JAMA Open Network: Commentary – Cannabis Education—A Professional and Moral Obligation for Physicians | Cannabis Law Report | Where to order Skittles Moonrock online

The consensus statement by Zolotov et al¹ delineates the core cannabis competencies medical students should master, a framework long overdue in US medical education. Nearly 3 decades after state-level medical cannabis legalization began, this work by Zolotov et al¹ represents a tremendous breakthrough. Yet, arriving so late is not academic lag—it may be considered a professional failure of our medical education system.

Millions of patients now regularly use medical cannabis, yet our medical curricula largely ignore it. Surveys show a consistent educational void: residents report low confidence in counseling about cannabis, and trainees encounter minimal structured instruction despite practicing in states with legal medical marijuana. Across allied health and medical trainees, there is not just interest but demand for structured cannabis education.

Clinicians are increasingly confronted by patients using cannabis—often unsupervised and poorly informed. Patients rely on dispensary staff, online forums, or social media without reliable physician guidance. As Zolotov et al¹ emphasize, this disconnect compromises safety, deepens inequities, and erodes trust. It is no longer defensible for clinicians to remain willfully ignorant.

High-impact empirical evidence confirms both benefits and risks of cannabis that demand scientific literacy. A large meta-analysis of 32 randomized clinical trials (including 5174 patients) found modest yet significant improvements in pain and quality-of-life domains with oral medical cannabis.³ Others highlight adverse outcomes, such as cannabinoid hyperemesis syndrome, and potential cardiovascular, neurocognitive, and psychiatric risks.⁴ A 2024 evidence map systematically organized nearly 200 trials on medical cannabis effectiveness across multiple conditions, yet most physicians lack tools to interpret this data in practice.⁵ Physicians must understand these nuances, not just in abstract pharmacology, but to guide clinical decisions and harm mitigation.

A promising example of how clinical guidance can directly support cannabis education comes from the American College of Physicians (ACP), whose recent best practice advice outlines practical, evidence-based recommendations for the use of cannabis and cannabinoids in managing chronic noncancer pain.⁶ The ACP urges physicians to counsel patients with clarity. Some individuals may experience modest benefits, particularly in reducing pain or improving sleep. At the same time, the risks—particularly cognitive impairment, cannabis use disorder, and psychiatric exacerbation—can be clinically significant. The guidance from ACP explicitly emphasizes the importance of avoiding inhaled cannabis, advising against use in individuals who are pregnant or breastfeeding, exercising caution in vulnerable populations (eg, young adult and adolescent patients, patients with current or past substance use disorder, patients with serious mental illness, frail patients, and those at risk for falling), and considering cannabis only after evidence-based treatments have been tried. While not developed as a formal curriculum, this guidance maps closely to the very competencies Zolotov et al¹ propose, particularly around clinical risk assessment, communication strategies, and navigating therapeutic uncertainty. Importantly, the ACP’s call for physicians to be equipped to offer balanced, individualized, evidence-based counsel reinforces the consensus that cannabis education is no longer optional. As medical schools consider operationalizing the framework by Zolotov et al,¹ integrating such practice-oriented guidelines offers a robust foundation for building practical clinical competence.

The competencies proposed by Zolotov et al¹ should be mandated and integrated, not relegated to optional electives. Medical schools and residencies must embed cannabis training alongside opioids, benzodiazepines, and insulin—not as an afterthought, but as a core clinical domain. Importantly, such training must encompass the 6 core competencies: endocannabinoid system physiology; pharmacokinetics of tetrahydrocannabinol, cannabidiol, and other cannabinoids; relevant indications (eg, chronic pain, chemotherapy-induced nausea); risk profiles (eg, psychosis); dosing and administration methods; legal and regulatory frameworks; and strategies for patient-centered communication and shared decision-making.

Moreover, cannabis education is intrinsically an issue of health equity. Underserved populations are more likely to self-medicate when formal health care access is limited. When clinicians lack knowledge, patients face misinformation or unsafe use without medical support (eg, pregnant individuals, individuals with mental health conditions). A 2023 study by Metz et al⁷ linked prenatal cannabis use to increased risk of low birth weight and hypertensive disorders, underscoring the stakes when clinicians are uninformed or silent.

Opponents may decry the schedule I classification as a barrier to training or research. But clinicians routinely practice in ethically fraught and politically charged realms (eg, abortion, addiction, reproductive health), navigating care even when laws lag. Cannabis demands the same professional responsibility. We need not wait for the US Drug Enforcement Administration reclassification to act. Education can and must advance based on patient needs, accumulated clinical evidence, and ethical obligations

Zolotov et al¹ provide a blueprint; the question now is institutional ambition. Accreditation bodies, national boards, and medical educators must mandate cannabis competencies as part of licensing and graduation thresholds. Continuing Medical Education organizations should rapidly develop modules; residencies must integrate hands-on clinical experiences or simulation scenarios; medical schools should add didactic and case-based cannabis content starting in year 1, with reinforcement in clerkships.

We must also address sources of misinformation head-on. Medical students report receiving most of their cannabis education from unreliable sources and express confusion about its therapeutic role—a clear indictment of institutional inertia.⁸ Here, medical education innovators should learn from emerging tools: simulation exercises, patient-actor encounters, and artificial intelligence–powered case modules can build experiential competence, especially on nuanced topics, like patient communication and complex risk counseling. These methods are gaining traction in many fields, like end-of-life care and sensitive issues, and could be easily adapted for cannabis education.

This is not just reform—it is reclamation of our professional mission. Physicians are healers, guided by evidence and oath, not outdated legal definitions. Delay in clinician preparedness translates into preventable harm, perpetuated stigma, and a failure of trust.

The consensus statement by Zolotov et al¹ consensus has arrived after years of delay, but it inspires a call to action and roadmap. We now must act. Medical cannabis is here. Will physicians catch up, or will we, through omission, continue to let patients navigate therapeutic uncertainty alone?

https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2839746