Cannabis in the Clinic: How to Implement an Embedded Medical Cannabis Program in an Academic Palliative Care Practice

Key Message: We describe a dedicated medical cannabis clinic integrated into an established ambulatory palliative care practice that addresses patient safety, supports informed decision-making, and responds to growing public demand for non-opioid symptom management. We offer our model as a practical and replicable model that can be readily integrated into clinical workflows.

Abstract: Medical cannabis is legal in 55 jurisdictions across the United States, including 40 states that permit full access and 10 states with limited access (low-THC). Six states require providers to receive education to certify patients; however, no U.S. medical schools mandate cannabis education, and only 9% offer any formal coursework on the topic. (1) Despite the growing interest in medical cannabis, most physicians receive minimal to no training in this area.

Education has rapidly expanded through elective certificates, postgraduate programs, and industry-sponsored educational certifications, but these are not required for physicians. (2) As public interest grows, clinicians face increasing demand for medical cannabis certifications and questions from patients and caregivers on access, efficacy, and safety.

This session remedies these gaps by describing how we implemented a dedicated medical cannabis clinic integrated into an established ambulatory palliative care practice. Our clinic addresses patient safety, supports informed decision-making, and responds to growing public demand for non-opioid alternatives to symptom management. We offer our model as a practical, replicable, and disseminable model that can be readily embedded into ambulatory practice clinical workflows, including templates for documentation and patient communication pearls to support patients in making informed decisions.

During the session, we will illustrate how we counsel patients on risks such as adverse psychiatric effects and cardiovascular risks, as well as conflicting evidence regarding the use of immunotherapy for patients. (3-5) We will also demonstrate how we counsel patients about hemp-derived THC variants (Delta-8, Delta-11), which are widely available yet unregulated and variable in potency.

Finally, we will illustrate how to practically implement this model in other ambulatory palliative care practices, including visit templates, counseling strategies, patient education materials, financial sustainability, and workflows developed with interdisciplinary support for documentation and monitoring.

References: 1. https://www.fsmb.org/siteassets/advocacy/key-issues/medical-marijuana-cme-requirements.pdf

2. Evanoff AB, Quan T, Dufault C, Awad M, Bierut LJ. Physicians-in-training are not prepared to prescribe medical marijuana. Drug Alcohol Depend. 2017 Nov 1;180:151-155.

3. Behling-Hess, C., Simonson, G., Salz, T., Fleege, N., & Zylla, D. (2025). The impact of cannabis on immune checkpoint inhibitor therapy: a systematic review of immunomodulatory effects of cannabis in patients with and without cancer. Supportive Care in Cancer, 33(3), 166.

4. Bar-Sela, G., Cohen, I., Campisi-Pinto, S., Lewitus, G. M., Oz-Ari, L., Jehassi, A., ... & Meiri, D. (2020). Cannabis consumption used by cancer patients during immunotherapy correlates with poor clinical outcome. Cancers, 12(9), 2447.

5. Kamel, I., Mahmoud, A. K., Twayana, A. R., Younes, A. M., Horn, B., & Dietzius, H. (2025). Myocardial Infarction and Cardiovascular Risks Associated With Cannabis Use: A Multicenter Retrospective Study. JACC: Advances, 4(5), 101698.