Gender Differences in the Support of Medical Marijuana Use Among Primary Care Providers

Abstract

Background:

Despite the increased use and availability of cannabis, little is known about provider perceptions and practices regarding cannabis. The present study examined support for use of medical marijuana/tetrahydrocannabinol (THC) among a national sample of primary care providers and explored whether support varied by gender of the provider.

Methods:

Participants (N = 85) were primary care providers recruited through ResearchMatch.org who completed a 10-minute computer-administered survey on perceptions, attitudes, and experiences involving chronic pain management and medical marijuana/THC.

Results:

Demographically, the sample was predominantly female (60%) and White (70.6%), with a mean age of 40.81 years. Over one-third (37.6%) were nurse practitioners or physician assistants. A majority of practitioners supported use of medical marijuana/THC for chronic cancer pain (82.4%), chronic noncancer pain (64.7%), end-of-life/palliative care (64.7%), neuropathic pain (58.8%), intractable epilepsy (52.9%), and anxiety (50.6%). The lowest rates of support were found for patients with dementia with agitation (34.1%) and insomnia (31.8%). Female practitioners were significantly more likely than male practitioners to support medical marijuana/THC use for the following conditions: chronic cancer pain (90.2% vs. 70.6%; p < 0.05); end-of-life/palliative care (80.4% vs. 41.2%; p < 0.001); cachexia associated with severe illness (58.8% vs. 23.5%; p < 0.01); spasticity in multiple sclerosis (51% vs. 29.4%; p < 0.05); antitumor effects (52.9% vs. 17.6%; p < 0.01); and dementia with agitation (43.1% vs. 20.6%; p < 0.05).

Conclusions:

Findings suggest female providers are more likely to be supportive of medical marijuana/THC than male providers. Future research should assess how knowledge and training around medical marijuana/THC impacts level of support, as well as how level of support may impact behavior.

Introduction

Cannabis use is common in the United States, as it is the most widely used addictive substance after alcohol and tobacco, and a growing number of states have been legalizing cannabis for medical and/or recreational purposes.¹ As of July 2024, 38 states in the United States allow for the medical use of cannabis products, with 24 states, three territories, and Washington, D.C. having also legalized recreational cannabis for adult non-medical use.² Pain is the most common medical condition for which patients request medical cannabis.³ As the most common pain care providers, primary care practitioners (PCPs) face the challenge of more patients requesting information on medical cannabis. Medical cannabis has also been examined for management of other medical and psychiatric conditions, such as epilepsy, chemotherapy-induced nausea/vomiting, anxiety, depression, insomnia, and agitation in patients with dementia.^4–6

Several studies have examined health care provider views regarding medical cannabis. A 2013 survey of family physicians in Colorado found that only 19% believed providers should be recommending medical marijuana to patients.⁷ On the contrary, Carlini et al.⁸ conducted a survey of health care providers in Washington State and found that most believed there are significant health benefits to using medical cannabis.⁸ Similarly, Lee et al.⁹ found that the majority of oncology health care providers believe medical cannabis is safe (72%) and beneficial (57%) for their patients.⁹

Furthermore, many of these studies have identified conflicting beliefs among health care providers regarding medical cannabis. Philpot et al. surveyed PCPs in a Minnesota-based health care system and found that while most providers generally supported medical cannabis as a legitimate medical therapy and believed that medical cannabis was beneficial for treating cancer, terminal illnesses, and intractable pain, only 38.7% believed providers should be offering it to patients for managing medical conditions.¹⁰ A more recent study of Washington state health care professionals found that less than half believed health care professionals should recommend medical cannabis, but 71.5% believed that medical cannabis should be used to reduce opioid use for chronic noncancer pain, and 76.2% reported that cannabis can help patients suffering from chronic, debilitating medical conditions.¹¹ Ronne et al.¹² found widely varying attitudes from providers in five different countries toward prescribing medical cannabis, with a range of 10%–95% of physicians willing to prescribe/provide it to patients, depending on setting, specialty, and physician experience.¹² A recent qualitative study in Australia also identified contrasting beliefs about the utility of medical cannabis among providers.¹³ In line with these varied findings, in a systematic review of health care professionals’ beliefs surrounding medical cannabis, Gardiner et al.¹⁴ found that while none of the studies showed medical professionals rejecting the usefulness of medical cannabis entirely, there were varying degrees of support for its clinical utility.¹⁴

