• Devan Kansagara, Benjamin J Morasco, Megan O Iacocca, Matthew J Bair, Elizabeth R Hooker, and William C Becker.
• Center to Improve Veteran Involvement in their Care (CIVIC), VA Portland Health Care System, Portland, Oregon.
• Pain Med. 2020 Nov 1; 21 (11): 3180-3186.

BackgroundCannabis is increasingly available and used for medical and recreational purposes, but few studies have assessed provider knowledge, attitudes, and practice regarding cannabis.MethodsWe administered a 47-item electronic survey to assess nationwide Veterans Health Administration (VHA) clinician knowledge, beliefs, attitudes, and practice regarding patients' use of cannabis.ResultsWe received 249 completed surveys from 39 states and the District of Columbia. Fifty-five percent of respondents were female, 74% were white, and the mean age was 50 years. There were knowledge gaps among a substantial minority of respondents in specific areas: terminology, psychoactive effects of cannabis components, VHA policy, and evidence regarding benefits and harms of cannabis. Most respondents were likely or very likely to plan to taper opioids if urine drug testing was positive for tetra-hydro cannabinol (THC; 73%). A significantly greater proportion of respondents from states in which cannabis is illegal for any purpose (odds ratio [OR] = 4.9, 95% confidence interval [CI] = 2.0-10.8) or is recreationally illegal (OR = 5.0, 95% CI = 2.4-10.8) reported being likely or very likely to taper opioids as compared with respondents from states in which cannabis is legal for medical and recreational purposes.ConclusionsAmong the sample, we found knowledge gaps, areas of discomfort discussing key aspects of cannabis use with their patients, and variation in practice regarding opioids in patients also using THC. These results suggest a need for more widespread clinician education about cannabis, as well as an opportunity to develop more robust guidance and evidence regarding management of patients using prescription opioids and cannabis concomitantly.Published by Oxford University Press on behalf of the American Academy of Pain Medicine 2020. This work is written by a US Government employee and is in the public domain in the US.

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