大麻对话:医疗保健专业人员的角色

With recent developments in cannabis legislation in the United States, it is more important than ever that heath care providers are prepared to have conversations with their patients about cannabis use. In this blog, the authors of a recent review inAddiction Science & Clinical Practice, discuss the role health care professionals play in having evidence-based discussions with patients who use cannabis whether medical or recreational.

近年来,随着大麻立法的不断变化的景观,大麻的使用变得更加易于使用和接受。目前,33 states plus the District of Columbia (D.C.)allow cannabis use for medical purposes, and in11 of those states plus D.C.娱乐用途也是合法的。一项将在联邦一级合法化大麻合法化的法律(H.R. 3884) - 由two-thirds of US adults- 正在通过众议院努力。超过8%的美国成年人报告使用大麻last month, and over 2% of adults report using cannabis日常的. In short, clinicians will increasingly encounter patients who are using cannabis whether for medical purposes, recreation or both.

In parallel with these trends, the potency of cannabis has increased substantially while the public perception of the potential harmful effects of cannabis has decreased. Most people who are using cannabis get their advice through employees at cannabis dispensaries, also known as “budtenders,” while很少有人从医生那里得到有关大麻的建议这为卫生保健专业人员成为一个日益重要的医疗保健对话的一部分,为医疗保健专业人员创造了一个极为重要的机会。

大麻和健康:烟多于火

There is a lot of uncertainty about the health effects of cannabis. One thing is clear: we desperately need more high-quality scientific research about the benefits and harms of cannabis. There are signals that cannabis has the potential to be helpful for certain conditions, though the evidence is not as consistent and long-term as we would like. For example, two recent systematic reviews (read them这里这里) found indications that cannabis may offer promise for neuropathic pain in some patient populations, however, the research is not definitive.

运动谨慎

Cannabis is often thought of as a natural remedy and as having few serious adverse effects. However, there are some reasons for caution that healthcare professionals should educate patients about:

  1. Overdose risk: Edible cannabis products have a delayed onset, and individuals may unwittingly take too much with additive effects mounting over time.Acute psychosis可以随着THC的过多摄入而发生。还有意外摄入和过量服用的风险children, and individuals who use cannabis for medical or recreational purposes should be advised to properly store all cannabis products out of the reach of children.
  2. Cannabis use disorder:许多人没有意识到大麻使用重量成瘾的风险,以及停止或减少使用而导致戒断症状的潜力
  3. Higher risk populations:常规使用大麻 - 特别是在年轻人中,在患有精神分裂症遗传易感的大麻中 -associated with chronic psychosis.
  4. Lack of safety information in older, multimorbid populations

首先不伤害

Even though there is much to be learned about the health effects of cannabis, and many health care professionals aren’t in a position to directly endorse its use, patients are using – and will continue to use – cannabis. To help decrease the potential harms associated with cannabis, providers should engage in evidence-based discussions with patients.

Start the conversation:

  1. 询问患者以常规和非判断方式使用大麻的使用。
  2. 如果患者使用大麻,请询问目的,数量,频率和给药途径。
  3. 使用诸如此类的工具评估大麻使用障碍three-item Cannabis Use Disorders-Short Form, followed by assessment withDSM-V标准在正面屏幕的情况下。

向患者传达风险:

  1. Cannabis naïve patients should be cautious with edible products.
  2. Individuals should avoid frequent and long-term cannabis smoking, and long, deep breath holds during inhalation.
  3. 鉴于存在危险的合成大麻素,标签不准确以及严重疾病的风险,例如与烟相关的肺部疾病,警告不使用药房外获得的任何不受管制的产品,包括仅CBD宣传的产品。
  4. Caution patients who are prescribed other central nervous system (CNS)-acting agents (e.g. , opioids, benzodiazepines, muscle relaxants, and gabapentinoids) of the additive effect of cannabis on psychomotor slowing and other CNS side effects. Decreasing CNS-acting agent polypharmacy (in a safe, patient-centered way) prior to or concomitant with patients initiating cannabis regimens is recommended.
  5. 使用大麻时避免驾驶。

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