In addition to discrepant beliefs and practices regarding medical cannabis use, physician care practices may differ by provider gender. Several studies have found that female physicians are significantly more likely than male physicians to discuss general health prevention practices with their patients, including sensitive topics (e.g., sexual behavior, violence, use of substances other than alcohol); perform prevention services; and provide preventative counseling.^15–19 In particular, female physicians are also more likely than males to recommend some cancer-specific prevention practices and implement female-specific preventative practices.^15,18,20 Research has also demonstrated that female physicians have longer visit durations and are more patient-centered than their male counterparts.^18,21,22

While studies have separately examined both the perceptions of health care providers on the use of medical cannabis and general gender differences in physician care practices, the literature is lacking on studies examining gender differences among the perspectives of PCPs in the United States and their views on medical cannabis. Of the aforementioned studies and literature reviews assessing providers’ attitudes toward medical cannabis, none examined gender/sex differences. Given that practitioner support for medical cannabis influences prescribing decisions,¹³ gender differences in support could potentially impact patient outcomes and access to care. The current study assessed levels of support for the use of medical marijuana/tetrahydrocannabinol (THC) among a national sample of primary care providers, including attending physicians, advanced practice providers, and residents/fellows, and explored whether level of support varied by gender of the provider.

Materials and Methods

Participants

Participants were 85 primary care providers recruited from ResearchMatch.org, a nonprofit research tool sponsored by the National Institutes of Health that connects researchers with volunteers across the country interested in participating in research studies. ResearchMatch.org currently has over 145,000 volunteers registered with the site. Individuals were eligible to participate in the study if they met the following criteria: (1) at least 18 years of age and (2) currently a primary care provider.

Study procedures

Participants in this convenience sample were recruited through ResearchMatch.org from April 2021 to June 2021. A recruitment email was distributed one to two times per week to ResearchMatch.org participants. The recruitment email included a description of the study, stating that the goal was to gather information about attitudes and beliefs regarding chronic pain management from primary care providers, as well as a link to the REDCap screening survey imbedded in a button labeled “Yes, I’m interested.” Those expressing interest were taken to an anonymous REDCap screener.²³ Individuals who met study criteria then read an online information sheet. Those who agreed to participate proceeded with a 10-minute, anonymous, quantitative self-administered REDCap survey about their attitudes and beliefs regarding the treatment of chronic pain, patient use and misuse of prescription opioids, and potential impact of other substances (e.g., cannabis) on chronic pain treatment (see Supplementary Data S1 for full survey). Participants who completed the survey were given the opportunity to receive a $100 Amazon e-gift card through a random drawing. The research was reviewed and approved by the Virginia Commonwealth University Institutional Review Board.

Measures

Demographic information

Participants were asked about race, age, gender, provider type, practice setting, affiliation with academic medical center, and years of experience.

Support of medical marijuana/THC use

Participants were asked to indicate whether they support the use of medicinal marijuana/THC in patients with the following conditions: chronic cancer pain, chronic noncancer pain, neuropathic pain, intractable epilepsy, antitumor effects, spasticity in multiple sclerosis, patients with dementia with agitation, insomnia, post-traumatic stress disorder (PTSD), anxiety, depression, end-of-life/palliative care, chemotherapy-induced nausea and vomiting, and cachexia associated with severe illness.

Data analysis plan

Descriptive statistics were used to examine provider support of medicinal marijuana/THC use. Chi-square and independent t-test analyses were used to compare participant characteristics by provider gender. Chi-square analyses were also used to examine associations between those supporting use and provider gender. All analyses were conducted using SPSS version 26. Items left blank or with multiple responses were excluded from analyses involving that specific item.

Results

Sample demographics

Nearly two-thirds (60%) of participants were female, 40% were male, and 0% were other gender. As shown in Table 1, mean age was 41.25 years old. The sample was predominantly White (70.6%), followed by African American (15.3%), Asian (8.2%), and Other race (5.9%). Over one-third (37.6%) were nurse practitioners or physician assistants, 35.3% were attending physicians, 23.5% were residents, and 3.5% fellows. Significant gender differences were found by occupation (p = 0.005) and primary care practice setting (p = 0.02). No other gender differences were found.

