Patients Rights and Cannabis

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This article provides links and reference material in two area.  First, the general topic of patient rights will be explored by way of a review of widely available material from our health care system.  Second, issues involving cannabis use by patients will be presented by way of selected academic journal articles. 

Patients and caregivers should be aware of the rights all patients in our health care system have, and then refer to and utilize these rights while having health care providers and organizations provide them with service and guidance on their treatment.

Part One – Patient Rights

This connection is well framed, even invited, by this article about how to “Fight for Your Rights as a Patient” from WebMD.  This opening passage frames the challenge for all patients:

At one time, the relationship between a doctor and a patient was a whole lot different than it is today. Patients may have never questioned their doctors or other medical professionals about, well, anything. They accepted “doctor’s orders” as the final word and willingly went along with tests and medications without making a peep. But today, health care providers and their patients are much more likely to work together to come up with a plan to keep people in the best of health.  But the only way that relationship can happen is if you learn to speak up for yourself. In other words, be your own advocate.

Additional material on patient rights from WebMD can be found in their Patient Rights Directory.

One of the early presentations on A Patients Bill of Rights  was produced by the American Hospital Association (AHA) in 1973.  It begins:

Effective health care requires collaboration between patients and physicians and other health care professionals. Open and honest communication, respect for personal and professional values, and sensitivity to differences are integral to optimal patient care. 

The AHA replaced this long document with a short brochure on the Patient Care Relationship to address the rights and responsibilities of patients during hospital stays.

Contemporary standards on patient rights are reflected in the Patient Rights presented by the American Medical Association (AMA).  Consider how the following statements from the AMA pertain to doctor-patient discussions of cannabis use:

The health and well-being of patients depends on a collaborative effort between patient and physician in a mutually respectful alliance. Patients contribute to this alliance when they fulfill responsibilities they have, to seek care and to be candid with their physicians.

  1. To courtesy, respect, dignity, and timely, responsive attention to his or her needs.
  2. To receive information from their physicians and to have opportunity to discuss the benefits, risks, and costs of appropriate treatment alternatives, including the risks, benefits and costs of forgoing treatment. Patients should be able to expect that their physicians will provide guidance about what they consider the optimal course of action for the patient based on the physician’s objective professional judgment.

The AMA also advocates for and supports the use of family and patient advocates in this article: What patient advisors do–and why your practice needs one

Hospitals and health systems are using patient and family advisors to help them reach the Triple Aim—better quality of care, lower cost and greater satisfaction with care delivery—tapping insights directly from people who have to navigate the patient side of the world of health care. 

Cannabis users need to be prepared to work with patient and family advisors to both facilitate their own care as well as to contribute to their education about therapeutic cannabis use.

The Tufts Medical Center provides “6 tips for preparing to meet a new doctor”.

Two of these steps are to create a “Symptoms Diary” and to bring a list of questions and concerns.  These are areas in which patients can and should discuss cannabis use and its effect on their symptoms.

Part Two – Patient Issues

Before reviewing recent research on cannabis patient issues, here are three important guides for all medical cannabis patients:

  1. Medical Cannabis Laws and Anti-Discrimination Provisions (From the Marijuana Policy Project)
  2. The Medical Cannabis Patient’s Guide for U.S. Travel (From Americans for Safe Access)
  3. Resources for Advocates (From Americans for Safe Access)

One of the most important patient issues was addressed by Forbes Magazine – a lot of doctors simply do not know much about medical cannabis use.  Consider this opening comment, especially in light of a patient’s right to frank and informed discussion of alternatives with their physician.

A study of more than 400 health care professionals has revealed that most physicians lack knowledge of medicinal cannabis, with 65% saying that they have been asked about medical marijuana as a treatment for chronic pain but were unable to answer their patients’ questions.

See: Herrington, A.J.  (2021) Study Shows Most Physicians Lack Knowledge of Medical Cannabis.  Forbes. November 24, 2021.

The articles below contain many different perspectives on patient issues involving medical/therapeutic cannabis use.  The comments and editorial positions of each of these sets of authors are presented for educational and discussion purposes, and do not represent the position of Patients Out of Time on any issue they address.

In this 2017 article, Ryan and Sharts-Hopko conclude that: 

The experience of the patient who uses marijuana for medicinal purposes is unique in multiple ways.  The stigma associated with marijuana use, the nondisclosures to healthcare professionals, the blurred line between recreational and medical use, and the risk vs. benefit ratio of the drug are all important topics for further research.

See:  Ryan, Jennie & Sharts-Hopko, Nancy. (2017). The Experiences of Medical Marijuana Patients: A Scoping Review of the Qualitative Literature. Journal of Neuroscience Nursing. 49. 185-190. 10.1097/JNN.0000000000000283.

