NH Medical SocietyHerbal Marijuana Survey

Presented by Seddon R. Savage MD, MS

Survey Goals

• Learn current and anticipated engagement by NH clinicians in use of herbal marijuana for therapeutic purposes

• Assess clinician understanding of marijuana effects and side effects

• Link mailed to – 2642 physicians with four reminders– 900 APNPs on one occasion– Total 3540

• 467 responses– 239 physicians– 64 APRNs– 164 unknowns

• Response rate overall: 13.2%

If you know a patient uses or want to try MJ, how often do you advise them on risks & benefits

Never Rarely Sometimes Often NA0

50

100

150

200

250

Advise risks/benefits if using

Advise risks/benefits if using

How often have you recommended a trial of marijuana for clinical purpose

Never Rarely Sometimes Often NA0

50

100

150

200

250

300

350

400

Recommend MJ

Recommend MJ

How often have you recommended a trial of cannabinoid medications?

Never Rarely Sometimes Often NA0

50

100

150

200

250

300

350

400

Recommend Cannabinoid Med

Will you be willing to certify a patient’s medical condition and symptoms for certification to use MJ?

Never Rarely Sometime Often NA0

20

40

60

80

100

120

140

160

Willing to certify

Would you want to be on a list of physicians willing to certify patients for Clinical Cannabis?

Yes No0

50

100

150

200

250

300

350

400

450

List MJ Providers?

How would you rate your knowledge of herbal marijuana/cannabis effects?

0 1 2 3 4 50

20

40

60

80

100

120

140

160

ComprehensiveNone

0 to 2 3 to 50

50100150200250300350

Knowledge

Marijuana Knowledge Challenges

• Herbal marijuana primarily studied in terms of outcomes and effects of illicit use

• Cannabinoids studied in terms of therapeutic effects and side effects

• Less research on therapeutic effects of herbal MJ– Highly variable herb with 50-200 biologically active

chemicals (>50 cannabinoids all with different actions)• Cannot extrapolate from research on cannabinoids to

herbal marijuana• Cannot extrapolate from one strain of marijuana to

another strain

Marijuana Sources of “Evidence”

• Research related to illicit use• Few research studies of therapeutic use– Few randomized controlled clinical trials

• Observation and experience• Clinical case reports in popular media• Extrapolation from cannabinoid research• Expert consensus reached by any or all of above

Perception of Evidence Acute Therapeutic Effects

Inc Appetite

Nause

a

Redx IOPressu

re

Anxiety

Tissu

e pain

Nerve pain

Redx GI c

ramp

Redx Spasti

city

Anti-seizu

re0

50

100

150

200

250

300

350

400

450

Mod-StrongNone-Sketchy

Perception of Evidence Acute Side-Effects

Cognitive

chan

ges

Rdx memory

formtn

Risk M

VA

Risk fa

lls elderly

Asthma/

bronch in

c

Psychosis

Tach

ycard

ia

Stroke

risk

0

50

100

150

200

250

300

350

400

450

Mod-StrongNone-Sketchy

Perception of Evidence Chronic Side-Effects

Memory im

pairment

Amotivational

syndrome

Worse

asthma/

bronchitis

Lower b

irthweigh

ts

Addiction

NeurodevelRisk

Fetus

Physcl D

ependence/W

D

PersistN

eurodevelRisk

Child0

50

100

150

200

250

300

350

400

450

Mod-Strong

None-Sketchy

Key Messages

• Education is needed to enhance clinician understanding of – Potential effects and side effects– Possible risks

• Patient counseling is needed to ensure understanding– Potential effects and side effects– Possible risks

• Data collection and research are needed to determine actual effects, side-effects & risks

• Thank you to NHMS for launching survey