Colorado healthcare providers felt unprepared to talk to patients about marijuana health risks after legalization | Research

The takeaway

While Colorado providers frequently screened patients for marijuana use, most felt they lacked knowledge about health risks and were uncomfortable discussing specific effects, particularly around secondhand smoke, edibles, and safe storage.

Read this if you want to understand how legalization affected healthcare providers' ability to counsel patients about marijuana.

Only 23% of providers working with children routinely assessed marijuana use

What the researchers found

A survey of 114 Colorado healthcare providers who care for children, adolescents, pregnant women, and breastfeeding women found that about half of those working with adolescents and pregnant/breastfeeding women assessed marijuana use at every or most visits. Only 23% of those working with children did so.

Providers were generally knowledgeable about Colorado marijuana laws and cautious about supporting legalization. They perceived moderate to high health risks, particularly for certain populations. However, few felt completely knowledgeable about marijuana health risks, and many lacked confidence discussing specific effects.

The biggest knowledge gaps were around secondhand smoke exposure, underage use, safe storage of cannabis products, and the risks of edible overconsumption.

Why it matters

Legalization created a new clinical responsibility for providers, but this study shows that the medical education system had not kept up. Providers were screening for use but could not confidently discuss the specific risks, creating a gap between detection and effective counseling.

The numbers in context

114 providers surveyed. ~50% assessed marijuana use at every/most visits with adolescents and pregnant women. 23% did so with children. Few felt completely knowledgeable about health risks. Key gaps: secondhand smoke, underage use, safe storage, edible overconsumption.

How the study worked

Survey of 114 Colorado-based healthcare providers using Venue-Day-Time sampling methodology throughout the state. The sample included physicians, nurses, and medical assistants who care for vulnerable populations. The survey assessed knowledge of laws, risk perceptions, counseling practices, and training needs.

What this study cannot tell us

Small sample (114 providers) from a single state. Venue-Day-Time sampling may not represent all Colorado providers. Self-reported knowledge and confidence may not reflect actual clinical competence. The survey captured a snapshot early in Colorado's legalization experience, when knowledge gaps would be expected to be largest.

How to read the evidence

Cross-sectional survey with a small convenience sample from one state. Identifies important issues but has limited generalizability.

When this study was published

Published in 2017, reflecting early post-legalization conditions in Colorado. Provider education efforts have expanded since then.

The bigger picture

As more states and countries legalize cannabis, the provider preparedness gap identified in Colorado is likely widespread. Patients increasingly expect their healthcare providers to have informed opinions about cannabis, but medical training has historically treated cannabis primarily as an illicit drug rather than a health topic requiring nuanced clinical guidance.

Questions still open

Has provider preparedness improved in the years since legalization? What specific training programs are most effective at closing these knowledge gaps? Do providers in other legalized states show similar patterns?

Common questions

Why were providers uncomfortable discussing marijuana risks?

Medical training historically focused on cannabis as an illicit drug rather than a health topic requiring nuanced counseling. Legalization suddenly required providers to discuss dosing, product types, storage, and specific risks, areas not covered in most medical education programs.

What risks did providers feel least prepared to discuss?

Providers identified secondhand marijuana smoke exposure, risks of underage use, safe storage of cannabis products, and the dangers of edible overconsumption as their biggest knowledge gaps.

Read the original research

The clinical implications of legalizing marijuana: Are physician and non-physician providers prepared?

Addictive behaviors, 72, 1-7

View on PubMed ↗Publisher’s paper ↗

Citation

Brooks, Elizabeth; Gundersen, Doris C; Flynn, Erin; Brooks-Russell, Ashley; Bull, Sheana. (2017). The clinical implications of legalizing marijuana: Are physician and non-physician providers prepared?. Addictive behaviors, 72, 1-7. https://doi.org/10.1016/j.addbeh.2017.03.007