In 2019 Philpot, Ebbert, and Hurt explored medical cannabis knowledge among primary care givers.  One of the important findings was the uncertainty about interactions between cannabis and other medications.  A key finding, though, was this: 

We observed that 50% providers were not ready or did not want to answer patient questions about medical cannabis.

Key recommendations here are to “close knowledge gaps for clinicians”, “alleviate concerns about drug interactions”, and “expand the knowledge base” regarding the effects of cannabis use on patient Quality of Life.

See:  Philpot, L.M., Ebbert, J.O. & Hurt, R.T. A survey of the attitudes, beliefs and knowledge about medical cannabis among primary care providers. BMC Fam Pract 20, 17 (2019). https://doi.org/10.1186/s12875-019-0906-y

Another important patient issue was recognized and investigated by Boehnke, Litinas, and Worthing in 2021.  Their research addressed the following problem:

People report using cannabis as a substitute for prescription medications but may be doing so without the knowledge of their primary health care providers (PCPs). This lack of integration creates serious concerns, e.g., using cannabis to treat medical conditions that have established treatment options.

Their closing comments further clarify this issue:

Similarly, although many medical cannabis patients tell their PCP about their use of medical cannabis, their license was typically authorized by an outside physician who had no current role in the patient’s healthcare. Our results show the poor integration between medical cannabis and mainstream healthcare, suggesting a need for improved physician education around appropriate cannabis use.

See:  Boehnke, K.F., Litinas, E., Worthing, B. et al. Communication between healthcare providers and medical cannabis patients regarding referral and medication substitutionJ Cannabis Res 3, 2 (2021). https://doi.org/10.1186/s42238-021-00058-0

An expansive review of policy issues related to patients and providers from the perspective of nursing practitioners was provided by Ryan, McCabe, and Boyd in 2021.  Their first recommendation for nurses is:

All nursing students and all practicing RNs and APRNS should have a working knowledge of their individual state’s medicinal and recreational cannabis laws and policies. Significant variability exists between the intricacies of state policies, and all nurses should be familiar with those details. Furthermore, all nurses should understand the federal cannabis laws and how these laws have prohibited research.

In addition to support for increased continuing education and research on medical cannabis, the authors conclude with the following recommendation:

[W]e recommend that current and future cannabis policies reflect a need for inclusion and diversity so that racial/ethnic minorities, those in lower socioeconomic statuses, and other marginalized populations are provided equal access.

See:  Ryan JE, McCabe SE, Boyd CJ. Medicinal Cannabis: Policy, Patients, and Providers. Policy Polit Nurs Pract. 2021 May;22(2):126-133. doi: 10.1177/1527154421989609. Epub 2021 Feb 10. PMID: 33567970; PMCID: PMC8098049.

In 2023 Hulaihel, Gliksberg and colleagues addressed the stigma issue (also raised in the 2017 article referenced above) through research on patients living with chronic pain in Israel.  Explaining the study, the authors note:

This study aims to examine the meaning of stigma in the context of MC use and how it is experienced by patients living with chronic pain who are using MC. As MC use is becoming increasingly common, it is imperative to better understand how patients experience and deal with stigma associated with their MC use.

An interesting section of their article address “Self-Control”:

The participants spent time and effort during the interviews to describe rules of conduct that they follow in relationship with their MC use. Creating and obeying rules of using MC was a way for the participants to exemplify their self-discipline and demonstrate their responsibility.

The primary finding the authors report in their conclusion has profound implications for patient communication with health care providers and policy makers:

Despite the fact that participants of this sample are authorised to use [Medical Cannabis] MC, and despite the fact that they live in a social and cultural context of liberal attitudes towards MC, stigma, and especially felt stigma, is part of the participants MC experiences. . . The results of the current study show that there may be a need to develop strategies aimed at reducing stigma related to MC treatment. Some of this may relate to how MC use is talked about and handled in social encounters with people who do not use MC and thus focus on enacted stigma.

See: Hulaihel, A., Gliksberg, O., Feingold, D., Brill, S., Amit, B. H., Lev-ran, S., & Sznitman, S. R. (2023). Medical cannabis and stigma: A qualitative study with patients living with chronic painJournal of Clinical Nursing, 32, 1103–1114. https://doi.org/10.1111/jocn.16340

Conclusion

This presentation has reviewed the general concept of patient rights, with emphasis on informed communication between health care providers and patients, and presented this information in conjunction with research on issues now facing medical cannabis users. This research indicates that informed communication is NOT taking place between health care providers and patients with respect to medical cannabis use.

All links to research articles above provide full-text, open public access to the publications.  Interested individuals are encouraged to review the source material cited above to better understand patient rights and the need for medical cannabis patients to asset them in our contemporary health care system.

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