Hostname: page-component-586b7cd67f-2plfb Total loading time: 0 Render date: 2024-11-25T20:21:40.254Z Has data issue: false hasContentIssue false
  • English
  • Français

Long-term medical cannabis use and risk factors for diversion: Report on physician's guidance and patients’ behaviour

Published online by Cambridge University Press:  13 June 2019

Sharon R. Sznitman ,
Victoria Goldberg ,
Hedva Sheinman-Yuffe ,
Yuval Zolotov Open the ORCID record for Yuval Zolotov [Opens in a new window] ,
Ezequiel Flechter  and
Gil Bar-Sela
Sharon R. Sznitman*
Affiliation:
School of Public Health, University of Haifa, Haifa, Israel
Victoria Goldberg
Affiliation:
Division of Oncology, Rambam Health Care Campus, Haifa, Israel
Hedva Sheinman-Yuffe
Affiliation:
Division of Oncology, Rambam Health Care Campus, Haifa, Israel
Yuval Zolotov
Affiliation:
School of Public Health, University of Haifa, Haifa, Israel
Ezequiel Flechter
Affiliation:
Division of Oncology, Rambam Health Care Campus, Haifa, Israel
Gil Bar-Sela
Affiliation:
Center for Malignant Diseases, Emek Medical Center, Afula, Israel Faculty of Medicine, Technion Israel Institute of Technology, Haifa, Israel
*
Author for correspondence: Sharon R. Sznitman, School of Public Health, University of Haifa, Eshkol Building, Room 705, Mount Carmel 3190501, Haifa, Israel. Tel.: +972 4 8288675; fax: +972 4 8288637; [email protected]
Get access Rights & Permissions [Opens in a new window]

Abstract

Objectives

Various jurisdictions have legalized cannabis for medical purposes. As with all psychoactive medications, medical cannabis carries a risk of diversion and accidental ingestion. These risks may be particularly high among long-term medical cannabis patients as safety practices may become less salient to patients once the treatment becomes part of everyday life. The current study examines whether patients who have used medical cannabis for longer periods differ from those who have used for shorter periods in terms of sociodemographic background and other key aspects of medical cannabis use. Furthermore, the study examines the relationship between length of medical cannabis treatment and risk factors related to storage and diversion. Finally, the study examines the extent to which oncologists provide information to their patients about safe storage and disposal.

Methods

One hundred twenty-one medical cannabis oncology patients were interviewed face-to-face and 55 oncologists participated in a survey about safe storage and disposal practices related to medical cannabis.

Results

Length of medical cannabis treatment was related to administration by smoking and using higher monthly dosages. In terms of risk for unsafe storage and diversion, length of medical cannabis was positively associated with using cannabis outside the home and having been asked to give away medical cannabis. Physicians did not report providing information to patients regarding safe storage and disposal practices in a regular manner.

Significance of results

Results suggest that there is an ongoing risk of unsafe storage and diversion over the course of medical cannabis treatment. Oncologists may need to give more consistent and continued training in safe storage and disposal practices, especially among long-term medical cannabis patients.

Keywords

medical cannabislegalizationoncology patientsoncologistsdiversionstorageunintentional ingestion
Type
Original Article
Information
Palliative & Supportive Care , Volume 18 , Issue 1 , February 2020 , pp. 18 - 23
Copyright
Copyright © Cambridge University Press 2019

