How Patients and Doctors Discuss Cannabis Through Hospital Messaging Systems | Research

The takeaway

Analysis of nearly 383,000 patient portal messages found cannabis discussions shifted dramatically after medical legalization: from drug screening concerns to patients actively seeking help accessing medical marijuana.

Healthcare system administrators, primary care providers, and health informatics researchers

7.2% of patients discussed cannabis through their patient portal

What the researchers found

Before medical cannabis legalization in Pennsylvania (2012-2016), cannabis-related messages were primarily about drug screening results (39% of patient messages, 77% of provider messages). After legalization (2017-2022), patient messages shifted to seeking medical cannabis access (35%) and reporting current use (25%). Provider responses were split between assisting with access (28%) and stating inability to prescribe or recommend (26%).

Why it matters

Patient portal messages reveal how people actually communicate with their doctors about cannabis, bypassing the social desirability bias of face-to-face visits. The shift from screening-focused to access-focused discussions shows how legalization changes the patient-provider dynamic.

The numbers in context

1,782 patient messages from 1,098 patients (7.2% of total) and 800 provider messages from 430 providers (7%) discussed cannabis. Top reasons for patient use: pain (50.5%), anxiety (13.7%), sleep (11.1%). 56 different purposes coded in patient messages.

How the study worked

Content analysis of 382,982 secure messages from 15,340 patients and 6,101 providers at a Pennsylvania health system (2012-2022). Natural language processing identified cannabis-related messages, followed by qualitative coding of a random sample.

What this study cannot tell us

Single health system in Pennsylvania limits generalizability. Only explicit cannabis mentions were captured; coded language may have been missed. The qualitative sample may not represent all cannabis-related messages.

How to read the evidence

Large dataset with both quantitative and qualitative analysis, though limited to one health system.

When this study was published

2024 study using 2012-2022 data

The bigger picture

The finding that one-quarter of provider responses after legalization stated inability to prescribe or recommend cannabis echoes the knowledge gap theme seen in other studies. Patients are ready to discuss cannabis; the healthcare system is not always ready to respond.

Questions still open

Do patients who discuss cannabis via portal messages have different outcomes than those who do not? Could AI-assisted message routing connect cannabis-inquiring patients with knowledgeable providers?

Common questions

Do patients discuss cannabis with their doctors through online portals?

Yes. About 7% of patients in this study discussed cannabis through secure messaging. After medical cannabis legalization, the most common reason was seeking help accessing medical marijuana.

How did legalization change cannabis conversations between patients and doctors?

Before legalization, most cannabis messages were about drug test results. After legalization, patients shifted to requesting help with medical cannabis access, while about a quarter of provider responses said they could not prescribe or recommend it.

Read the original research

Discussions of Cannabis Over Patient Portal Secure Messaging: Content Analysis.

Journal of medical Internet research, 26, e63311

View on PubMed ↗Publisher’s paper ↗

Citation

Shetty, Vishal A; Gregor, Christina M; Tusing, Lorraine D; Pradhan, Apoorva M; Romagnoli, Katrina M; Piper, Brian J; Wright, Eric A. (2024). Discussions of Cannabis Over Patient Portal Secure Messaging: Content Analysis.. Journal of medical Internet research, 26, e63311. https://doi.org/10.2196/63311