Abstract

Introduction Medical cannabis use is increasing worldwide, and information about its use could aid clinicians in decision making. A Prescription Drug Monitoring Program (PDMP) is an electronic database designed to track controlled substance (CII-CV) prescriptions; the use evolved to support patient care. We analyzed the perceived impact of cannabis information in the PDMP within an integrated health system in Pennsylvania and state PDMP policies around cannabis.

Methods We conducted a sub-analysis of 50 semi-structured interview transcripts.

Interviews were conducted March-July 2023 with a multidisciplinary group of clinicians and administrators to understand cannabis use documentation. Twenty-four participants were asked if cannabis in the PDMP would impact their work. Additionally, we asked PDMP administrators of 50 US states and the District of Columbia (D.C.) if cannabis is in their PDMP. If yes, we inquired about software, timeframe, and data sharing.

Results Almost two-thirds of 26 participants (N = 17, 65.4%) believed cannabis in the PDMP would positively impact patient care. Fifty states and D.C. replied to our survey. Six states (i.e., CT, LA, NY, OH, MS, and VA) have medical cannabis dispensations. Four states (i.e., AZ, IL, ND, and UT) have a medical cannabis card indicator in the PDMP.

Conclusions:

Participants perceive medical cannabis in the PDMP could enhance clinical decisions, but inclusion requires policy changes in 40 states and D.C. Rescheduling of cannabis could accelerate adoption of medical cannabis into the PDMP. The PDMP is an underutilized tool that could provide crucial information to clinicians, but substantial policy changes are necessary.

Highlights

Unrecognized drug interactions with cannabis can be harmful

Minimal research exists on the impact on patient care with cannabis in the PDMP

This research offers an examination of state legislation to patient care

Clinicians suggest medical cannabis in the PDMP could benefit patient care

Graphical Abstract

Themes from clinician interviews and heat map showing the ten states that have medical cannabis in their Prescription Drug Monitoring Program (PDMP) along with the characteristics of other states. Cannabidiol: CBD; Kansas: KS: Idaho: ID; Tetrahydrocannabinol: THC.

Competing Interest Statement

BJP was part of study (2019-21 relating to osteoarthritis research funded by Pfizer and Eli Lilly). EAW reports serving on an advisory board for AstraZeneca. The other authors have no competing interests.

Funding Statement

Geisinger is the recipient of research support from Ascend Wellness Holdings, an approved medical marijuana clinical registrant in Pennsylvania. The funder was not involved in the study or the decision to submit for publication. Funding was provided by the Geisinger Academic Clinical Research Center research program. Only the interview portion of this research was funded by this mechanism.

Author Declarations

I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained.

Yes

The details of the IRB/oversight body that provided approval or exemption for the research described are given below:

Geisinger's Institutional Review Board of Geisinger gave ethical approval for this work.

I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals.

Yes

I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance).

Yes

I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable.

Yes

Data Availability

The non-human subjects part of manuscript the data produced in the present study are available upon request to the authors, but the human subjects, qualitative interviews, part of this manuscript are not available upon request due to maintaining confidentiality to our participants.

GlossaryCBDCannabidiolCBD-ACannabidiolic AcidCHSCannabinoid Hyperemesis SyndromeCII-CVSchedule II to Schedule V Controlled SubstancesDOHDepartment of HealthEHRElectronic Health RecordIRBInstitutional Review BoardIQRInterquartile RangeITInformation TechnologyMGAsMultidisciplinary Group of AdministratorsMGCAsMultidisciplinary Group of Clinician AdministratorsMGCsMultidisciplinary Group of CliniciansNDCNational Drug CodePDMPPrescription Drug Monitoring ProgramSDESmart Data ElementTHCTetrahydrocannabinolTHC-ATetrahydrocannabinolic AcidTHC/CBDTetrahydrocannabinol/Cannabidiol Ratio