New York Physicians' Perspectives and Knowledge of the State Medical Marijuana Program

Abstract

Introduction: In 2014, New York (NY) became the 23rd state to legalize medical marijuana (MMJ). The purpose of this survey was to collect data about practicing NY physicians' comfort level, opinions, and experience in recommending or supporting patient use of MMJ. Materials and Methods: An anonymous web-based survey was distributed to medical societies and to academic departments in medical schools within NY. Results: A total of 164 responses were analyzed. Physician participants were primarily located in New York City and surrounding areas. The majority (71%) agreed that MMJ should be an option available to patients. Most respondents were not registered to certify MMJ in NY, but were willing to refer patients to registered physicians. Common reasons for not registering included specialty and federal status of cannabis. More than 75% reported having patients who used cannabis for symptom control, and 50% reported having patients who inquired about MMJ within the past year. Most respondents are willing to discuss MMJ with their patients, but had little familiarity with the state program and a modest knowledge of the endocannabinoid system. Pain was a common symptom for which cannabis was recommended by registered physicians (69%) and purportedly used by patients (83%). Most respondents would consider MMJ as an adjuvant to opioids, and 84% believed opioids have greater risks than MMJ. Conclusion: Given that the majority of surveyed physicians support MMJ as an option for patients, few are registered and have adequate knowledge of MMJ. Although our study sample is small and geographically limited, our survey results highlight key physician issues that are likely applicable to practitioners in other states. Concerted efforts are needed at the federal, state, and academic levels to provide practitioners with evidence-based guidelines for the safe use of MMJ.

Keywords: New York; medical marijuana; opioids; pain; physicians; survey.

FIG. 1.

Factors influencing decision to register and conditions for which registered physicians recommend MMJ. (A) Registered (black) and not registered (gray) physician participants (n=133 answered) were given the option to select more than one factor, and/or list other reasons. (B) Qualifying conditions and associated symptoms for which registered physicians currently or anticipate recommending MMJ (n=13 answered). CME, continuing medical education; MMJ, medical marijuana.

FIG. 2.

Knowledge and perspectives of MMJ and the NY-MMP. Participants (n=164 answered) rated (A) their knowledge of the eCB system, the extent to which they agree with the statement that MMJ should be an option available to patients, (B) their familiarity with the patient (n=163 answered) and physician requirements for participating in the MMP, and (C) their opinions regarding the number of qualifying conditions and available MMJ formulations. eCB, endocannabinoid; NY-MMP, New York State Medical Marijuana Program.

FIG. 3.

Response to unexpected THC+ in a UDS for patients on opioids. The course of action of primary care and pain medicine physicians, if for an otherwise expected UDS, THC is detected while their patients are using opioids. THC, tetrahydrocannabinol; UDS, urine drug screen.

FIG. 4.

Certified patients and registered physicians in NY, as of July 12th, 2017. (A) Cumulative number of certified patients (red) and registered physicians (blue). Data were compiled from the periodic updates posted on the NY-MMP website. Arrows indicate key events or changes in the MMP. (B) Specialties of registered practitioners who opted in to publicly display their contact information on the NY-MMP website as of July 2017. Note that approximately one-third (380/1105) of the registered practitioners chose to do so. Of these, 41% (155/380) report primary care and 22% (83/380) report pain medicine/management as their specialty.