This fall, students at Washington State University’s Elson S. Floyd College of Medicine will for the first time receive instruction on medicinal marijuana as part of their core classwork.
That decision could help solve problems identified by another team of researchers at WSU. The lack of peer-reviewed science on the medicinal capabilities of cannabis drives consultants in state retail shops to depend on their own experience, and health care providers to avoid discussing the drug entirely, according to a pair of research studies slated for publication in academic journals this year.
The research is the first look at Washington’s unique cohort of so-called “medical consultants,” workers at retail locations throughout the state who are licensed through the Health Department to work with patients possessing what is colloquially known as a “green card” to purchase the drug for therapeutic uses, said Louise Kaplan, an associate nursing professor at WSU Vancouver and the lead researcher on the studies.
“We felt it was really important to understand their knowledge, their attitudes and their practices, and that could be used to guide changes in either their educational course, or the type of oversight that might be recommended,” Kaplan said.
Consultants must be at least 21 years old and complete one of three 20-hour courses endorsed by the health department. For a store to be certified with the state’s Liquor and Cannabis Board as a medically endorsed location, it must have one of these consultants on staff; 14 such shops in Spokane County have received that certification.
While these consultants may work with patients on safe storage of the drug and what varieties might be useful for their conditions diagnosed by a licensed medical professional, these workers are not allowed under state law to provide medical advice or suggest cannabis as a replacement for other types of therapy to treat disorders.
While the courses include several hours of instruction on the ins-and-outs of Washington’s laws concerning medical cannabis, the results of the surveys showed that a majority of these consultants (which number more than 700 statewide) could not correctly identify certain conditions that do not qualify a patient to receive the drug for therapeutic purposes. State law authorizes cannabis’s use for conditions such as cancer, pain relief and post traumatic stress disorder, but not for anxiety and depression, a mistake that was frequently made by the consultants in the survey.
“What the state was concerned about is the quality of the programs,” Kaplan said. “To see which program the medical marijuana consultant had taken and evaluate their knowledge.”
Consultants are also more likely to say that state-sponsored certification instruction and advice from others in the field shape their advice to patients in stores, as opposed to health care providers, who rely on peer-reviewed science.
Washington’s requirement of any type of instruction for its consultants sets it apart from other states that have legalized medicinal cannabis, said Debbie Churgai, interim director of the national group Americans for Safe Access that pushes for reforms to increase clinical access to the drug.
“Most states don’t have required education for doctors, or patients, or anyone that works in a dispensary,” Churgai said. “For Washington state to have that requirement is amazing.”
But before a patient can walk into a retail store and purchase cannabis tax-free and at a quantity larger than is allowable for recreational users, they have to receive authorization from a doctor. Kaplan’s companion study suggests most doctors, outside of the naturopathic field, avoid any discussion with their patients of medicinal cannabis.
The biggest reasons given in the study were clinical policies that forbade consultation on the drug, which is still federally illegal and could jeopardize providers’ access to Medicare and Medicaid funds, and a lack of knowledge about the drug and its effects.
That presents a problem for people who want to receive authoritative advice from their providers, but meet with doctors who aren’t comfortable discussing the option of medicinal cannabis with their patients, Kaplan said.
“The issue is with older adults, they typically view health care providers with more authority,” she said. Of the 310 health care providers in the study authorized by state law to provide green cards to their patients, only 57 said they had done so.
“Right now, unfortunately, people can’t talk to their doctor,” Churgai said. “Either the doctor doesn’t want to hear about it, or discourages them. That’s what we need to change.”
Americans for Safe Access have created what’s known as a continuing medical education course that is available to licensed physicians, nurse practitioners, pharmacists and psychologists hoping to learn more about the drug. The course has been accredited by the American Medical Association.
Health care providers in the study said they were more likely to receive their information about medical cannabis from peer-reviewed journals, and 84% said they believed that medical marijuana should be part of their initial education.
That’s precisely what the College of Medicine plans to begin introducing in its curriculum this year, said Christina VerHeul, the college’s spokeswoman. In the past, students could approach their instructors with questions about medicinal cannabis and may have received some exposure to the research in clinical hours, she said, but with a new associate dean of curriculum joining the school, administrators are in talks about what research and instruction to include as part of instruction in this academic year, she said.
Kaplan’s team planned to present their research this week at a conference on medical cannabis held in Vancouver, Washington, and their first study on the medical consultants is slated for publication in the University of Toronto Medical Journal. Future research will look at the two groups – consultants and health professionals – together to determine what, if any, changes need to be made to the education of both groups in the future, she said.
“We want to see more shared decision-making in health care, that’s one of the things we want to emphasize,” she said.
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