Best practices for safe use of medical cannabis

Ogden Surgical Medical Society

May 14, 2026

Matt McIff, MD

Family medicine physician

Presentation overview

• A look at current cannabis use
• The need for medical cannabis education
• Endocannabinoid system
• Areas of concern
• Products available in Utah
• Medical assessment best practices
• Questions?

Cannabis use trends nationwide

National Center for Drug Abuse Statistics

Medical cannabis in Utah

Cumulative current active and expired patients.

As of April 2026, 113,000 patients or 3% of Utahns.

Utah Center for Medical Cannabis data and reports

Participating recommending medical provider’s by license type.

As of April 2026, there are almost 1,200 providers participating in the Utah Medical Cannabis Program. This represents 6% of eligible providers.

Cannabis education

A 2024 pilot study was conducted to assess health care provider’s confidence in their knowledge of cannabinoids:

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Russo E, Agredano PM, Flachenecker P, Lawthom C, Munro D, Hindocha C, Bagul M, Trinka E. The attitudes, knowledge and confidence of healthcare professionals about cannabis-based products. J Cannabis Res. 2024 Jul 24;6(1):32. doi: 10.1186/s42238-024-00242-y.

• 57% “lack confidence”
• Many rely primarily on news and social media for cannabis-related information
• Nearly half (47.4%) reported being hesitant to discuss medical cannabinoid use with their own patients, due to:
• regulatory constraints
• institutional policies
• overall lack of adequate training

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2025 Utah Medical Cannabis Market Analysis - University of Utah MCORE

2025 Utah Medical Cannabis Market Analysis - University of Utah MCORE

1988

Discovery of THC and CBD by Raphael Mechoulam PhD and Yehiel Gaoni PhD at Hebrew University.

American chemist Allyn Howlett PhD located a large grouping of receptors in the brain that responded to THC.

Mechoulam’s lab found a brain chemical that mirrored the effects of THC – Anandamide (and later another for CBD – 2-AG)

Endocannabinoid system – brief history

1964

1992

Endocannabinoid system

The endocannabinoid system is a large and sprawling system involving many organs.

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The system’s purpose:

• master regulator of the body
• homeostasis and neuroprotection
• primary messengers across nerve synapses
• modulate the flow of neurotransmitters

Endocannabinoid system

How can medical cannabis supplementation or treatment help the endocannabinoid system?

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• Regulate neurotransmission (usually downregulate)
• Achieve homeostasis
• Broad treatment involving multiple functions with mild-moderate effects
• Secondary or adjunct therapy

Possible benefits of cannabis

Research has shown that medical cannabis may help treat the symptoms for specific medical conditions, such as:

• In adults with chemotherapy-induced nausea and vomiting, oral cannabinoids are effective antiemetics.
• In adults with chronic pain, patients who were treated with cannabis or cannabinoids are more likely to experience a clinically significant reduction in pain symptoms.
• In adults with multiple sclerosis (MS)-related spasticity, short-term use of oral cannabinoids improves patient-reported spasticity symptoms.

The Current State of Evidence and Recommendations for Research. Washington (DC): National Academies Press (US); 2017 Jan 12. 4, Therapeutic Effects of Cannabis and Cannabinoids.

Common effects of cannabis that can be negatives:

Areas of concern

Vestibulum congue

Areas of concern

Cannabis use before the age of 25.

Cannabis use may affect children differently than adults. Extra caution should be taken when recommending medical cannabis to youth.

• Using cannabis before age 25 can harm brain development. This can worsen attention, concentration, and memory, especially when using cannabis every day or most days.

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• Using cannabis before age 25 increases risk of mental disorders like psychosis and schizophrenia. The more often the use, the greater the risk.

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• Cannabis can cause psychotic symptoms like severe paranoia. The risk is greatest in people younger than 25 or when using products higher in THC.

Adolescent Cannabis Use and Risk

Areas of concern

Cannabis Use Disorder (CUD)

Approximately 30% (3 in 10) of people who use cannabis may develop CUD.

• Some estimates suggest a lower rate of probability for the general users.

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• Youth and those you use daily or frequently have a higher probability.

