Use and Reported Helpfulness of Cannabinoids Among Primary Care Patients in Vermont

Nicole Wershoven, Amanda G. Kennedy, and Charles D. MacLean

Journal of Primary Care and Community Health, 2020, 11, 1-6.

Doi : 10.1177/2150132720946954

Abstract

Introduction : While cannabis has been medically legal in Vermont since 2004 and recreationally legal since 2018 there has been minimal published research regarding the use and practices in the adult population. This gap in understanding results in primary care providers having difficulty navigating conversations surrounding cannabinoid use. The purpose of this research was to identify current use and perceptions of cannabinoids, including Δ9-tetrahydrocannabinol (THC) and cannabidiol (CBD), in adult primary care patients in Vermont.

Methods : An anonymous written survey was given to 1009 Vermont primary care patients aged 18 years and older. All measures were patient-reported and included use of CBD and THC products, perceived helpfulness for certain medical conditions, knowledge of CBD and THC, perceived knowledge of their provider, and concerns regarding cannabis legalization.

Results : 45% of adult primary care patients reported using cannabinoids in the past year. Only 18% of patients reported their provider as being a good source of information regarding cannabis. Of the patients who used cannabis in the past year, a majority reported it helpful for conditions such as anxiety and depression, arthritis, pain, sleep, and nausea.

Conclusions : Primary care providers need to be knowledgeable about cannabinoids to best support patient care. In addition, with a significant number of patients reporting cannabinoids helpful for medical conditions common in primary care, it is important that research continue to identify the potential benefits and harms of cannabis.

Keywords : cannabinoids, primary care, survey, rural health, medications

Background

Approximately 15% of adults in the United States selfreport cannabis use in the past year, with nearly 9% reporting use within the past 30 days.1 Cannabis contains over one hundred cannabinoids with Δ9-tetrahydrocannabinol (THC) and cannabidiol (CBD) being the most frequently studied.2 THC is a potent cannabinoid known for its psychoactive properties, while CBD is generally considered safer and
well-tolerated in humans.3

Medical use in the United States is limited by Drug Enforcement Agency scheduling, variability of state policies,
inadequate information about risks, and limited evidence of benefit in prospective human trials. There is some
evidence to suggest that cannabinoids (THC, CBD, or a combination) may be helpful for symptoms, including neuropathic pain and spasticity associated with multiple sclerosis. However, data are generally from trials with small sample sizes and are at risk of bias.4 Recent randomized trial data support the use of CBD for managing seizures related to Lennox-Gastaut syndrome.5,6 In this era of evolving evidence and public policy, it is not clear how patients are using cannabinoids to address medical symptoms or conditions. There are some recent data regarding perceptions of risks and benefits by patients using medical cannabis, 7,8 however data specific to adult primary care patients are needed, especially related to use of CBD, where little data currently exist. The purpose of this research was to identify current use of cannabinoids (both CBD and THC) in adult primary care patients, including perceived helpfulness in relieving symptoms.

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