Using medical cannabis can be challenging due to a lack of industry standardization on labels and little patient education
Is cannabis right for me? Are there side effects? Contraindications? What’s in the product? How safe is it?
These are some of the questions patients who begin to use medical cannabis may ask. As medical use has grown, a limited amount of credible information about how to use the drug can be challenging for them.
Unlike with a traditional prescription written by a health care provider, patients may not have a medical professional telling them how to use cannabis or what exactly to purchase. Adding to the confusion is that there is no standardized way to talk about cannabis.
Some issues patients face stem from labeling, Steph Sherer, founder of the advocacy group Americans for Safe Access, said during a webinar hosted by the American Public Health Association. This includes missing information about other products mixed in with cannabis, which can lead to adverse events, in part because there is no standard across states. Plus, few states check to see if the serving size on the label actually matches what it says, and in some cases the THC concentration is much higher, potentially causing accidental intoxication.
Lack of standardized labeling, testing protocols for cannabis
Not having standardized labeling can pose health risks, since there are wide variations in labeling requirements across states, ranging from four regulations to 26, according to a study in Cannabis and Cannabinoid Research. While all states included THC content and manufacturer contact information on labels, only close to half showed the amount of THC per serving, instructions for use or content restrictions, which could cause patients to take too much or too little of the product. Patients may expect to see labeling that aligns with products they are more familiar with, such as tobacco or dietary supplements, but different cannabis labels can make it more difficult to understand the information. Standardized labeling could make cannabis safer and more effective for patients, researchers concluded.
Another layer of complication is that states have different safety and testing protocols, with Michigan and New York, for example, showing different requirements for testing heavy metals, solvents and other contaminants. Differences also go back to labeling. The study in Cannabis and Cannabinoid Research found that testing information varies, with only 52% of states displaying information about testing facilities and even fewer – 35% – showing mold testing information.
Additionally, patients are not seeing themselves represented as markets seek consistency by moving toward legalized adult use in areas that also allow medical use. Many products specifically for patients don’t make it to shelves, while those that do are focused on consumers who want new products, Sherer said. Some retailers have tried to make accommodations for patients, such as offering a special product line for them, but many “don’t enjoy outing themselves,” and research is showing that some patients are displaced by adult-use programs, she added.
A study in the International Journal of Drug Policy found that enrollment in medical use programs has decreased in states that have allowed adult use, in which people above a designated age can legally purchase and use cannabis. In states that only have medical use, enrollment has grown. States with only medical use laws saw growth of 380 cardholders per 100,000 people per year, but when adult-use cannabis became legal, states saw medical program enrollment decrease 100 cardholders per 100,000 people per year.
When patients go to a dispensary, they may not get much information about using the products they purchase. A survey of dispensary staff published in JAMA Network Open showed that consumers are getting some information about cannabis storage and common side effects but not much information about risks, such as withdrawal or cannabis use disorder.
Why is this happening, and why is education a missing component of the cannabis landscape?
Broadly, a long prohibition on cannabis and the decision to make cannabis a Schedule I drug under the Controlled Substance Act has limited the ability for it to be studied, due to strict requirements involving approval from federal agencies and, in some cases, states. Still, some rules have been relaxed in recent years. A commentary in the Journal of Studies on Alcohol and Drugs argued that rescheduling cannabis from a Schedule I drug to Schedule III would enhance research and allow researchers to gain more insights into the benefits and risks of cannabis use, which could have implications for policy and therapeutic applications. It also could lead to a more evidence-based approach to use that may, by extension, affect patient education and decision-making.
Another reason patient education is lacking is that patients haven’t typically been included as stakeholders in conversations about cannabis, Sherer said. Discussions have centered around businesses, their taxes and operations, and that has continued with the most recent proposal to reschedule marijuana, which now appears to be in limbo.
One thing patients can do to help educate themselves about the products they’re buying is to ask for a certificate of analysis, which shows testing results, from either the retailer or the company. As long as the packaging displays the percentage of cannabinoids, the certificate should be available, according to Sherer. She advises that if patients ask for the certificate and the business refuses to supply it, they should not buy the product.
The NIH’s National Center for Complementary and Integrative Health also has information patients can reference when considering medical use.