CDC

Areas of concern

Drug interaction checker: drugs.com

Drug-drug interactions

• Cannabis can affect the amount of anesthesia needed before surgery.
• Warfarin - cannabis may increase blood levels and effects; closer monitoring of INR
• Cannabis should not be taken with cilostazol, clopidogrel, clobazam, or citalopram
• Cannabis should not be taken with sedatives

There are 403 drugs known to interact with cannabis; 28 are major. Some common issues are:

Areas of concern

• Psychiatric diagnoses – schizophrenia spectrum

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• Cardiac conditions like ischemic heart disease, arrhythmia, CHF, uncontrolled HTN

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• Immunocompromised or on immunosuppressives

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• Pregnancy and lactation

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• History of allergic reaction to cannabinoids

Contraindications

Patients with certain health conditions may respond poorly to medical cannabis. Extra caution should be taken with these patients.

• Links to psychosis, schizophrenia & cannabis use disorder.
• Links to anxiety and depression in non-therapeutic studies.

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There was only low-quality evidence for therapeutic benefits for anxiety & depression.

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Areas of concern

Thanitsara Rittiphairoj, Louis Leslie, Jean-Pierre Oberste, et al. High-Concentration Delta-9-Tetrahydrocannabinol Cannabis Products and Mental Health Outcomes: A Systematic Review. Ann Intern Med.2025;178:1429-1440. [Epub 26 August 2025]. doi:10.7326/ANNALS-24-03819

High-concentration THC

A recent systematic review looked at 99 studies regarding high-concentration THC. The review found:

Product information

Product and dosing are extremely individualized. Patients will respond differently to different methods of delivery and ratio of cannabinoids.

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Whole flower preparation

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Advantages:

• Contains all cannabinoids and terpenes.

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Disadvantages:

• Carcinogens and plant materials may be inhaled.
• Improper storage can lead to mold and plant degradation.

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Topicals

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Advantages:

• Localized pain management.
• Avoids first-pass metabolism.

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Disadvantages:

• Low skin penetration.

Product information

Product and dosing are extremely individualized. Patients will respond differently to different methods of delivery and ratio of cannabinoids.

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Edibles

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Advantages:

• Long duration and stronger effects.
• Dosing is easier and more precise.

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Disadvantages:

• Onset is delayed.
• Risk of accidental or over- consumption.

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Tinctures / oral mucosal

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Advantages:

• Easy to use and titrate.
• Can add to food or beverages.

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Disadvantages:

• Inconsistencies in formulations and labeling.

Product information

Product and dosing are extremely individualized. Patients will respond differently to different methods of delivery and ratio of cannabinoids.

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Inhalation /

vaporization

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Advantages:

• Immediate onset.

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Disadvantages:

• Proper use required.

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Vape concentrates

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Advantages:

• Immediate onset.

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Disadvantages:

• Higher THC common in vape cartridges.
• Inhalation (vaping and smoking): EVALI (e-cigarette vaping product associated lung injury), increased risk of lung disease such as bronchitis

Assessment factors

What can be done to promote safe practices?

Medical cannabis

should not be the first line treatment.

Carefully screen patients before recommending medical cannabis to them.

During an assessment, discuss treatment goals, address any concerns and plan for ongoing care.

Assessment factors

• Have you checked other medical conditions, like pregnancy, heart conditions, and mental health conditions?
• Have you checked other medications they’re taking?
• Have you checked if they’ll need help receiving care?
• Have you assessed their age?
• Do they have a history of using cannabis or other substances?

Use these questions to assess if medical cannabis benefits outweigh the risks.

Assessment factors

Talk to your patients about:

• Expected effects, potential side effects, and how to use cannabis safely (driving, storage, and etc,)
• Tracking the effects of cannabis and how they will tell you if they have concerns or issues
• Which products and doses to use, or ask them to work closely with the pharmacist about products and doses
• Treatment goals while using cannabis
• A plan for follow-up

Create a safe space for your patient to talk to you about their treatment goals, questions, and concerns.

Questions

Utah Department of Health and Human Service

Center for Medical Cannabis

(801) 538-6504

medicalcannabis@utah.gov | medicalcannabis.utah.gov