Lack of Communication About Medical Marijuana Use Between Doctors and Their Patients

Elin C. Kondrad, MD; Alex J. Reed, PsyD, MPH; Matthew J. Simpson, MD, MPH; Donald E. Nease, Jr., MD


J Am Board Fam Med. 2018;31(5):805-808. 

In This Article

Abstract and Introduction


Introduction: Medical marijuana is now permitted in most states, but it is not clear whether primary care physicians (PCPs) are aware of or recommend its use in their patients.

Methods: We distributed paired surveys to PCPs and their patients to assess the frequency of patient marijuana use and communication with PCPs about use.

Results: Of 242 patients surveyed, 22% reported marijuana use in the past 6 months, and 61% of these identified as medical marijuana users. PCPs did not complete state forms to recommend medical marijuana for any of the surveyed medical marijuana users. PCPs were aware of marijuana use in their patients only 53% of the time. PCPs identified conditions they believed could be adversely affected by marijuana use in 31% of users.

Conclusion: There is poor communication between patients and PCPs about medical marijuana use, which is being sanctioned by physicians other than patients' PCPs. We suggest more frequent assessment of and discussion about marijuana use in patients, particularly in states that have approved medical marijuana.


Medical marijuana use is permitted in 28 states and the District of Columbia.[1] Although people use marijuana for a variety of conditions, the evidence for its benefits is limited in quality and is largely based on studies of synthetic cannabinoids rather than the preparations used by medical marijuana patients.[2–6] Cannabinoids are also associated with an increased risk of adverse events compared with placebo or other medications.[3,4]

Medical marijuana use may not be identified in routine office screenings for drug use because most users do not consider it a drug of abuse, yet it may also not be identified in medication reconciliation because it is not prescribed and filled at a pharmacy but is recommended and bought at a dispensary. In a 2013 survey of Colorado family physicians, most respondents were skeptical of marijuana's medical benefits and were concerned about adverse effects; fewer than 20% believed physicians should recommend medical marijuana to patients.[7] In addition, a small group of physicians are responsible for disproportionately large numbers of medical marijuana recommendations, raising concerns about conflicts of interest among physicians who generate a substantial portion of their income by recommending marijuana.[8] We sought to assess primary care physicians' (PCPs) awareness of medical marijuana use by their patients and to investigate whether patients received a medical marijuana recommendation in the context of a longitudinal doctor-patient relationship.