Moving Us Closer To Osler
A Miller Coulson Academy of Clinical Excellence Initiative

Considerations When Talking With Patients About Cannabis


The medical literature on cannabis use is not clear, making it difficult to know what to tell patients. Share both positives and negatives about using marijuana, and help your patient make the best care plan for them.

I remember watching the classic 1936 propaganda film “Reefer Madness” in high school health class and having a reasonable class discussion related to it. Indeed, there was more marijuana use than alcohol use in my high school days. Times have changed and clearly a legalistic view of marijuana use has been a failure. Marijuana legalization is spreading state by state, not just for “medical” use, but for recreational use as well. 


“Cannabis means health,” says a billboard a few blocks from my workplace. “It has to be safe because it’s natural and from a plant,” a patient tells me. Of course, this isn’t accurate, as many plants are toxic, and cocaine and morphine are also plant derived 


“I want to try cannabis for my anxiety (or depression),” another patient says. But the medical literature shows many people become agitated or paranoid from cannabis, and we don’t have studies to understand cannabis use for mood disorder.  


So how do we have a conversation with our patients about using cannabis? Not easily. Here are a few things to consider when talking with patients:  


1. Marijuana is addictive, but conversely, not everyone becomes addicted.  

For adolescents, progression to daily use is more common than in adults. 


2.Marijuana is harmful, but not everyone is harmed. 

Daily use can result in severe nausea and vomiting (cannabinoid hyperemesis syndrome) that’s difficult to treat. Hot showers are the most helpful remedy. Use can also result in impaired driving. However, most recreational users with occasional use don’t suffer harm. 


3. Cannabis is a big problem for vulnerable populations. 

This is very true for adolescents. Daily use of marijuana in adolescents is associated with high school dropout, use of other drugs, and attempted suicide.  


Original trailer from the 1936 film “Reefer Madness:”






This piece expresses the views solely of the author. It does not represent the views of any organization, including Johns Hopkins Medicine.