Patients want to talk about cannabis, but get most information from dispensary workers

Key takeaways:

• A new installment of ACP’s Best Practice Advice focuses on cannabis use for chronic pain management.
• An author discussed the most important details for PCPs to know.

NEW ORLEANS — Evidence suggests that, for many patients, the harms of cannabis outweigh its potential benefits for chronic noncancer pain, according to new Best Practice Advice from ACP.

Adam Obley, MD, FACP, detailed ACP’s advice on cannabis use to manage chronic pain at the college’s annual Internal Medicine Meeting.

When patients use cannabis for medicinal reasons, “they most often cite chronic pain as the diagnosis they're using cannabis to treat,” Obley, an associate professor of medicine in the division of general internal medicine and geriatrics at Oregon Health and Science University, said in his presentation. He said a recent survey revealed that one in four adults in the U.S. reported cannabis use in the previous year, and, among those who had reported use in the past month, about 40% reported near-daily or daily use.

“It's important to note that clinicians in the United States can only prescribe three FDA-approved cannabinoid formulations, which have a very limited set of indications — things like chemotherapy-induced nausea and vomiting, HIV-associated cachexia, and some uncommon seizure disorders,” Obley said. “Despite that, about four out of five U.S. adults believe that cannabis has at least one health related benefit.”

ACP’s most recent edition of Best Practice Advice centers on cannabis and cannabinoid use to treat noncancer-related chronic pain.

To inform the advice statement, researchers analyzed 26 randomized controlled trials and 12 observational studies examining the effects cannabis or cannabinoids had on chronic noncancer pain compared with usual care or placebo.

Notably, Best Practice Advice Statements are different from ACP Clinical Guidelines. And although there was substantial evidence to inform the statements, Obley said that this subject was better suited to best practice advice for two reasons: there were important limitations in many of the studies (mostly regarding long-term follow-up) and, in most clinical guidelines, the guidance focuses on “something that a physician prescribes, or a test that a physician orders, or a screening that a physician recommends,” but the clinical context around cannabis is different.

“While I think we're getting closer to having that information about the benefits for cannabis and chronic pain, making that assessment about long-term harms and finding that balance to make a good clinical guideline statement — [the evidence] simply wasn't there,” he said.

Obley said the most important points for primary care providers to know are:

• cannabis use in the U.S. is very common and rising;
• patients want to talk about cannabis use with their clinicians, “but currently receive most of their information from dispensary workers”;
• most clinicians do not feel comfortable discussing this topic with patients;
• some formulations of cannabis probably lead to slight improvements “in pain severity and function, particularly for neuropathic pain,” but it can also increase sedation, nausea and dizziness; and
• cannabis’ long-term harms may include cognitive impairments, dependence, psychiatric disorders, withdrawal syndromes, pulmonary and cardiac conditions, and, potentially, some types of cancer.

Ultimately, Obley said ACP thinks “clinicians should be prepared to counsel patients on the benefits and harms of cannabis use and to identify the groups of patients in which the harms are likely to outweigh the benefits.

“We should advise pregnant patients or breastfeeding women against using cannabis, and we should advise patients against using inhaled cannabis,” he added. “Cannabis smoke contains many of the same toxins and carcinogens as tobacco smoke.”

For more information on the evidence behind medical cannabis, read Healio’s Special Report here.

References:

• Kansagara D, et al. Ann Intern Med. 2025;doi:10.7326/ANNALS-24-03319.
• Obley A. Friday plenary: New in Annals of Internal Medicine: Hear it first from the authors. Presented at: ACP Internal Medicine Meeting; April 3-April 7, 2025; New Orleans.