Perceptions of MMJ Among Pain Specialists in The USA

By John Taenzler, Ph.D., Partner

The following data was drawn from a survey of 86 Pain Management Specialists (APMs) in states where MMJ is legal. All data was collected using a double-blind protocol.  Cannalytic Insights adheres to the CASRO Code of Standards and Ethics.

When asked about their history of recommending MMJ to their pain patients, nearly half (47%) of Anesthesiology/Pain Management specialist (APMs) in the United States say they have never done so.  This is despite these specialists reporting that they have an average of 21 pain patients per month asking them about the possibility of using MMJ.

Further, among APMs who have yet to prescribe MMJ, 38% say they are currently opposed to using MMJ to treat patients’ underlying condition. This resistance continues despite each APM saying that, over the past 3 months, they have had an average of 48 patients come to them admitting to using MMJ in a self-medicating fashion to treat their pain.

FIGURE 1

Given the wide-spread problems with opioid dependence and abuse, why are APMs resistant to considering MMJ for their pain patients?

APMs report that among their pain patient using MMJ, over half (53%) tell them they have received a benefit, including 24% reporting benefits that have exceeded their expectations.

In addition, 26% of MMJ-using pain patients report that cannabis has been better than over-the-counter medications they have used, and 23% report that the benefits have been better than prescription medications.

• Only 11% of pain patients are described as reporting to their pain management physician unacceptable or serious side effects from using MMJ

Given the apparent enthusiasm pain patients have had toward using MMJ for their pain, APMs remain largely reluctant to widely recommending this treatment approach.

APMs justify their resistance to MMJ by discounting their patients’ experiences.

Lacking clinical trial evidence, APMs must rely on their clinical observations to assess the impact of MMJ on their patients.

When a patient presents to the APM with claims of benefits from MMJ, these physicians are more likely to attribute these benefits to the psychoactive properties of the MMJ or to a “placebo effect”, rather than a clinically measurable benefit.

• APMs currently prescribing (or highly willing to prescribe), state they are only able to measure a clinical effect in 39% of their patients who claimed that MMJ is effective.
• This is worse in APMs who are currently unwilling to recommend MMJ. These physicians say only 16% of their patients using MMJ (without their consent) have a clinically measurable effect.

FIGURE 2

APMs also view the MMJ market as NOT treating the medical aspects of cannabis serious enough.

Nearly two-thirds (64%) of APMs believe that MMJ should be viewed like prescription medications, and not like over-the-counter medications or like alcohol/tobacco (29%).

• This attitude is particularly strong among APMs who are “on the fence” about whether to prescribe MMJ. Nearly two-thirds (64%) of these APMs say MMJ should be viewed like prescription medication (vs. 15% who say it should be viewed like OTCs).

Furthermore, the terminology perpetuated by the MMJ industry is perceived by APMs as diminishing the seriousness of pain and the cannabis-based treatment options available.

• Nearly seven in ten (69%) APMs say the names of cannabis strains (e.g., Blue Dream, Sour Diesel, Girl Scout Cookies, etc.) diminished the seriousness of MMJ.
• Nearly as many (64%) APMs say the term “bud-tender” used for sales associates at distributors diminished the seriousness of MMJ.

The current MMJ market does not overcome the natural risk-averse approach APMs take to treating patients.

As a rule, physicians in the USA are very risk-averse when it comes to prescribing.  Multiple studies examining the medical decisions made by physicians have demonstrated that when considering a new treatment approach, their decisions are driven more by risk avoidance (e.g., will the new treatment be safe? will the new treatment overcome a risk posed by alternatives?), than by optimism of a beneficial outcome.

Lack of evidence from compelling, well-controlled clinical trials is a key barrier for 70% of APMs considering MMJ for their patients.  Further, professional organizations (e.g., American Academy of Pain Management), have not developed guidelines for when and how to use MMJ for treating pain.

In addition, physicians in the USA, must consider the risk of litigation (e.g., malpractice) should they advocate a product that results in a serious adverse event.  As such, 73% of APMs express a concern about litigation if they were to actively encourage use of MMJ, including 46% who say that litigation is a significant barrier.

Further, 63% would not like their colleagues to know that they are encouraging use of an unproven product, with 43% stating they would be perceived by other physicians as “reckless” or “irresponsible”.  This too is a significant barrier to their use of MMJ.

MMJ producers and distributors risk capping the potential of cannabis as a legitimate pain treatment by overlooking the concerns and informational needs of APMs.

APMs also perceive that they have been overlooked by the MMJ market, with a majority (69%) saying that producers of MMJ products should spend more time educating physicians.

In the pharmaceutical and biotechnology industries, education and marketing to physicians is key to increasing utilization of a medication. Furthermore, by providing physicians with a means to attain meaningful data and real-world support, companies can reduce the perceived risks of MMJ and demonstrate a commitment to physicians and their patients.

Using the pharmaceutical industry as a model, MMJ producers and distributors can take various steps to educate physicians on the potential benefits of medical marijuana.  This will allow for the effective promotion of cannabis to APMs as a legitimate treatment for pain, including:

• Branding efforts that do not diminish the seriousness of cannabis products for treating pain.
• Making no claims of benefits and/or risks without data supporting each claim.
• Providing a forum to where APMs can turn to about the pharmacokinetics, logistics, and regulations surrounding cannabis.
• Demonstrate to APMs that their pain patients are being well served by providing services, resources, and products directly addressing the needs of these patients.