1. NH Medical Society Herbal Marijuana Survey Presented by Seddon R. Savage MD, MS

2. Survey Goals Learn current and anticipated engagement by NH clinicians in use of herbal marijuana for therapeutic purposes Assess clinician understanding of marijuana effects and side effects

3. Link mailed to – 2642 physicians with four reminders – 900 APNPs on one occasion – Total 3540 467 responses – 239 physicians – 64 APRNs – 164 unknowns Response rate overall: 13.2%

4. If you know a patient uses or want to try MJ, how often do you advise them on risks & benefits

5. How often have you recommended a trial of marijuana for clinical purpose

6. How often have you recommended a trial of cannabinoid medications?

7. Will you be willing to certify a patient’s medical condition and symptoms for certification to use MJ?

8. Would you want to be on a list of physicians willing to certify patients for Clinical Cannabis?

9. How would you rate your knowledge of herbal marijuana/cannabis effects?

10. Marijuana Knowledge Challenges Herbal marijuana primarily studied in terms of outcomes and effects of illicit use Cannabinoids studied in terms of therapeutic effects and side effects Less research on therapeutic effects of herbal MJ – Highly variable herb with 50-200 biologically active chemicals (>50 cannabinoids all with different actions) Cannot extrapolate from research on cannabinoids to herbal marijuana Cannot extrapolate from one strain of marijuana to another strain

11. Marijuana Sources of “Evidence” Research related to illicit use Few research studies of therapeutic use – Few randomized controlled clinical trials Observation and experience Clinical case reports in popular media Extrapolation from cannabinoid research Expert consensus reached by any or all of above

12. Perception of Evidence Acute Therapeutic Effects

13. Perception of Evidence Acute Side-Effects

14. Perception of Evidence Chronic Side-Effects

15. Key Messages Education is needed to enhance clinician understanding of – Potential effects and side effects – Possible risks Patient counseling is needed to ensure understanding – Potential effects and side effects – Possible risks Data collection and research are needed to determine actual effects, side-effects & risks

16. Thank you to NHMS for launching survey