Delivery Routes

Recreational marijuana has several delivery routes, including inhalation (via cigarette, cigar, or herbal vaporizer) and consumption in the form of “edibles.” In states where recreational cannabis is legal, dispensaries sell a variety of cannabis-infused food items (eg, beverages, candies, cookies, honey sticks, butter, brownies, and cooking oils) Some package labels list the total milligrams of THC and CBD.1 Cannabis oils have also become popular and can be taken orally or used topically.1 Peters and Chien1 offer a thorough review of these delivery routes. Medical marijuana is available as an oil, pill, vaporized liquid and nasal spray, as dried leaves and buds, and as the plant itself.14

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Tips for Clinicians

Both experts offer tips to clinicians seeking to recommend medical marijuana to their patients.

Work closely with a prescriber

“Not all clinicians are prescribers, so if you are considering recommending medical marijuana to a patient, you need to work closely with a reliable and experienced physician who can prescribe and sign the person’s medical card,” Dr Rudroff said.

Be nonjudgmental

“Most older adults seeking to use medical marijuana are not ‘stoners,’ are not stereotypical members of the ‘stoner culture’ and are not seeking to get high,” Dr Prozialeck emphasized. He noted that most “are people from all walks of life and ages who simply need extra help with pain, insomnia, or other age-related conditions.”

Proactively ask about marijuana use

“Nonjudgmentally ask patients if they use recreational marijuana or if they use non-prescribed medical marijuana—what type they use and where they obtain it,” Dr Prozialeck advised. It might be helpful for the patient to bring specific information about what they are using so that the clinician can see the THC vs CBD content, he added.

Monitor patients closely

“Continue to be aware of the products patients are using, the other medications they are taking, and any adverse effects they might be having,” Dr Prozialeck suggested.

Advocate for more research

“There is a dearth of research regarding the effects of marijuana and clinicians should be advocates for more research and education in medical schools and CME activities regarding this important topic,” he concluded.

References

1.    Peters J, Chien J. Contemporary Routes of Cannabis Consumption: A Primer for Clinicians. J Am Osteopath Assoc. 2018 Feb 1;118(2):67-70.

2.    Governing the States and Localities. State marijuana laws in 2018 map. Available at: http://www.governing.com/gov-data/safety-justice/state-marijuana-laws-map-medical-recreational.html. Accessed: October 7, 2018.

3.    National Institutes of Health. National Institute on Drug Abuse (NIDA). Nationwide Trends. Available at: https://www.drugabuse.gov/publications/drugfacts/nationwide-trends. Accessed: October 7, 2018.

4.    University of Washington. Alcohol and Drug Abuse Institute. Marijuana use by older adults. Available at: http://learnaboutmarijuanawa.org/factsheets/olderadults.htm. Accessed: October 7, 2018.

5.    Substance Abuse and Mental Health Services Administration (SAMSHA). Results from the 2016 National Survey on Drug Use and Health. Available at: https://www.samhsa.gov/data/sites/default/files/NSDUH-DetTabs-2016/NSDUH-DetTabs-2016.pdf. Accessed: October 23, 2018.

6.    Substance Abuse and Mental Health Services Administration (SAMSHA). The CBHSQ Report. A day in the life of older adults: substance abuse facts. Available at: https://www.samhsa.gov/data/report/day-life-older-adults-substance-use-facts. Accessed: October 7, 2018.

7.    Han BH, Sherman S, Mauro PM, Martins SS, Rotenberg J, Palamar JJ. Demographic trends among older cannabis users in the United States, 2006–13. Addiction. 2017;112(3):516-525.

8.    Compton WM, Han B, Hughes A, Jones CM, Blanco C. Use of Marijuana for Medical Purposes Among Adults in the United States. JAMA. 2017 Jan 10;317(2):209-211. doi: 10.1001/jama.2016.18900.

9.    Agornyo P, et al. Older adults’ use of medical marijuana for chronic pain: A multi-site community-based survey. Presented at: American Geriatrics Society Annual Meeting; May 3-5, 2018; Orlando, Florida.

10. Bradford AC, Bradford D, Abraham AJ. Association Between US State Medical Cannabis Laws and Opioid Prescribing in the Medicare Part D Population. JAMA Intern Med. April 2018.

11. Wen H, Hockenberry JM. Association of Medical and Adult-Use Marijuana Laws With Opioid Prescribing for Medicaid Enrollees. JAMA Intern Med. 2018 May 1;178(5):673-679.

12. National Council for Aging Care (NCAC). The complete guide to medical marijuana for seniors. Available at: http://www.aging.com/the-complete-guide-to-medical-marijuana-for-seniors/. Accessed: October 20, 2018.

13. Centers for Disease Control and Prevention (CDC). The State of Aging and Health in America, 2013. Available at: https://www.cdc.gov/aging/pdf/state-aging-health-in-america-2013.pdf. Accessed: October 19, 2018.

14. Mayo Clinic. Marijuana. Available at: http://www.mayoclinic.org/drugs-supplements/marijuana/interactions/hrb-20059701. Accessed: October 23, 2018.

15. Shrivastava A, Johnston M, Tsuang M. Cannabis use and cognitive dysfunction. Indian J Psychiatry. 2011;53(3):187-91.

16. Lim K, See YM, Lee J. A Systematic Review of the Effectiveness of Medical Cannabis for Psychiatric, Movement and Neurodegenerative Disorders. Clin Psychopharmacol Neurosci. 2017 Nov 30;15(4):301-312.

17. Suryadevara U, Bruijnzeel DM, Nuthi M, Jagnarine DA, Tandon R, Bruijnzeel AW. Pros and Cons of Medical Cannabis use by People with Chronic Brain Disorders. Curr Neuropharmacol. 2017;15(6):800-814.