Written by Elissa Capelle Vaughn,
As the evolving outlook on cannabis continues to shape conversations on the topic, how do clinicians approach the subject of cannabis safety for patients?
Creating a safe and educational space for these crucial discussions is critical to patient care. Medical professionals need a comprehensive tool set, from screening tools like questionnaires to education on product labeling, to ensure patient conversations are effective and focused on safe management of alternative treatments and harm reduction.
1. Strategies for Screening and Assessments for Cannabis Safety
The more information clinicians and nurses have, the more effective the patient communication process will be. Before asking about cannabis use specifically, you should have the patient’s medical history available. This history may include both physical and mental conditions, as well as any current medications.
Clinicians must use validated screening tools when asking questions. A consistent, evidence-based framework is needed to accurately identify signs of problematic use, which may prompt necessary conversations for intervention.
2. How to Ask Questions
When inquiring about cannabis use, ensure questions are relevant to the patient’s location and medical history.
For example, if a patient lives in a location where recreational cannabis is legal, asking whether they use “street drugs” wouldn’t yield a relevant answer. The patient would most likely say “no” since they’re less likely to view their cannabis use in this way.
Instead, you would ask if they use recreational or medical cannabis; this question accurately reflects the legal and social landscape of the patient’s location. Framing the question this way opens the door to a more substantive conversation between clinician and patient.
The next set of questions can focus on cannabis use itself, including the amount, frequency, type, and preferred methods of use.
In addition to patients’ medical histories and cannabis use habits, it’s important to understand the distinction between various strains. For example, reviewing this article on cannabis types and strains can help medical professionals develop more specific questions that yield valuable information relevant to patient health.
3. Cannabis Use Screening Tests
If you want to ascertain marijuana abuse patterns in patients, you can run a Cannabis Abuse Screening Test, also known as a CAST test.
This screening test identifies use patterns that can (or have) resulted in possible negative impacts on social, mental, and physical wellness. CAST tests can be effective when screening cannabis use in adolescents and young adults, providing necessary information for intervention planning.
Identifying potential cannabis abuse patterns is critical for an age group with ongoing development of the prefrontal cortex.
The Cannabis Use Disorders Identification Test-Revised, or the CUDIT-R, is a multi-item screening tool for adults that assesses cannabis use disorder. A CUDIT-R test produces a score; if that score meets or is higher than a certain threshold, there may be a need for more in-depth screening.
Additional screening may be necessary to understand the impact of cannabis use on a patient’s health. Conducting a Timeline Followback (TLFB) test can reveal more insight into cannabis consumption patterns. A TLFB is a calendar-based screening method that better visualizes (and quantifies) frequency, including the amount consumed, during specific time frames.
4. Risk Assessments for Interactions and Comorbidities
The next set of inquiries can reveal a deeper understanding of the impact of a patient’s cannabis use on current medications, both OTC and prescribed. The assessment should also be relevant to any pre-existing conditions the patient may have. This information is vital to preventing any adverse reactions.
The cannabinoids in Cannabis, THC and CBD, can potentially impact the effectiveness of patient medication or trigger side effects. Interactions may occur if both cannabis and medication are metabolized by the same cytochrome P450 (CYP450) enzyme system.
At this stage of the assessment, gather information about possible high-risk combinations and counsel patients if necessary. For example, patients who have prescriptions for sedative-hypnotics like benzodiazepines should be aware of the risks of cannabis use. Possible side effects may include:
- Depression of the central nervous system
- Heightened risk of impairment
- Dizziness
- Heightened risk of falls or accidents
Include questions about anticoagulants in your risk assessment. Patients who take blood thinners should be aware of the impact cannabinoids can have on their prescription drugs’ metabolism. Interaction could potentially affect the potency, increasing the risk of bleeding.
Patients taking prescription medications for a cardiovascular disease should know that cannabis can temporarily increase heart rate and blood pressure. Additional physiological stress from cannabis could also potentially increase the risk of a cardiac event.
