JAMA offers a patient script for the cannabis talk

Clinical takeaway: Screening for cardiovascular disease, psychiatric history, and pregnancy identifies patients for whom cannabis risks are clear. For everyone else already using, the practical questions are potency, dose, and what else is on their medication list.

Cannabis often does not enter the visit either as a medical or recreational substance. It arrives as an aside on the way out the door, or may never surface at all. That silence is a clinical problem. Stigma, mistrust, and federal legal status all discourage disclosure, and what goes unsaid cannot be considered in relation to a sedating prescription, a psychiatric history, or heart disease.

More than one-fifth (21.2%) of people ages 12 and older used cannabis in the past year. That is about 61.6 million, up from 19.0% in 2021. The increase was concentrated among adults 26 and older even as adolescent use fell. Patients reach for it most often for pain, anxiety, and sleep, the three uses the evidence supports least. A new patient-facing page from JAMA separates the narrow set of approved cannabinoid indications from everything else and sets out what to tell patients who are using regardless.

Most of what patients use comes from a dispensary, where the label describes intent rather than strength. Cannabis labeled medicinal averaged 19.2% Δ9-THC, close to the 21.5% in products labeled recreational, and both sit well above the under-10% typically used in trials for conditions such as neuropathic pain. Compared with lower-potency use, high-potency cannabis is linked to psychotic-like experiences (12.4% vs 7.1%) and generalized anxiety disorder (19.1% vs 11.6%). Nearly one-third of people using cannabis for medical purposes meet criteria for cannabis use disorder.

The FDA-approved list, by contrast, is only three conditions long. Dronabinol, nabilone, and cannabidiol are approved for chemotherapy-induced nausea and vomiting, HIV/AIDS-related weight loss, and rare childhood-onset seizure disorders such as Dravet syndrome, where benefits run from small to moderate. For acute and chronic pain, insomnia, dementia, psychiatric disorders such as PTSD, multiple sclerosis, Parkinson disease, glaucoma, inflammatory bowel disease, and rheumatic disease, the page states plainly that cannabis and cannabinoids are not recommended.

The guidance is short enough to say out loud: licensed dispensary, lower-THC product, once or twice daily at most, oral or sublingual rather than smoked or vaped, no alcohol or sedating medications such as benzodiazepines or opioids, and no driving for 6 to 8 hours after inhaled or oral use or 8 to 12 after edibles.

Most patients aren't complying with these recommendations. Among US adults reporting past-year cannabis use, 70% used dried flower and 42% vape oils against 59% for edibles. Moving someone off inhalation also gets them into slower kinetics, since edibles may not peak for one to three hours.

None of this works without a candid conversation and patient disclosure, which makes an opening question vital. A patient who names the product, the strength, and how often they use can be steered toward a safer version of what they are already doing. But one who says nothing gets no counseling at all.

Source: Walter K. (2026 Aug 6) JAMA. Therapeutic use of cannabis and cannabinoids