Providers Face Multiple Challenges Working With Cannabis Use Disorder Patients

Although cannabis is viewed by many as a harmless or “soft” drug, addiction treatment providers face both ethical and liability implications when working with patients who have acute cannabis use disorders.

At the Cape Cod Symposium on Addictive Disorders, Tanya L. Gouveia, MS, MPA, LCDP-II, LADC-I, who runs Addiction Recovery Counseling and serves as an adjunct professor at Bristol Community College in North Dartmouth, Massachusetts, presented a session on cannabis use disorder education, prevention, and clinical issues.

Ahead of her presentation, Gouveia spoke with Addiction Professional by email to discuss how cannabis impacts patients’ ability to sustain recovery, ethical and liability implications for providers who work with cannabis use disorder patients, and best practices for discussing cannabis use with patients in a manner that enhances the therapeutic bond.

Editor’s note: This interview has been edited for length and clarity.

Addiction Professional: What does existing research say with regards to benefits and harms related to cannabis use, as well as its impact on patients’ ability to sustain recovery?

Tanya Gouveia: The one statement I see most often is “more research is needed.” But the most important piece of information that I have been able to see is clinical research that is being done uses cannabis products with less than 10% THC in their studies. There is other literature that explains for medical marijuana to have efficacy, the THC content should be around 4%. This is significant when treating clients with substance use disorders who are consuming cannabis products with 20% or more THC. It is losing its medical efficacy and could potentially put the client in greater harm for medical and mental health crises, increase the likelihood of a relapse to other substances, and compromise a person’s ability to follow the principles of recovery.

Now, there is emerging evidence and FDA-approved medicines that are based off of CBD or synthetic THC. However, it is important to note that these medicines do not allow for the consumer to obtain an intoxicated effect. These medicines are to alleviate symptoms of medical conditions or other medical interventions like chemotherapy.  

AP: What are some examples of ethical and liability implications that providers should be aware of when working with patients who have acute cannabis disorders?

TG: There is a widely held belief that cannabis is harmless, a “soft drug,” or in general just not that big of a deal in comparison to other highly abuseable substances. The laws regarding cannabis are similar to alcohol, yet we hold them to different standards. If a client comes into a provider’s office smelling of alcohol with a flat affect and physical indications of being intoxicated, we have a clinical expectation and a legal obligation to make sure that person is not a danger to themselves or others, to encourage medical interventions, and in some cases notify family members. If a client comes in with the same presentation but smelling of marijuana, would the same interventions be made? Do agencies have policies in place and set treatment expectations with their clients if someone were to appear in these conditions?

My fear is that bad things will have to happen first before providers are held accountable for lack of action if a client or others are harmed and significant policies or more serious law enforcement support is more widely used. I encourage providers and agencies to develop standard operating procedures and policies on how to handle these situations. I also strongly encourage all providers that have client contact to have their own liability insurance.

AP: What advice do you have for generating discussions with patients regarding cannabis use that can enhance the therapeutic bond rather than create division over encouraged abstinence?

TG: The most important thing is to validate the client that you understand cannabis has a significant presence in their life for a reason that is important to them. I am very clear with clients that my job is not to change them, but instead to help them achieve their goals while also addressing any barriers that may prevent that from happening. Education is one of our greatest tools as providers. I have seen many clients complain of gastrointestinal issues they have associated with stress, recent alcohol consumption, or diet. Never would they have guessed that a condition called cannabinoid hyperemesis syndrome creates symptoms similar to their current complaints. This is common in chronic, high potency cannabis use. With this new information, that client can then decide how they want to proceed, and our job as providers is to respect that decision while supporting their journey.

Reference

Gouveia TL. Cannabis use disorder education, prevention and clinical issues. Presented at the Cape Cod Symposium on Addictive Disorders. Sept. 8-11, 2022. Hyannis, Massachusetts.