Is there a doctor in the house? Patient experiences regarding information-seeking and clinician advice in New Jersey’s medicinal cannabis program

Abstract

To ensure medical oversight in an environment of rapidly expanding medicinal cannabis use, states have established a framework of medicinal cannabis programs (MCPs), with regulatory standards governing qualifying medical conditions and care-monitoring by authorized clinicians. Whether MCP regulations strengthen medical oversight, however, is unclear, given the notable lack of research into health communications and clinician practices within MCPs. This paper addresses this gap by providing information from the patient’s perspective about medical information-seeking and advice within New Jersey’s MCP. Adult (18 +) registered medicinal cannabis users ( n  = 228) were recruited for this online study as part of a larger, population-based survey of New Jersey cannabis users conducted in 2022–2023. Respondents were questioned about medical advice sought and received with respect to dosage, side effects, tolerance, withdrawal symptoms and strains. Descriptive statistics, chi-square analysis, ANOVA and multivariable logistic regression were used as appropriate to describe patients’ information-seeking behaviors and identify factors associated with receiving advice from MCP-authorized clinicians. Findings revealed a sizeable communication gap between patients and MCP-affiliated clinicians. Only 52% received advice from clinicians in any of the five topic areas studied, while 85% received advice in any area from dispensary staff. The primary driver of suboptimal communication was online certification by MCP specialty clinicians. Compared to patients certified by a cannabis specialist online, the odds of receiving advice were higher among patients certified by their primary care clinicians (AOR = 3.73; 95% CI = 1.25–11.14), other established clinicians (AOR = 3.11; 95% CI = 1.35–7.16) or a cannabis specialist in person (AOR = 4.09; 95% CI = 1.78–9.39). Males (AOR = 2.44; 95% CI = 1.23–4.83) and Black patients (AOR = 4.08; 95% CI = 1.18–14.15) also had higher odds of receiving advice, while lower odds of advice were found for patients age 50 and older (AOR = 0.38; 95% CI = 0.19–0.79) and those with PTSD (AOR = 0.09; 95% CI = 0.02–0.41). While some states require in-person only certification and monitoring, New Jersey and other states permit all medical assessments and monitoring to be conducted virtually. More stringent state requirements surrounding MCP clinician training, patient certification, and care management may potentially enhance medical oversight while ensuring safer cannabis use and more effective outcomes.