Use of cannabis for medicinal purposes (medical cannabis) has a centuries-long history in the US and throughout the world, but has been illegal in the US at the federal level since 1937. Cannabis and all cannabinoids are classified in Schedule I of the Controlled Substances Act (CSA), meaning that they are considered to have a “high potential for abuse,” “no currently accepted medical use in treatment,” and “a lack of accepted safety for use” (21 U.S. Code § 812). More recently (2018), hemp and its products (including cannabidiol [CBD]) were removed from the CSA. In contrast, state-level interest in medical cannabis has been growing over the past 2 decades. As of August, 2020, 33 states, the District of Columbia, Puerto Rico, and Guam have made medical cannabis legal under state law, although not all programs are operational. Another 13 states have laws allowing use of cannabidiol (or “low-THC” cannabis) to treat seizures. However, most US physicians, including psychiatrists, receive little or no training about medical cannabis. They have inadequate knowledge and expertise to respond appropriately to patients who are interested in medical cannabis, to recommend it to patients who might benefit, or to discourage its use by patients for whom it would not be therapeutic. Our session will fill this knowledge gap through interactive presentations by 3 nationally known experts. Presentations will serve as a focus for discussion among presenters and attendees, culminating in a discussion of presented case vignettes and then general discussion. Our session will describe the difference between “prescribing” a medication under federal law vs. “recommending” or “authorizing” medical cannabis under state law, the major medical and psychiatric conditions for which medical cannabis can be recommended (most commonly pain, cancer, multiple sclerosis or muscle spasm, seizures, nausea and vomiting, HIV/AIDS, glaucoma, post-traumatic stress disorder, agitation associated with Alzheimer’s disease), the current scientific evidence supporting those indications, major side-effects associated with medical cannabis (e.g., dizziness, dry mouth, fatigue, drowsiness, euphoria, disorientation, confusion, loss of balance, motor incoordination, hallucinations), and potential public health consequences (e.g., increased motor vehicle accidents, diversion and increased misuse of cannabis, decreased use of opiate analgesics). Our session will also review the practical clinical pharmacology of medical cannabis, including the advantages and disadvantages of various routes of administration (smoked, inhalation of vapor, oral), cannabis strains with varying concentrations of THC, CBD, THC:CBD ratios, dosages, and drug-drug interactions. Attendees will apply this information to discussion of several case vignettes of patients interested in taking medical cannabis.

**This content was captured at the 2021 APA Annual Meeting and may reference information from various sources and terminology from previous editions of the DSM.

Learning Objectives

• Understand the differences between federal law and the various state laws governing medical cannabis, and the legal status of hemp.
• Be familiar with the clinical indications for medical cannabis and the levels of scientific evidence supporting them.
• Recognize the different clinical effects associated with various cannabis routes of administration and THC and cannabidiol concentrations.
• Identify potential patients for whom medical cannabis might be indicated or contraindicated
  Be familiar with potential public health consequences of medical cannabis use.

Target Audience

Psychiatrists, Residents/Fellows

Estimated Time to Complete

Estimated Duration: 75 minutes
Begin Date: April 1st, 2022
End Date: April 1st, 2025

How to Earn Credit

Participants who wish to earn AMA PRA Category 1 Credit ™ or a certificate of participation may do so by completing all sections of the course including the evaluation. After evaluating the program, course participants will be provided with an opportunity to claim hours of participation and print an official CME certificate (physicians) or certificate of participation (non-physicians) showing the completion date and hours earned. 

Continuing Education Credit

The American Psychiatric Association (APA) is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians. 

The APA designates this enduring CME activity for a maximum of 1.25 AMA PRA Category 1 Credit™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Planning Committee and Faculty Disclosures

The American Psychiatric Association adheres to the ACCME’s Standards for Integrity and Independence in Accredited Continuing Medical Education. Any individuals in a position to control the content of a CME activity — including faculty, planners, reviewers or others — are required to disclose all relevant financial relationships with ineligible entities (commercial interests). All relevant conflicts of interest have been mitigated prior to the commencement of the activity.

Program Presenters

• David A. Gorelick, MD, PhD, University of Maryland School of Medicine, has no financial relationships with commercial interests.
• Kevin Hill, MD, Beth Israel Deaconess Medical Center, has no financial relationships with commercial interests.
• Arthur R. Williams, MD, Columbia University Department of Psychiatry, has no financial relationships with commercial interests.

Program Planners

• Jacqueline Maus Feldman, M.D., Chairperson, Scientific Program Committee, Reports no financial relationships with commercial interests.
• Robert O. Cotes, M.D., Vice-Chairperson, Scientific Program Committee, Reports no financial relationships with commercial interests. 
• Uchenna Okeye, M.D., Vice-Chairperson, Scientific Program Committee, Reports no financial relationships with commercial interests. 
• Katie Putnam, Membership Development Specialist, American Psychiatric Association. Reports no financial relationships with commercial interests.
• Ally Brown, Associate Director, Online Learning, American Psychiatric Association. Reports no financial relationships with commercial interests.

Accessibility for Participants with Disabilities

The American Psychiatric Association is committed to ensuring accessibility of its website to people with disabilities. If you have trouble accessing any of APA’s online resources, please contact us at 202-559-3900 for assistance.

Technical Requirements

This internet-based CME activity is best experienced using any of the following:

• The latest and 2nd latest public versions of Google Chrome, Mozilla Firefox, or Safari
• Internet Explorer 11+

This Web site requires that JavaScript and session cookies be enabled. Certain activities may require additional software to view multimedia, presentation, or printable versions of the content. These activities will be marked as such and will provide links to the required software. That software may be: Adobe Acrobat Reader, Microsoft PowerPoint, and Windows Media Player.

Optimal System Configuration:

• Browser: Google Chrome (latest and 2nd latest version), Safari (latest and 2nd latest version), Internet Explorer 11.0+, Firefox (latest and 2nd latest version), or Microsoft Edge (latest and 2nd latest version)
• Operating System: Windows versions 8.1+, Mac OS X 10.5 (Leopard) +, Android (latest and 2nd latest version), or iOS/iPad OS (latest and 2nd latest version)
• Internet Connection: 1 Mbps or higher

Minimum Requirements:

• Windows PC: Windows 8.1 or higher; 1 GB (for 32-bit)/2 GB (for 64-bit) or higher RAM; Microsoft DirectX 9 graphics device with WDDM driver; audio playback with speakers for programs with video content
• Macintosh: Mac OS X 10.5 or higher with latest updates installed; Intel, PowerPC G5, or PowerPC G4 (867MHz or faster) processor; 512 MB or higher RAM; audio playback with speakers for programs with video content

For assistance: Contact educme@psych.org for questions about this activity | Contact learningcenter@psych.org for technical assistance