Table 1.

Participant Characteristics

	Total sampleMean (SD) or N (%)	FemalesMean (SD) or N (%)	MalesMean (SD) or N (%)	p-Value
Mean (SD)
Age	41.25 (14.7)	40.89 (14.9)	41.80 (14.6)	0.80
N (%)
Race/Ethnicity				0.58
Caucasian	60 (70.6%)	37 (72.5%)	23 (67.6%)
Black/African American	13 (15.3%)	6 (11.8%)	7 (20.6%)
Asian	7 (8.2%)	4 (7.8%)	3 (8.8%)
Other	5 (5.9%)	4 (7.8%)	1 (2.9%)
Occupation				0.005**
Nurse Practitioner/Physician Assistant	32 (37.6%)	23 (45.1%)	9 (26.5%)
Attending Physician	30 (35.3%)	11 (21.6%)	19 (55.9%)
Resident/Fellow	23 (27.1%)	17 (33.3%)	6 (17.6%)
Primary care practice setting				0.02*
Rural	12 (14.1%)	10 (19.6%)	2 (5.9%)
Suburban	31 (36.5%)	22 (43.1%)	9 (26.5%)
Urban	42 (49.4%)	19 (37.3%)	23 (67.6%)
Primary care practice in a community or academic setting				0.54
Community	63 (74.1%)	39 (76.5%)	24 (70.6%)
Academic	22 (25.9%)	12 (23.5%)	10 (29.4%)
Affiliated with an academic medical center (% Yes)	37 (43.5%)	20 (39.2%)	17 (50%)	0.33
Years of experience				0.37
< 5 years	29 (34.1%)	18 (35.3%)	11 (32.4%)
5–9 years	21 (24.7%)	15 (29.4%)	6 (17.6%)
10–24 years	22 (25.9%)	10 (19.6%)	12 (35.3%)
≥25 years	13 (15.3%)	8 (15.7%)	5 (14.7%)

The bold data indicate significant difference. *p < 0.05; **p < 0.01.

SD, standard deviation.

Support of medicinal marijuana/THC use for entire sample

Figure 1 summarizes support of medical marijuana/THC use for a variety of pain and other medical, and psychiatric conditions for the total sample (N = 85). Over half of practitioners supported use of medical marijuana/THC for chronic cancer pain (82.4%), chronic noncancer pain (64.7%), end-of-life/palliative care (64.7%), neuropathic pain (58.8%), intractable epilepsy (52.9%), and anxiety (50.6%). The lowest rates of support were found for patients with dementia with agitation (34.1%) and insomnia (31.8%).

FIG. 1.

Primary care provider support of medical marijuana/THC use among the total sample (N = 85).

Support of medicinal marijuana/THC use by provider gender

Figure 2 summarizes support of medical marijuana/THC use for a variety of pain, other medical, and psychiatric conditions by provider gender. Female practitioners were significantly more likely than male practitioners to support medical marijuana/THC use for 6 of the 14 conditions assessed, including: chronic cancer pain (90.2% vs. 70.6%; p < 0.05); end-of-life/palliative care (80.4% vs. 41.2%; p < 0.001); cachexia associated with severe illness (58.8% vs. 23.5%; p < 0.01); spasticity in multiple sclerosis (51% vs. 29.4%; p < 0.05); antitumor effects (52.9% vs. 17.6%; p < 0.01); and dementia with agitation (43.1% vs. 20.6%; p < 0.05).

FIG. 2.

Primary care provider support of medical marijuana/THC use by provider gender. *p < 0.05, **p < 0.01, ***p < 0.001.

Discussion

As legalization of medical marijuana/THC has expanded further and further across the United States over the past two decades, a majority of Americans now live in states with legal access to medical marijuana/THC.² Thus, understanding health care providers’ attitudes toward the use of THC for medical problems is a timely and increasingly important endeavor. This study assessed levels of support for the use of medical marijuana/THC among a national sample of primary care providers, including attending physicians, advanced practice providers, and residents/fellows, and explored whether level of support varied by gender of the provider. Our findings were consistent with prior research indicating that a majority of primary care providers express support for using medical marijuana/THC for cancer pain, but attitudes toward the use of medical marijuana/THC for noncancer medical issues are more variable.¹⁰ In the current sample, 82.4% of providers (and over 90% of women providers) expressed support of medical marijuana/THC for cancer pain. Levels of support were lower for mental health diagnoses, including insomnia (31.8%), depression (42.4%), PTSD (44.7%), and anxiety (50.6%), compared with chronic noncancer pain (64.7%), neuropathic pain (58.8%), palliative care (64.7%), and intractable epilepsy (52.9%).

