program, which provides enterprise solutions to equip leadership, physicians and care teams with resources to help drive the future of medicine.
“Preventing Cannabis Use Among Minors”
- In this first episode, Maria H. Rahmandar, MD, explores the risk factors, screening strategies and health impacts that cannabis use may have on children and adolescents. She notes that there is concern about any use in adolescents or young adults because the developing brain is particularly susceptible to negative impacts of substance use. Several validated tools are available that do a good job of capturing substance use and concerns that could develop into disorders, said Dr. Rahmandar.
“Cannabis and Pain Management”
- In the second installment, Samer Narouze, MD, PhD, and Ali Zarrabi, MD, discuss the intersection of cannabis use and pain, reviewing the scientific literature, adverse events and challenges to cannabis use for pain.
- Cannabis could be an option for chronic pain if other traditional options fail, said Dr. Narouze. Patients should be closely monitored for potential harms resulting from cannabis use, added Dr. Zarrabi. Some studies have shown that cannabis is ineffective against cancer pain. “I think there's still quite a bit of research needed to explore the impact of cannabis on pain functioning, catastrophizing, ruminating and quality of life,” noted Dr. Zarrabi.
“Cannabis Use Among Pregnant Persons”
- The third episode details the effects of prenatal exposure to cannabis and identifies ways to screen for and counsel pregnant patients on cannabis use during preconception, pregnancy and lactation. Legalization of marijuana throughout the U.S. has led to increased use of cannabis among pregnant women, said guest expert Tricia Wright, MD, an ob-gyn.
- “There's this perceived notion that because it is natural, it is safer than medications to treat nausea and vomiting,” said Dr. Wright. “Unfortunately, the literature does not support that.” In 2019, AMA commended the surgeon general for issuing an advisory on the harmful health effects of cannabis use by pregnant women and youth.
“How Addictive is Cannabis?”
- In this episode, Smita Das, MD, PhD, MPH, discusses the addiction potential and the withdrawal and overdose effects of cannabis. One in 10 people who uses cannabis has a cannabis use disorder. Among daily users, that number is closer to one in three, she noted. While there’s no evidence or reported cases of overdose directly in adults, the cannabis industry is growing and current products are more potent.
- “Increased ER visits and poison-center calls have been related to cannabis, especially among children and youth,” said Dr. Das. Pediatric cannabis edible ingestion has increased 1,300% from 2017 to 2021. Screening is an important tool to identify cannabis use, she emphasized.
“All About Cannabis Pharmacology”
- Dr. Narouze appears again to explain the chemical structures, mechanism of action in the body and pharmacodynamics of cannabinoids. He also talks about clinical information related to potential drug-drug interactions and adverse events from use of these products.
“Cannabis Use and Psychiatric Disorders”
- Dr. Das returns in this episode, joining Kevin Gray, MD, to discuss the effects of cannabis use on mental health and psychiatric disorders, including psychosocial outcomes. They also addressed perceptions of using cannabis for mental health.
- Nearly 50% of people believe that cannabis is beneficial for anxiety and depression, whereas 15% believe that cannabis increases the risk for these conditions, said Dr. Das, quoting survey results. Cannabis can actually make conditions such as depression and anxiety worse. Someone turning to cannabis to treat a mental health condition may be missing out on evidence-based practices, she said.
“What to know about FDA-approved cannabis-derived products”
- In the final episode, Randy Easterling, MD, outlines the regulatory status of FDA-approved, cannabis-derived medications and their approved uses. So far, the FDA has approved four products that have been derived from or synthetically related to cannabis.
- Some of these treatments are used for chemotherapy-induced nausea and vomiting and loss of appetite; others are approved for pediatric epilepsy and other seizure disorders. To approve these types of medications, the FDA requires random double-blind trials and proof of efficacy and safety.
- “I applaud the American Medical Association for providing a platform to present recent evidence-based information concerning the use of cannabis for medicinal purposes,” said Dr. Easterling of the podcast series.
These podcasts are education modules that are part of the AMA Ed Hub™, an online learning platform that brings together high-quality CME, maintenance of certification, and educational content from trusted sources, all in one place—with activities relevant to you, automated credit tracking, and reporting for some states and specialty boards.
The modules are enduring material and designated by the AMA for varying amounts of AMA PRA Category 1 Credit™. Learn more about AMA CME accreditation.
With the AMA, you can hear from physicians, scientists and other leading voices on emerging issues and new innovations in health care. All AMA podcasts are available on Apple Podcasts, Spotify, Simplecast and many other listening services.
You can listen and learn more with the AMA’s top podcast episodes.
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