Adherence to prescription guidelines for medical cannabis in disability claimants.

Objective To examine a case series of 70 disability claimants who were referred to a clinic for multidisciplinary medical evaluation for physician compliance with cannabis prescription guidelines for pre-existing cannabis prescriptions. Design Retrospective case series analysis. Setting A private clinic in New Brunswick specializing in multidisciplinary medical assessment for institutional third-party insurers. Participants All referrals for independent review of cannabis prescriptions between May 2016 and February 2018 (N=70). Main outcome measures Compliance with the cannabis prescription guidelines. Results Treating physicians were found to have not adhered to the guidelines in 53 of 61 patients (86.9%) who were prescribed cannabis products for pain management and in 8 of 9 patients (88.9%) who were prescribed cannabis products for treatment of posttraumatic stress disorder. Clinical assessment and radiologic review failed to identify a neuropathic cause of pain in 70.5% of pain cases. Adequate trials of noncannabinoid medications had not been attempted for 72.1% of patients with pain nor for any of the patients with posttraumatic stress disorder. Contraindications to cannabis were identified in 65.7% of cases, including evidence suggesting a past or present cannabis use disorder or currently active substance use disorder in 34.3% of cases. The prescriptions were found to be consistent with prescription guidelines in just 12.9% of cases. Conclusion Very few of the reviewed cannabis prescriptions were found to be consistent with cannabis prescription guidelines. Respectful attention to guidelines might avoid unwarranted overprescribing, limit the secondary increase in comorbidity, and facilitate future scientific study and evaluation of medical cannabis.