To our knowledge, this is the first study to analyze whether gender of the provider impacted level of support for medical marijuana/THC. Gender analyses revealed that, overall, female providers were significantly more likely to be supportive of medical marijuana/THC than male providers. Statistically significant gender differences were observed for support of chronic cancer pain, palliative care, cachexia, multiple sclerosis, antitumor effects, and dementia with agitation. The largest gap was observed for support of medical marijuana/THC for palliative care, with nearly twice as many women providers (80.4%) than men providers (41.2%) expressing support.

Our findings are consistent with previous literature on the differences in clinical care by provider gender. Compared with their male counterparts, female physicians have been found to be more likely to discuss general health prevention practices with their patients, perform prevention services, provide preventative counseling, and recommend specific practices.^15,16 Conversely, unpublished data from this survey indicate our present findings may be unique to medical marijuana/THC and not representative of general differences in support for medical interventions by gender. For example, we found no gender differences in whether providers would recommend cannabidiol to patients or in their belief that cannabidiol can lead to improved outcomes in chronic pain patients.²⁴

As legalization of medical marijuana/THC continues to expand, medical providers, and especially primary care providers, should be prepared for growing levels of patient inquiries and personal experiences with the use of medical marijuana/THC. Research has indicated that the vast majority of medical residents report little to no education in medical school or residency about medical marijuana/THC.²⁵ Despite this, medical providers have developed beliefs and attitudes about the use of medical marijuana/THC, whether from personal opinion or professional education, that may impact patient recommendations or provision of care. This study sheds light on current levels of support for the use of medical marijuana/THC for different medical problems among primary care providers. Furthermore, results suggest that provider characteristics such as gender may differentially influence level of support. As provider attitudes toward medical cannabis have been found to affect prescribing decisions,¹³ gender differences in provider support for medical marijuana/THC may, in turn, impact patient outcomes and access to care.

Limitations

Results of this study should be interpreted within the context of its limitations. Our sample of primary care providers was volunteer based, and it is possible that providers who self-selected to participate in a study about chronic pain management had different or stronger beliefs about the topic than those who did not. The sample was also small (N = 85), which may impact the generalizability of our findings. Due to our small sample size, we were unable to control for possible confounding factors. We could not include the provider response rate as we do not know how many primary care providers are in the ResearchMatch.org database. The literature on the effectiveness of medical marijuana/THC is unclear,²⁶ which may influence provider attitudes toward its use. Male providers in the sample were more likely to be attending physicians and to live in urban areas, either of which could have contributed to observed gender differences. We focused on levels of support of medical marijuana/THC from an attitudinal perspective, without assessing providers’ report of contributing factors to their levels of support (e.g., education, training, personal experience, experience with providing medical marijuana/THC authorizations) or impact of support on medical decision making.

Future research

Future research should assess knowledge and training around medical marijuana/THC to determine how this impacts level of support, as well as how level of support may impact behavior. Additional research is needed to determine if there are gender differences among types of providers in care involving medical marijuana/THC. Finally, future studies should also examine the role of patient gender in medical marijuana/THC utilization among primary care providers.

Footnotes

Authors’ Contributions

K.P.: Conceptualization, methodology, formal analysis, investigation, writing—original draft, supervision, project administration, and funding acquisition. A.W.: Writing—original draft and project administration. T.B.C.: Writing—original draft and writing—review and editing. W.S.: Conceptualization, methodology, investigation, writing—review and editing, and supervision. D.S.S.: Conceptualization, methodology, investigation, writing—review and editing, and supervision.

Author Disclosure Statement

The authors have nothing to disclose.

Funding Information

This research was supported by NIDA R36 DA046671 (PI: K.P.).

Supplementary Material

Abbreviation Used

References

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Supplementary Material

Please find the following supplemental material available below.

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