Shared Decision-Making for Patients Using Cannabis for Pain Symptom Management in the United States

Abstract

Objectives: Gaps in research evidence and inconsistent policies regarding use of cannabis for pain and associated symptoms result in confusion for healthcare providers and patients. The objective of this review was to synthesize information on cannabis use for pain with legal and policy implications to create a shared decision-making model that can be used to guide patient care interactions. Approach: Current cannabis policies, state laws, research, and patient care practices related to medical and recreational cannabis in the United States were reviewed, along with best practices in shared decision-making. Reviewed literature was then synthesized to create a model that can be used by registered nurses and others to address cannabis use, where legal, for pain and related symptoms. Result and conclusions: Cannabis is a legal option for many patients with pain. To minimize harms and optimize benefits, nurses can play a key role when authorized by law in assisting with decision-making surrounding cannabis use.

Therapeutic use of cannabis in the US

“…Whether or not NPs authorize cannabis, they need to be aware of its potential impact on their patients and encourage open communication. Shared decision-making techniques can be used for cannabis as with any medication or medical decision 49. However, the stigma of cannabis use, even with medical authorization and indication, can limit both the practitioner and the patient from such information sharing 65.…”

“… 48 Patient-generated evidence and perspectives can also help drive further study as well as be used in patient decision-making processes. 49 …”

“…Shared decision-making techniques can be used for cannabis as with any medication or medical decision. 49 However, the stigma of cannabis use, even with medical authorization and indication, can limit both the practitioner and the patient from such information sharing. 65 There is also evidence that cannabis stigma is racialized, both in the media and in policy application to patients.…”

“…Ongoing self-education and assessment of both clinical and patient-provided evidence is a key part of any shared decision-making discussion, including those regarding cannabis. 49 …”

Policy Issues Affecting Nursing Pain Management: A New Decade of Hope

“…Specifically, the authors call for increased education of clinicians worldwide about opioid use disorders and to consider harm reduction techniques such as medicated assisted treatment, which may help save lives from opioid overdoses. In a similar vein, Wilson et al, (2020) discuss the ethical, legal and policy implications for using a shared decision making for patients using cannabis for pain symptom management in the United States.…”