An Evidence-Based Intervention to Enhance the Readiness of Providers to Discuss Medical Cannabis With Patients Who Have Chronic Neurological Conditions

Background: In 2018, Utah voters approved Proposition 2, which will allow patients to use cannabis when recommended by a licensed provider. Availability and legal implications have left providers with significant knowledge deficits in prescribing cannabis. The purpose of this project was to develop an evidence-based intervention to prepare neurology providers for the legalization of medical cannabis in Utah. The specific aims were to (a) determine a baseline knowledge of medical cannabis among neurology providers; (b) identify gaps in knowledge; (c) disseminate an evidence-based educational intervention that outlines the pharmacology and current evidence available on medical cannabis; and (d) at 2 weeks postintervention, reassess provider knowledge. Methods: A short survey about cannabis was sent to 32 providers who care for patients with neurological conditions in outpatient and inpatient settings within the University of Utah Hospital and Clinics. An evidence-based module that reviewed the Utah Medical Cannabis Act, University of Utah guidelines for providers regarding cannabis recommendations, pharmacology, and clinical-trial data, was provided to the 18 providers who responded to the survey. Fourteen days after the module was distributed, a postintervention survey was sent by email. Results: Eighteen providers responded to the preintervention survey, and 11 of those 18 (61%) responded to the postintervention survey. Median survey scores increased significantly from pre- to postintervention in the following areas: increased confidence in discussing cannabis with patients who have epilepsy improved from neither confident or unconfident to somewhat confident (W = 3.5, p = .04); the measure of agreeability on whether or not providers should be recommending cannabis improved from neither agree or disagree to somewhat agree (W = 0, p = .03); side-effects profile of cannabidiol versus tetrahydrocannabinol remained strongly agreeable (W = 15, p = .05); cannabis administration for diminishing motor symptoms in patients with Parkinson's disease declined from neither agree or disagree to somewhat disagree (W = 28, p = .01); and cannabinoid administration to prevent seizure-induced neurotoxicity improved from somewhat agree to strongly agree (W = 0, p = .05). After completing the evidence-based module, providers indicated that (a) cannabis does have a role in medicine, (b) cannabis can improve and/or prevent some symptoms from occurring in patients with chronic neurological conditions, (c) they have a better understanding of the Utah Medical Cannabis Act and University of Utah Health Sciences policy as it relates to writing recommendations, and (d) it is imperative to reschedule cannabis within the Controlled Substance Act in order to conduct further randomized controlled clinical trials. Conclusions: The evidence-based module improved both knowledge and provider comfort in discussing cannabis with their patients. Current federal law remains a barrier to providers recommending cannabis for their patients, as evidenced by variability in provider responses regarding cannabis and federal law. This project can be reproduced for other specialties and has the potential to benefit patients by clarifying questions and concerns of providers.