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More People Are Using Medical Cannabis Than Medical Records Suggest, Study Finds

By Alexander Beadle

Published: May 30, 2022   
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Medical cannabis use is significantly more prevalent than patient medical records suggest, a new study has found.

Published in JAMA Network Open, the new research led by scientists at the Kaiser Permanente Washington Health Research Institute surveyed nearly 1,700 ordinary primary care patients and asked about their previous history with cannabis use, before comparing this to their existing medical records.

The researchers found that just 10 percent of patients who reported medical cannabis use in the survey also had this use documented in their electronic health records (EHR). Since the documentation of medical cannabis use can help clinicians to identify possible drug interactions and other important treatment considerations, the researchers are urging clinicians to continue to initiate conversations with their patients about cannabis use.

Medical records only reflect 10 percent of actual medical cannabis users

All of the participants in this study were ordinary primary care patients registered with Kaiser Permanente Washington. Surveys were sent out to 5,000 randomly selected patients over the age of 18 who had recently completed a routine single-item cannabis screen, with some amount of over-sampling done to ensure an adequate number of responses from minority racial and ethnic groups.

In total, 1,688 patients responded to the survey, which quizzed them on their past-year cannabis use frequency and recency. Patients were also instructed to take a very broad definition of cannabis use, including cannabis-infused ointments, tinctures, and CBD products.

Patient medical records were considered to indicate medical cannabis use if they contained either an official ICD-10 diagnosis code indicating medical cannabis use, or if more than one note related to medical cannabis use was made on a patient’s EHR by their clinician. An automated machine-learning natural language processing algorithm was trained and used to scan through the EHR notes for each patient and identify relevant mentions of medical cannabis use.

The researchers found that 26.5 percent of respondents identified themselves as using medical cannabis when explicitly asked. However, the prevalence of EHR-documented medical cannabis use among all primary care patients was just 4.8 percent. When applied to the survey respondents, patient records identified 10 percent or less of the patients who self-reported using medical cannabis.

Implicit questions on cannabis use may be more informative

In the patient survey, respondents were explicitly asked to record whether they used cannabis for medical purposes, recreational purposes, or both. But a more implicit question on medical cannabis use was also included, which broadly asked whether the participants had used cannabis to help manage one or more health conditions, such as sleeping problems, stress, and pain, and to select those that applied from a list.

The researchers found that although 26.5 percent of respondents self-identified themselves as medical cannabis users, 35.1 percent of the total respondents reported using cannabis for specific health reasons. This suggests that asking more general or implicit questions about cannabis use could collect data to better reflect the reality of how many people are using cannabis medicinally.

“Documentation of health reasons for cannabis use may help clinicians identify contraindications, drug interactions, and patient-initiated substitution of prescribed medications for cannabis,” the researchers wrote. “Combined with cannabis screening, routinely asking about health reasons for use could improve recognition and documentation of medical cannabis use and the management of health conditions for which cannabis is being used.”

Of those who reported using cannabis to manage a health condition, the most common reasons given were to manage pain, sleep, stress, anxiety, and depression. A number also endorsed using cannabis to tackle muscle spasms, combat nausea, and improve focus.

While previous studies have looked at medical cannabis use in specialty care settings or for patients with specific health conditions, the researchers say that this study is the first of its kind to estimate the self-reported prevalence of medical cannabis use within a population of general primary care patients.

Based on their findings, they recommend that clinicians continue to make efforts to discuss medical cannabis use with their patients, even if the healthcare center they are with operates a basic cannabis screening question. Given that some patients appear to be using cannabis to treat health problems, yet do not identify as medical cannabis users, instigating a broader conversation about cannabis or CBD products for health management could help to bring these cases to a doctor’s attention.


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