Surveys conducted in the 1990s (1) and 2000s (2) found that between 30% and 54% of internists and oncologists were in offering cannabis as a therapeutic option for their patients. Yet, despite this, the willingness of many physicians to prescribe medical cannabis for their patients has been less than enthusiastic. Many physicians are concerned about the legality of making medical cannabis recommendations or writing prescriptions regardless of state laws that make medical cannabis legal (3).
Because cannabis and its products are illegal at the Federal level, many physicians believe that they may find themselves in legal jeopardy even though medical cannabis is legal in the states where they practice medicine. Further, because medical cannabis has not be test or evaluated like other medicinal products, physicians have little or no scientific data to convince them that anecdotal claims about the there therapeutic benefits of cannabis are true. Finally, physicians make recommendations to patients about specific prescription drugs because they are educated about the safety and efficacy of those products. In the absence of this vital information, physicians will not write prescriptions.
The existing confusion about the legality/criminality of cannabis-derived products has also had an effect on the behavior of insurers and third party payers. To that point, medical cannabis is not on the formularies of almost all insurers in states where medical cannabis is legal and, because of this, they do not reimburse patients for out-of-pocket medical cannabis costs. While payers currently do not reimburse patients for the use of medical cannabis, it is possible that insurers may reimburse patients who use US Food and Drug administration (FDA)-approved cannabis products but continue to not reimburse patients who use unapproved medical cannabis treatments. Regardless of the outcome, medical cannabis costs continue to rise and its access and use by patients who might benefit from it may be in jeopardy unless payers place it on their formularies.
Because of the legal patchwork for Cannabis that has evolved over time in the US, it is likely that cannabis-derived pharmaceuticals may only be available in the states that have legalized their use. This would force companies developing cannabis-derived pharmaceuticals to duplicate commercial operations in states where medical cannabis is legal and underwrite multiple product launches in individual states because interstate transport of these products is currently illegal. This would be extremely costly (driving up product price) and also decrease patient access to these products to address unmet medical needs. To that point, most companies developing cannabis-derived pharmaceuticals believe that rescheduling of these products from Schedule I drugs to Schedule 2 or 3 would obviate most of these concerns and allow the US Cannabis market to grow to its full potential. Alternatively, FDA may reschedule cannabis-derived pharmaceuticals on a case-by-case basis upon approval of individual products.
Finally, because Cannabis-derived pharmaceuticals represent a new class of therapeutics, patient and healthcare provider education will be vital to successfully commercialize these products. Put simply, if physicians don’t understand cannabis-derived pharmaceuticals, and they are not convinced they are safe and effective, then, they are not going to write prescriptions for their patients. Therefore medical cannabis and cannabis-derived pharmaceutical companies must invest in public outreach activities as well as continuing medical education workshops and courses for healthcare professionals to ensure product success.
Despite all of these challenges, there is growing popular demand for cannabis-derived pharmaceuticals in the US. And, it is likely that inclusion of these products in the American pharmacopoeia will begin to address growing unmet medical needs in the US healthcare system and improve patient access to possibly life-changing therapeutic treatments.
- Doblin RE, Kleiman MA. Marijuana as antiemetic medicine: a survey of oncologists’ experiences and attitudes. Journal of clinical oncology: official journal of the American Society of Clinical Oncology 1991; 9:1314-1319.
- Charuvastra A, Friedmann PD, Stein MD. Physician attitudes regarding the prescription of medical marijuana. Journal of Addictive Diseases 2005; 24: 87-93.
- Bowles DW, O’Bryant CL, Camidge DR, Jimeno A. The intersection between cannabis and cancer in the United States. Critical Reviews in Oncology/Hematology 2012l; 83:1-10.