Talking to Your Patients about Cannabis

Although the federal government's official position on cannabis remains unchanged, states across the country have taken issue with its classification by the US Drug Enforcement Agency as an illegal, Schedule 1 substance and passed a broad spectrum of laws legalizing it within their borders for purposes ranging from the treatment of rare diseases to recreational use. This movement has been driven not just by changing attitudes regarding the drug's use, but also by an increase in research demonstrating its potential to treat and alleviate the symptoms of a variety of diseases and conditions.

Regardless of where you stand on the issue of legalization, more and more people of all ages are using cannabis, and as their oral healthcare providers, we must strive to understand its effects on the oral environment and how its use by a patient can potentially affect our treatment decisions.

In this issue of Inside Dentistry, we examine the subject of patient cannabis use, identify some of the considerations for treatment, and explore how actions such as subtly changing the patient health history form and adopting a nonjudgmental approach can help you start a conversation with your patients about their use of cannabis and offer targeted advice about their ongoing oral care and hygiene.

Personally, I have not observed any noticeable increase in use among my patients, but I practice in a state that has not legalized cannabis for any purposes. Occasionally, I will smell cannabis on my patients' clothing, and because the topic has become less taboo, they seem more comfortable admitting to me that they smoked before the appointment. However, beyond assessing these patients for their ability to provide informed consent, I never really thought about how their cannabis use could affect my treatments. As you will learn, it has the potential to do so, and I plan to keep abreast of this potential as more research becomes available. In the interim, taking appropriate steps to improve patient communication about cannabis use seems more than prudent.

I believe it's important to remember that this isn't about "right or wrong"-it's about starting a dialogue and having the conversation with our patients. After all, the knowledge that we gain will allow us to provide them with the best possible dental care.

I'll be headed to New York City for the 2018 Greater New York Dental Meeting on November 23. If you see me walking around, please stop and let me know how we're doing. I always enjoy talking to our readers, and your wonderful feedback helps us continue to bring you the information that you're looking for.

Robert C. Margeas, DDS
Editor-in-Chief, Inside Dentistry
Private Practice, Des Moines, Iowa
Adjunct Professor
Department of Operative Dentistry
University of Iowa, Iowa City, Iowa
rmargeas_eic@aegiscomm.com