Psychiatric disorders, including anxiety, comorbid mood disorder, and any known psychiatric disorders, should be assessed for risk during a cannabis use screening. The THC in cannabis can potentially intensify symptoms of these, even heightening the risk of psychosis.
5. Harm Reduction Strategies for Cannabis Use
The harm reduction approach requires clinicians to take a more compassionate and realistic angle. When it comes to discussing the risks of cannabis use, meeting patients where they are can make a positive difference, especially when it comes to discussing strategies for minimizing or ceasing cannabis use.
Harm reduction is about reducing any adverse impacts on patients. Clinicians, especially those in the alternative treatment space, can discuss safe cannabis consumption through a harm reduction lens.
For example, advising a patient to start with low doses of cannabis at a slower frequency can lower the risk of potential side effects. This advice should be tailored toward specific use; medical-grade edibles, for instance, have a delayed onset for several hours, producing stronger effects which can heighten side effects like anxiety, rapid heart rate, or dizziness.
An assessment may lead to a recommendation about a consumption method. For example, a patient with documented respiratory issues should be advised to switch from smoking medical cannabis to consuming it as an edible in gummy form.
It’s important to warn patients against using any kind of synthetic cannabinoids on the market.
6. Product Safety
Regardless of assessment results, all patients should be advised never to drive a car or operate any kind of machinery while under the influence of cannabis. Safety discussions should also extend to best practices for purchasing; for example, patients should only buy products that are regulated and tested for safe consumption.
7. Safe Consumption Advice for Specific Populations
Since the impact of cannabis use varies across age groups, conversations on harm reduction and safe consumption must be tailored to address the unique variables of different segments.
For example, when addressing cannabis use in adolescents and young adults, patients must understand that their brains are still developing. Therefore, continued use can impact learning, memory recall, and mental health, such as anxiety.
It’s essential to adopt an empathetic tone with this age group and all segments. However, since this age bracket is particularly vulnerable to the adverse effects of cannabis use on brain development, creating a non-judgmental space where young patients feel comfortable discussing the roots of their cannabis use can pave the way toward harm reduction strategies.
Use visual aids to convey the science behind THC and how it can interfere with the brain development of adolescents. Highlight studies and statistics about the increased risk of mental health challenges (and even addiction) later in life.
The success of these conversations relies on trust. Assure patients of the confidentiality of these assessments.
Adults of all ages must also be aware of the risks of cannabis use, especially as metabolism changes with age. There are also age-related health issues to consider. For example, older adults who are taking medical cannabis, or considering it, should be counseled on fall risks; this is an opportunity for a safe consumption conversation, especially if an older adult is taking cannabis or CBD for pain.
The harm reduction approach may also advocate the use of cannabis products with low THC levels and higher CBD content. THC is the psychoactive compound, while CBD can help manage issues with sleep disturbances or pain management. CBD products carry much lower risks for side effects.
8. Product Labels
As a clinician, you also assume the role of educator. Therefore, a complete cannabis use screening should include education on cannabis product labeling and marketing. These conversations may involve clarifying the differences in consumption methods, including how long the effects last. When describing CBD topicals, you could explain how the product provides localized relief for joint pain without the psychoactive effects of THC.
Always focus on real data when counseling patients. Use visual aids to discuss what product label data means. For example, the percentage of THC and CBD is a critical data point to discuss; this data helps patients understand the potency of the product. This discussion can help guide patients toward safer products with higher CBD percentages versus THC.
Follow up with patients and update assessments accordingly with new information as it arises.
Incorporate Cannabis Safety Conversations Into Your Methodology
Remember to prioritize harm reduction, safe consumption, risk assessments, and proper education in your cannabis use screenings moving forward. Leverage all available (and valid) cannabis use tests, including CAST, CUDIT-R, and TLFB, to determine intervention strategies, especially for adolescent patients. Integrate engaging visual aids and practice empathy to empower patients to regulate (or even lower) their consumption, opening the door to a healthier future.
Author bio:
Elissa Capelle Vaughn is a New York-based content writer who covers trending topics in health and wellness. She also brings a diverse background in sales and marketing to her work when discussing communication strategies in the health field.
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