Use and Reported Helpfulness of Cannabinoids Among Primary Care Patients in Vermont

Abstract

Introduction: While cannabis has been medically legal in Vermont since 2004 and recreationally legal since 2018 there has been minimal published research regarding the use and practices in the adult population. This gap in understanding results in primary care providers having difficulty navigating conversations surrounding cannabinoid use. The purpose of this research was to identify current use and perceptions of cannabinoids, including Δ9-tetrahydrocannabinol (THC) and cannabidiol (CBD), in adult primary care patients in Vermont. Methods: An anonymous written survey was given to 1009 Vermont primary care patients aged 18 years and older. All measures were patient-reported and included use of CBD and THC products, perceived helpfulness for certain medical conditions, knowledge of CBD and THC, perceived knowledge of their provider, and concerns regarding cannabis legalization. Results: 45% of adult primary care patients reported using cannabinoids in the past year. Only 18% of patients reported their provider as being a good source of information regarding cannabis. Of the patients who used cannabis in the past year, a majority reported it helpful for conditions such as anxiety and depression, arthritis, pain, sleep, and nausea. Conclusions: Primary care providers need to be knowledgeable about cannabinoids to best support patient care. In addition, with a significant number of patients reporting cannabinoids helpful for medical conditions common in primary care, it is important that research continue to identify the potential benefits and harms of cannabis.

Comparing Cannabis Use for Pain to Use for Other Reasons in Primary Care Patients

“…Tobacco use disorder and nicotine use rates are high among people with CNCP, [37][38][39][40] concordant with our findings that a higher proportion of participants who used cannabis for pain had a diagnosis of tobacco use disorder. Finally, prior research involving adult primary care patients 41 is consistent with our observations that most participants who used cannabis for pain or other reasons found it helpful. With regard to our finding that participants who used cannabis for pain used it more frequently and were more likely to report tobacco use, yet were less likely to report CUD symptoms, it is conceivable that pain requires more frequent dosing of cannabis, that people with pain may use other substances in addition to cannabis for pain, and that they are less likely to report or develop CUD symptoms due to use for pain.…”

Cannabidiol as a Treatment for Chronic Pain: A Survey of Patients’ Perspectives and Attitudes

“…A similar response was observed in a survey among primary care patients, where only 18% describes their medical providers as being a good source for information regarding cannabis derived medications. 31 When asked about their personal experience, 35.5% of participants have never tried a CBD product while those who have report trying several different products for multiple conditions. A majority described some positive effects of CBD products on their conditions and reduction of pain medication.…”

Medical Cannabis for Headache Pain: a Primer for Clinicians

“…Voile et al [90] Brainstem CB1 receptor activation in PAG and PVM leads to top-down modulation of pain. Kelly and Chapman [74] AEA potentiates 5HT1A and inhibits 5HT2A receptors. Roger et al [22] Endocannabinoids interact with serotonergic neurons in the brainstem dorsal raphe to modulate pain mechanisms.…”

“…CBD may also have an analgesic role associated with TRP1 receptors and 5 HT1A receptor agonism. Evaluation of other anti-headache drugs that target the endocannabinoid system such as the use of FAAH or EMT inhibitors appear to have unique efficacy in female migraineurs [74]. Cannabis requires further evaluation in combination treatment or as a second line treatment in patients who are refractory to traditional medications.…”