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Upstate researchers identify barriers to medical marijuana usage in new study

Karna Sura, MD, and a team of researchers from Upstate Medical University recently published a study looking at cancer patients’ experience with medical marijuana and found that almost half the patients who qualified for it never obtained any.

The study, “Experience with Medical Marijuana for Cancer Patients in the Palliative Setting,” is published in in the June 2022 edition of in The Cureus Journal of Medical Science and can be found here (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9337788/)

The goal of the study was to better understand if patients who qualified were using the drugs and what benefits or barriers they experienced. Because marijuana is still illegal on a federal level, very little research about it exists.

“The impetus for the study was to learn whether patients are using the medical marijuana and if are they improving,” said Sura, assistant professor of radiation oncology. “Then, we can see how we can use that information to improve cancer care in terms of what is better for treatment in terms of medical marijuana.”

The research team, which includes Leslie Kohman, MD, Danning Huang, PhD, and Silviu Pasniciuc, MD, MS, did a retrospective analysis of patients who were enrolled in the New York state medical marijuana registry through the ambulatory palliative care department at the Cancer Center.

The study looked at 184 patients who received care from June 2017 to 2020. Fifty-one percent received at least one prescription from a New York licensed marijuana dispensary while 40 percent who were certified never obtained any medical marijuana. 

“I am surprised, but not shocked by those numbers,” Sura said. “Even prescription drugs don’t have 100 percent compliance.”

Sura said that there are several barriers to patients using medical marijuana.

Though providers enroll the patients in the program, patients have to complete another form online to get their card, and then go to speak to a dispensary pharmacist for information on how to administer the drug. Often the patients are older or not in good health, which can prevent them from following through. If patients don’t have a computer to sign up, they can submit paper forms, but Sura said those steps also serve as barriers.

Additional barriers are hesitancy, lack of information, concerns about the stigma attached to marijuana and a fear of getting addicted.

Cost is another big one. Medical marijuana is not covered by insurance and must be paid for with cash due to federal regulations.

Patients in the study spent an average of $60 per month, but if they had taken the marijuana as directed, they would have spent $300 per month.

For the 40 percent of patients in the study who did not use any medical marijuana, reasons included death (22 percent), used own supply (15 percent), cost (15 percent), registration issue (14 percent), dispensary issue such as dispensary couldn’t verify the medical marijuana card (3 percent).

Patients who did take the cannabis had positive outcomes. For patients who took at least one dose, 48 percent experienced an improvement in pain, 45 percent used fewer opioids, and 85 percent had an improvement in at least one symptom. Adverse side effects were low at just under 4 percent.

Sura said the medical marijuana helped study participants with pain relief, nausea, lack of appetite, anxiety, and sleep with minimal side effects.

“We know that chemo and radiation can cause side effects,” Sura said. “If we can make them feel better, their quality of life may be better. And medical marijuana can be an alternative for those who don’t do well on narcotics or don’t want them.”

The authors concluded that medical marijuana has an important role in the palliation of symptoms in advanced cancers with few adverse effects but that there are still many barriers to effective use. 

Sura said prospective research is needed to optimize delivery and dosing.

Since marijuana remains a Schedule I drug in the United States, federally supported research or research in federally-funded intuitions is prohibited. Sura hopes that that the state or federal government will soon allow funding for research, such as randomized studies, to further clarify efficient treatments.

“We have none of that information so collecting that data prospectively to look at would be really helpful,” he said. “You need funding to do that.”

Karna Sura, MD, led a team of researchers analyzing the use of medical marijuana for cancer patients in the palliative setting.