Cannabis: Calling on Pharmacists
Written by Maryjane C. Hammel PharmD'24
Published on December 4, 2020
It would be naive to deny the fact that the current attitude of Cannabis in the United States is shrouded in ambiguity throughout public, scientific, medical, and government opinion. In every corner of every discussion related to cannabis there is an undeniable degree of uncertainty centered around its most important facets, including its medicinal benefits, potential risks, legalization, and regulation. This uncertainty undoubtedly stems from marijuana’s controversial US history dating back to the 19th century and continues to exercise influence over its social and legal perceptions today. While cannabis is currently legalized for medicinal use in 33 states and recreational use in 11, it remains illegal at the federal level as a result of its schedule I categorization by the DEA in 1970.
While this increasing acceptance of cannabis has proved to be a great social victory, the medical sector has struggled to “catch up to speed.” With more and more patients now utilizing cannabis for its variety of proposed medicinal purposes, pharmacists and other healthcare providers struggle to confidently provide patients with credible information related to its safety and efficacy due to federal legal barriers surrounding its research by the usual routes. Herein lies the danger. The lack of federal guidance has allowed both for a variety of unregulated cannabis products to enter the marketplace as well as for its use to be predominately guided by misinformation and scientifically/medically unsupported claims, a potentially dangerous combination. A 2019 study by Ishida et al. evaluated the extent to which misinformation regarding cannabis was endorsed by participants and evaluated the sources of such false and misleading claims. The study found that among participants, 43% agreed with various statements of misinformation related to cannabis, with their most influential sources being social media, the internet, the marijuana industry, or friends and relatives. It appears that presently there are very limited routes for users to find legitimate information which they trust on the safe and effective use of the vast amount of cannabis products available to them.
It is not up to pharmacists to either debate the legality of cannabis or promote its use; however, it is their public obligation to engage their most important oath in protecting the health and safety of patients by ultimately expanding upon their professional knowledge and competence of cannabis as a drug. Pharmacists should be a resource to patients in regard to its safe and effective use. After all, pharmacists are the drug experts. So long as pharmacists remain within their scope of practice, they are perfectly positioned to counsel patients without fear of federal repercussion or their license to practice. Pharmacists should be knowledgeable of the functioning of the endocannabinoid system, the pharmacology of the cannabinoids, the various cannabis dosage forms and their unique effects, disease state precautions, adverse effects, and drug and disease interactions. Ultimately, pharmacists should be actively asking patients about their cannabis use status and applying their combined professional training and knowledge of cannabis to effectively counsel patients on its safe use.
In educating themselves, pharmacists have a responsibility to identify and refer to attributable clinical evidence and scholarly, peer-reviewed research as a baseline for growing their clinical knowledge-base. There are a variety of resources available to pharmacists for beginning their cannabis education. The American Pharmacists Association (APhA) offers several ACPE accredited self-paced continuing education courses related to cannabis on their website, several of which are free to members. The International Society of Cannabis Pharmacists (ISCPh) is another great resource offering ACPE accredited continuing education courses. In addition, pharmacists should take it upon themselves to research university-based academic certificate programs and courses that may be available as a formal expansion of their training.
While the confusing legal landscape surrounding cannabis appears set to change, pharmacists need to act in the interim to become well-versed in cannabis to guide and protect the increasing number of patients utilizing it. A study published in the Journal of the American Pharmacists Association in January of 2020 examined an Arkansas community’s attitudes toward pharmacist’s involvement in medicinal cannabis. Among the study’s findings were that 48.8% of the community expressed negative feelings towards pharmacist’s training in relation to cannabis and conveyed doubt in pharmacist’s ability to counsel on its appropriate use. In light of this, pharmacists need to act to educate themselves on cannabis with the ultimate goal in mind of gaining the trust of their patients in order to provide education on its safe and effective use. More importantly, pharmacists should not stop at their practice sites. Pharmacists should also be advocating for formal cannabis education in pharmacy curriculum as an ACPE accreditation requirement for accredited universities; finally, with increased pressure, it may be possible for pharmacists to influence policies related to cannabis. The faster we see these changes, the faster we can protect the health and safety of patients in relation to this currently under-researched drug therapy.