A multidisciplinary panel of 23 experts finalized 6 core competencies to guide cannabis education in US medical schools. Students and physicians should understand:
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the endocannabinoid system
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cannabis components and biological effects
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the US legal and regulatory environment
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evidence for therapeutic indications
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risk assessment
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basic clinical management
Each domain contains further subcompetencies that include patient safety, vulnerable populations, structural inequities, and interdisciplinary care. The competencies were rated highly for importance (mean 4.5) and wording (mean 4.4) using 5-point scales. Most panel members recommended 8 to 10 hours of instruction in existing pharmacology, public health, and clinical-medicine courses rather than developing separate electives.
Along with fellow researchers, Yuval Zolotov, PhD, of the Department of Health Systems Management at Ariel University in Israel and the Division of General Internal Medicine at Albert Einstein College of Medicine in New York, noted that as of February 2023, medical cannabis was legal in 38 states, the District of Columbia, Puerto Rico, and 3 US territories. Further, nearly 3.9 million patients were registered for medical cannabis use in 34 states and the District of Columbia. However, formal medical-school instruction on cannabis science and clinical management remains limited—only 9% of medical school curricula in the 2015 to 2016 academic year mentioned medical cannabis, despite clinical evidence for its therapeutic benefit in pain, muscle spasticity, and chemotherapy-induced nausea and vomiting.
Therefore, the research team used a modified Delphi process using web-based questionnaires from February to October 2023 to develop a consensus-based set of competencies with the participants, who included 14 physicians from multiple specialties, nurses, a pharmacist, and educators. Competencies with mean scores of 4 or higher for both importance and wording were retained. Two survey rounds refined 9 initial topic areas into the 6 domains outlined above. Round 2 importance ratings ranged from 4 to 4.8.
The study authors acknowledged limitations, including potential selection bias due to voluntary participation and limited demographic diversity among panelists (26% identified as non-White and 17% were aged 40 years or younger). Patients and caregivers were not included, and implementation feasibility was not evaluated. The researchers also cited logistical barriers such as limited participant expertise, stigma, and state-law variation that could complicate curriculum adoption, although, they said, "regardless of the legal landscape, clinicians should be well-informed as they maintain nonjudgmental and honest discussions with patients about their cannabis use and its health implications. Therefore, these competencies are pertinent to clinicians in all states; educational programs should be tailored to include state-specific guidelines about the roles that clinicians have as related to medical cannabis and their professional and legal liability."
Darshan H. Mehta, MD, of the Benson-Henry Institute for Mind Body Medicine at Massachusetts General Hospital and several other major medical centers in Boston, weighed in on the issue in an invited commentary. Dr. Mehta described the competency framework as a foundational reference for integrating cannabis education into medical training and noted that the competencies align with guidance from the American College of Physicians, which encourages evidence-based counseling for patients who use cannabis for chronic pain. He added that physician education on cannabis can address health equity issues and misinformation. He explained, "Medical students report receiving most of their cannabis education from unreliable sources and express confusion about its therapeutic role," and "patients rely on dispensary staff, online forums, or social media without reliable physician guidance," but tools such as simulation exercises, patient-actor encounters, and artificial intelligence–powered case modules can help physicians navigate patient communication and complex risk counseling.
Dr. Zolotov and colleagues agreed. “As the next steps," they wrote in their article, "we envision piloting these competencies in several medical school curricula, followed by a systematic evaluation of their impact on learners’ knowledge, skills, attitudes, and confidence."
Although cannabis laws are heterogenous, as Dr. Zolotov and fellow researchers described, physicians can still be equipped with knowledge from the competencies they suggested. "We need not wait for the US Drug Enforcement Administration reclassification to act," added Dr. Mehta, referring to the recent Department of Health and Human Services recommendation that the DEA reclassify cannabis to schedule III. "Education can and must advance based on patient needs, accumulated clinical evidence, and ethical obligations....Medical cannabis is here. Will physicians catch up, or will we, through omission, continue to let patients navigate therapeutic uncertainty alone?"
The project was supported by an unrestricted educational donation from Cannaceutica to George Washington University. The funder had no role in study design, analysis, or publication decisions. Several consensus authors reported unrelated advisory, editorial, or consulting roles. The commentary author reported personal fees from DynaMed and McGraw-Hill and participation on a medical advisory board outside the submitted work.
Source: JAMA Network Open & Invited Commentary