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Belle-Isle, L, Walsh, Z, Callaway, R, Lucas, P, Capler, R, Kay, R. and Holtzman, S (2014) Barriers to access for Canadians who use cannabis for therapeutic purposes. International Journal of Drug Policy. https://doi.org/10.1016/j.drugpo.2014.02.009CrossRefGoogle ScholarPubMed
Brown, EG, Gnana, D and Kirchmeyer, K (2017) Medical Board of California's guidelines for the recommendation of cannabis for medical purposes. Sacramento, CA: Medical Board of California. Available at http://www.mbc.ca.gov/Publications/guidelines_cannabis_recommendation.pdfGoogle Scholar
Federation of State Medical Boards (2017) Model guidelines for the recommendation of marijuana in patient care: report of the FSMB Workgroup on marijuana and medical regulation. Washington, D.C.: Federation of State Medical Boards. Available at https://www.fsmb.org/Media/Default/PDF/BRD_RPT_16-2_Marijuana_Model_Guidelines.pdfGoogle Scholar
Feinstein, A, Banwell, E and Pavisian, B (2015) What to make of cannabis and cognition in MS: in search of clarity amidst the haze. Mult Scler 21(14): 1755–1760.CrossRefGoogle ScholarPubMed
Gruber, SA, Sagar, KA, Dahlgren, MK, Racine, MT, Smith, RT and Lukas, SE (2016) Splendor in the grass? a pilot study assessing the impact of medical marijuana on executive function. Frontiers in Pharmacology 7, 355.CrossRefGoogle Scholar
Inciardi, JA, Surratt, HL, Kurtz, SP and Cicero, TJ (2007) Mechanisms of prescription drug diversion among drug-involved club- and street-based populations. Pain Med 8(2): 171–183.CrossRefGoogle ScholarPubMed
Institute for Safe Medication Practices (2018) Safe storage and disposal of medications. ISMP Canada Safety Bulletin 18(5): 1–6.Google Scholar
Kim, HS and Monte, AA (2016) Colorado cannabis legalization and its effect on emergency care. Annals of Emergency Medicine 68(1): 71–75.CrossRefGoogle ScholarPubMed
Landschaft, Y, Elbo, B, Mechoulam, R, Shapira, Y, Biler, M, Afek, A, Lev, B, Dor, M, Schwartzberg, E and Roska, P (2017) Medical grade cannabis - clinical guide. Jerusalem, Israel: IMCA - Israeli Medical Cannabis Agency, Ministry of Health.Google Scholar
Linares, R, Choi-Nurvitadhi, J, Cooper, S, Ham, Y, Ishmael, JE and Zweber, A (2016) Personnel training and patient education in medical marijuana dispensaries in Oregon. J Am Pharm Assoc 56(3): 270–273, e272.CrossRefGoogle ScholarPubMed
MacCallum, CA and Russo, EB (2018) Practical considerations in medical cannabis administration and dosing. European Journal of Internal Medicine 49: 12–19.CrossRefGoogle ScholarPubMed
McCabe, SE, Cranford, JA, Boyd, CJ and Teter, CJ (2007) Motives, diversion and routes of administration associated with nonmedical use of prescription opioids. Addictive Behaviors 32(3): 562–575.CrossRefGoogle ScholarPubMed
National Conference of State Legislatures (2013) State medical marijuana laws. Washington, D.C.: National Conference of State Legislatures. Available at http://www.ncsl.org/issues-research/health/state-medical-marijuana-laws.aspxGoogle Scholar
National Health Service (2017) Supply, storage and safe disposal of medicines policy. Available at https://www.bcpft.nhs.uk/about-us/our-policies-and-procedures/m/981-medicines-supply-storage-disposal/file.Google Scholar
Salomonsen-Sautel, S, Sakai, JT, Thurstone, C, Corley, R and Hopfer, C (2012) Medical marijuana use among adolescents in substance abuse treatment. J Am Acad Child Adolesc Psychiatry 51(7): 694–702.CrossRefGoogle ScholarPubMed
SPSS, I (2013) IBM SPSS Statistics for Windows. Armonk, NY: IBM Corp.Google Scholar
Sznitman, SR (2017) Do recreational cannabis users, unlicensed and licensed medical cannabis users form distinct groups? Int J Drug Policy 42: 15–21.CrossRefGoogle ScholarPubMed
Sznitman, SR, Goldberg, V, Sheinman-Yuffe, H, Flechter, E and Bar-Sela, G (2016) Storage and disposal of medical cannabis among patients with cancer: assessing the risk of diversion and unintentional digestion. Cancer 122(21): 3363–3370.CrossRefGoogle ScholarPubMed
Tanabe, P, Paice, JA, Stancati, J and Fleming, M (2012) How do emergency department patients store and dispose of opioids after discharge? a pilot study. Journal of Emergency Nursing 38(3): 273–279.CrossRefGoogle ScholarPubMed
Tandowski, A, Zolotov, Y and Sznitman, SR (2019) Do users of diverted medical cannabis differ from other cannabis users? J. Stud. Alcohol Drugs 80(1): 42–45.CrossRefGoogle ScholarPubMed
Thurstone, C, Lieberman, SA and Schmiege, SJ (2011) Medical marijuana diversion and associated problems in adolescent substance treatment. Drug and Alcohol Dependence 118(2–3): 489–492.CrossRefGoogle ScholarPubMed
UNODC (2017) World Drug Report. New York: United Nations.Google Scholar
Volkow, ND and McLellan, TA (2011) Curtailing diversion and abuse of opioid analgesics without jeopardizing pain treatment. JAMA 305(13): 1346–1347.CrossRefGoogle ScholarPubMed
Wang, G, Roosevelt, G and Heard, K (2013) Pediatric marijuana exposures in a medical marijuana state. JAMA Pediatrics 167(7): 630–633.CrossRefGoogle Scholar
Wang, GS, Roosevelt, G, Le Lait, MC, Martinez, EM, Bucher-Bartelson, B, Bronstein, AC and Heard, K (2014) Association of unintentional pediatric exposures with decriminalization of marijuana in the United States. Annals of Emergency Medicine 63(6): 684–689.CrossRefGoogle ScholarPubMed
World Health Organization (WHO) (2003) Guidelines for the storage of essential medicines and other health commodities. Essential Medicines and Health Products Information Portal, A World Health Organization resource. Available at http://apps.who.int/medicinedocs/en/d/Js4885e/Google Scholar