The integration of cannabis into oncology care has become an increasingly pressing topic for healthcare providers, with Mayo Clinic's gastrointestinal oncology pharmacist Marie Parish, PharmD, BCOP, fielding daily questions about its incorporation into cancer treatment plans.
Growing Patient Interest Amid Regulatory Constraints
The legalization of recreational cannabis in Minnesota has sparked increased patient interest, yet healthcare providers face significant challenges in providing evidence-based guidance. "Because it's still considered federally illegal—it's a Schedule I substance per the Controlled Substances Act—it is very, very challenging to get clinical trials off the ground," Parish explains. The current regulatory framework creates substantial obstacles for researchers, including difficulties in obtaining medical-grade products for testing and navigating complex DEA requirements.
Potential for Research Expansion
There's optimism about potential changes on the horizon, with discussions underway about reclassifying cannabis from Schedule I to Schedule III. Parish believes such a change could catalyze much-needed research: "My hope is that once that happens, that will open the floodgates for well-designed, well-powered, randomized controlled trials that can give us the data that we're looking for."
Adapting Clinical Practice
Healthcare providers are evolving their approach to patient consultations to address cannabis use more directly. Parish has implemented a systematic approach to these discussions, incorporating cannabis use questions into her standard medication review: "I will ask them about their home medications, I will ask them about their allergies, and then my third question is, 'Are you a medical or recreational cannabis user?'"
Pragmatic Harm Reduction Approach
Rather than adopting a prohibitionist stance, healthcare providers are focusing on harm reduction and patient education. "I can tell a patient, 'Don't do this,' but realistically, are they going to not do that? I don't know," Parish notes. She emphasizes the importance of providing practical safety guidance, such as recommending edibles or topical products over inhaled forms during chemotherapy.
This pragmatic approach aims to maintain open dialogue and trust with patients while ensuring their safety during cancer treatment. "Giving them options that are safer rather than just giving absolute black and white, yes [or] no, I've found to be much more beneficial, and I feel like I've reached more patients that way," Parish concludes.
