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Primary Submission Category: Health care/services

Barriers faced by primary care physicians when discussing cannabis-based treatments for chronic pain

Authors:  Biyyiah Lee, Riley Wegryn-Jones, Arie Shaw, Kevin Boehnke, Bhaavna Yalavarthi, Sia Rajgarhia, Catherine Kilda, Amy Bohnert, Vivian Kurtz, Pooja Lagisetty, Rachel Bergmans,

Presenting Author: Biyyiah Lee*

Background: Cannabis availability is increasing through legalization efforts, and over a million Americans use it for chronic pain management despite limited evidence. Our community-engaged research program revealed patients’ interest in discussing their cannabis use for pain with primary care providers (PCPs). However, barriers exist, and PCP interactions involving cannabis are not always informative or positive, as views on cannabis’s therapeutic potential for chronic pain vary.

Aim: We aimed to identify factors influencing PCP discussions with patients regarding cannabis for pain management.

Methods: This qualitative study involved semi-structured interviews with PCPs in Michigan treating adults with chronic pain and specializing in internal medicine, family medicine, or geriatrics. Interviews explored cannabis-related knowledge, patient encounters, and pain management strategies. We used an adapted Rigorous and Accelerated Data Reduction technique to develop preliminary themes.

Results: We completed 15 interviews (93.3% MDs, 6.7% DOs, experience ranging from 1-27 years in practice), and we identified 4 preliminary themes: 1) prescribing uncertainty due to limited guidelines, evidence, and FDA-approved treatments, 2) practical barriers from time constraints, competing priorities, and lack of training, 3) community and institutional endorsement shaping provider support, decision making, and legal concerns, and 4) stigma-driven bias.

Next Steps: We plan to conduct 5-10 additional interviews to achieve data saturation and seek feedback on our data interpretation from representatives of the study population.

Conclusions: This community-engaged research highlights the need for targeted educational interventions to address provider uncertainty, systemic barriers, and stigma in cannabis-based pain management. Strengthening clinical guidance, institutional support, and training may improve provider confidence and facilitate evidence-based discussions to improve pain care.