Orthopaedic Patient Perspectives on Medical Cannabis : A Survey of Over 2500 Patients

CLAY TOWNSEND, BS

ARI GREIS, DO

ASIF ILYAS, MD, MBA, FACS


SUMMARY POINTS


  • Based on a recent Pew Research poll, two-thirds of American citizens now support the legalization of cannabis, which has more than doubled since the year 2000.

  • As of early 2021, medical cannabis is now legal in 36 states and the District of Columbia for a variety of qualifying medical conditions.

  • A survey of 2,547 patients seeking orthopaedic consultation were anonymously surveyed and 9.4% were currently using medical cannabis for a medical condition.

  • The majority of survey respondents would consider using medical cannabis for chronic pain, or for other medical conditions. However, older patients were significantly less likely to believe medical cannabis is safe to use, or that medical cannabis is safer than prescription opioids.

  • The general public’s understanding of the mechanism, efficacy, and indications for medical cannabis was limited.

  • Cost and unemployment drug-testing concerns related to medical cannabis were found to be the primary barriers for utilization of medical cannabis.


INTRODUCTION


Based on a recent Pew Research poll, two-thirds of American citizens now support the

legalization of cannabis, which has more than doubled since the year 2000. 1 Cannabis is currently listed by the Drug Enforcement Agency as a Schedule I drug under the Controlled Substances Act of 1970, labeling it as having “no currently acceptable medical use” and having “high potential for abuse”. 2 In 1996, California became the first state to legalize medical cannabis (MC). As of early 2021, MC is now legal in 36 states and the District of Columbia for a variety of qualifying medical conditions, and recreational cannabis (RC) is now legal in 15 states. 3



The most common approved medical conditions in states with MC programs include

Alzheimer’s disease, amyotrophic lateral sclerosis, cachexia/wasting syndrome, cancer, Crohn’s disease, epilepsy and seizures, glaucoma, hepatitis C virus, human immunodeficiency virus/acquired immunodeficiency syndrome, multiple sclerosis and muscle spasticity, insomnia, anxiety, intractable nausea, and chronic pain. 4

Although research supporting the medical benefits of MC continues to emerge, the

perception and acceptance of MC by the public remains poorly understood. The purpose of this study presented in this Abstract / Research Brief was to assess current patient perspectives of MC, and to investigate factors related to its use that may represent barriers to patient utilization of MC.



METHODS


Over 2500 patients in an orthopaedic / musculoskeletal practice were surveyed on their

understanding and opinions of the safety profile, indications, legality, and potential uses of medical cannabis.



RESULTS


A total of 2,547 unique respondents completed the survey during the study period,

consisting of 1,476 (58.1%) females and 1064 (41.9%) males. Over half (57.1%) of survey

respondents were at least 50 years old. Most (78.0%) of survey respondents were college educated. Overall, 9.4% of respondents stated they are currently using MC for a medical condition, with the most common reason being for chronic musculoskeletal pain (68.0%). Overall, 89.3% of respondents believed MC should be legal throughout the United States, 32.6% believed RC should also be legal, and only 10.7% of respondents believed all forms of cannabis should be illegal.


Of the 2,304 (90.6%) respondents that did not currently use MC, the majority (81.6%)

answered that they would consider using MC for a chronic pain condition.


The majority of respondents (75.2%) strongly agreed or agreed that MC is safe for

treating pain associated with common orthopaedic conditions such as arthritis, back pain, and chronic nerve pain, with 22.6% being unsure, and 2.2% disagreeing or strongly disagreeing.


When asked what they would consider a potential barrier to using MC, cost was the

number one answer chosen by all respondents at 50.3%, followed by employment drug testing concerns (38.1%), being unclear on the best MC delivery method (33.3%), unclear advice on MC concentrations and ratios (28.1%), finding a certification doctor (27.0%), and being unable to travel out of state with MC (23.3%). Only 26.2% of respondents selected social stigma as a potential barrier for MC use.


The majority of respondents (75.2%) strongly agreed or agreed that MC is safe for

treating pain associated with common orthopaedic conditions such as arthritis, back pain, and chronic nerve pain, with 22.6% being unsure, and 2.2% disagreeing. The majority of respondents (77.1%) strongly agreed or agreed that MC is safer than prescriptions opioids for common pain conditions, with 20.7% of patients being unsure, and 2.2% disagreeing. Older patients were significantly less likely to believe MC is safe to use, or that MC is safer than prescription opioids. (Figure 1)




REFERENCES


1. Daniller A. Two-thirds of Americans support marijuana legalization. Pew Research

Center. https://www.pewresearch.org/fact-tank/2019/11/14/americans-support-marijuana-legalization/ Published 2019. Accessed January 20, 2021.

2. Comprehensive Drug Abuse Prevention and Control Act, 84 Stat. 1236, §21 U.S.C. ch.

13 § 801 et seq. 21 U.S.C. ch. 13 § 951 et seq (1970).

3. Legislatures NCoS. State Medical Marijuana Laws.

https://www.ncsl.org/research/health/state-medical-marijuana-laws.aspx. Published 2021. Accessed January 20, 2021.

4. Belendiuk KA, Baldini LL, Bonn-Miller MO. Narrative review of the safety and efficacy

of marijuana for the treatment of commonly state-approved medical and psychiatric

disorders. Addict Sci Clin Pract. 2015;10:10.


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