Although the drug is legal in Michigan, doctors in the state are hesitant to authorize their patients to use cannabis, while struggling to manage other influences on their patients’ health care decisions, says a University of Michigan researcher.

“We still have a real separation between the medicinal use of cannabis and mainstream health care, and that creates risks and problems,” said Daniel Kruger, a research investigator at the U-M Institute for Social Research. “We need to have better integration to promote health, both for individuals and society.”

Kruger and colleagues surveyed more than 1,500 Michigan physicians in a university-affiliated health care system. The doctors answered a series of questions via an anonymous online survey, recording their responses on a five-option scale.

The study was created in response to rapidly changing conditions surrounding the legalization and use of medical cannabis throughout the United States.

“Most Americans have lived under cannabis prohibition for most of their lives, and we’ve seen a very rapid transition from cannabis being something that’s considered illegal and a substance of abuse to millions of Americans having access to cannabis legally and millions of Americans using cannabis to treat all sorts of different health or medical conditions,” Kruger said.

The widespread use has created conflict between patients and doctors, particularly when it comes to information about how and when medical cannabis should be used, Kruger says. While information is plentiful on the internet, among family connections, and even from those legally selling medical and recreational cannabis, doctors often have little formal training or educational background concerning the drug.

There have also been very few formal studies on its effects and use cases, which often results in doctors deciding not to authorize medical cannabis use for their patients, he says.

Only about a third of physicians in the study had recommended medical cannabis to a patient and just 10% had signed an authorization form. Kruger believes a lack of education on the drug and its effects is a significant contributing factor to those rates.

“Most doctors and other health professionals were trained in the ‘prohibition era,’ the war on drugs, and so on,” he said. “They got the same kind of messages, many of which people consider to be false about cannabis being a gateway drug and having no benefits.”

Under those circumstances, many physicians default to federal guidelines that still classify medical cannabis as a Schedule 1 controlled substance, which in turn leads to people using cannabis medicinally on their own, with limited or nonexistent guidance from their doctors.

But that reality could be changing. Kruger believes the study could precede a shift in how doctors think about and recommend medical cannabis.

“Most, if not all, of the previous surveys of physicians have basically been attitude surveys,” he said. “Generally, they found that people overall did not support it. But this is the first study to actually go in depth and get into the actual specific behaviors of doctors and patients and the patient/physician interaction.”

The study was funded by the University of Michigan Medical School. Other researchers included: Majd Mokbel, Daniel Clauw and Kevin Boehnke of U-M; and Joseph Gerlach and Jessica Kruger of the University at Buffalo.