Colorado Family Physicians and Medical Marijuana: Has Recreational Marijuana Changed Physician Attitudes and Behaviors?

INTRODUCTION: Medical marijuana is permitted in 36 states; 15 states allow recreational marijuana use. Previous surveys showed that family physicians were concerned about the physical and mental health effects of medical marijuana use, but the impact of recreational marijuana legalization and liberalization of marijuana laws on physician attitudes is unknown. METHODS: A survey was distributed to 1582 members of the Colorado Academy of Family Physicians' listserv, with items on individual and practice characteristics and experience with and attitudes toward medical marijuana. The results of this survey were compared with that of a nearly identical survey conducted with the same group in 2011. RESULTS: The proportion of family physician respondents in Colorado recommending medical marijuana to patients was the same in 2020 as in 2011 at 31%; 53% of physicians said that legislation allowing recreational marijuana did not change their approach to medical marijuana with patients. Family physicians were more likely to be in favor of legalization of recreational marijuana in 2020 than in 2011. CONCLUSIONS: Marijuana decriminalization and a robust marijuana economy in Colorado have not led to more family physicians recommending marijuana to patients, but there is now greater support for the legalization of recreational marijuana among family physicians.

Lack of Communication about Medical Marijuana Use between Doctors and Their Patients.

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.

Colorado family physicians' attitudes toward medical marijuana.

INTRODUCTION: Over the last decade, the use of medical marijuana has expanded dramatically; it is now permitted in 16 states and the District of Columbia. Our study of family physicians in Colorado is the first to gather information about physician attitudes toward this evolving practice. METHODS: We distributed an anonymous web-based electronic survey to the 1727 members of the Colorado Academy of Family Physicians' listserv. Items included individual and practice characteristics as well as experience with and attitudes toward medical marijuana. RESULTS: Five hundred twenty family physicians responded (30% response rate). Of these, 46% did not support physicians recommending medical marijuana; only 19% thought that physicians should recommend it. A minority thought that marijuana conferred significant benefits to physical (27%) and mental (15%) health. Most agreed that marijuana poses serious mental (64%) and physical (61%) health risks. Eighty-one percent agreed that physicians should have formal training before recommending medical marijuana, and 92% agreed that continuing medical education about medical marijuana should be available to family physicians. CONCLUSIONS: Despite a high prevalence of use in Colorado, most family physicians are not convinced of marijuana's health benefits and believe its use carries risks. Nearly all agreed on the need for further medical education about medical marijuana.

"But my doctor recommended pot": medical marijuana and the patient-physician relationship.

As the use of medical marijuana expands, it is important to consider its implications for the patient-physician relationship. In Colorado, a small cohort of physicians is recommending marijuana, with 15 physicians registering 49% of all medical marijuana patients and a single physician registering 10% of all patients. Together, they have registered more than 2% of the state to use medical marijuana in the last three years. We are concerned that this dramatic expansion is occurring in a setting rife with conflicts of interest despite insufficient scientific knowledge about marijuana. This system diminishes the patient-physician relationship to the recommendation of a single substance while unburdening physicians of their usual responsibilities to the welfare of their patients.

Sexually transmitted infections and increased risk of co-infection with human immunodeficiency virus.

The incidence of trichomoniasis (Trichomonas vaginalis) in the United States is estimated at 5 million cases annually; chlamydia (Chlamydia trachomatis) at 3 million; gonorrhea (Neisseria gonorrhoeae), 650,000; and syphilis (Treponema pallidum), 70,000. However, most sexually transmitted infections (STIs) are asymptomatic-contributing to underdiagnosis estimated at 50% or more. Diagnosis of an STI signals sexual health risk because an STI facilitates the transmission and acquisition of other STIs, including human immunodeficiency virus (HIV). In fact, comorbid STIs increase patients' susceptibility of acquiring and transmitting HIV by two- to fivefold. Several studies have shown that aggressive STI prevention, testing, and treatment reduces the transmission of HIV. The authors discuss common clinical presentations, screening, diagnosis, and treatment for trichomoniasis, chlamydia, gonorrhea, syphilis, and herpes simplex virus.