The 2019 US National Survey on Drug Use and Health reports that the use of cannabis increased from 11% (2002) to 17.5% (2019) and represents 48.2 million Americans aged 12 years or older [10]. For the first time, there are now more documented cannabis users than tobacco users [11]. As products containing THC, CBD, OTC products, and prescription cannabinoid medications are becoming increasingly available (e.g., pharmacy, dispensary, illicit means), there is an increased likelihood of an unintended drug-drug interaction when co-administered with another herbal, OTC, or prescription medication [2].

Although medical marijuana policy liberalization is increasing among the States, patients may remain hesitant to share or may still be unaware of the necessity of discussing their use of cannabinoid products with their HCPs. Despite this increase in cannabis use, there is also a continued reluctance for the patient to disclose their cannabinoid use with their HCP [12]. Therefore, there can be missed patient safety opportunities (e.g., drug-drug interactions, perioperative management) when the patient does not fully disclose their cannabinoid use [13].

Reasons for not disclosing cannabinoid use vary, but the most common reasons are the stigma and bias associated with cannabinoid use along with the fear of adverse consequences [14]. Due to the often vague public health guidance, HCPs are at times hesitant, uncertain, or even unable to discuss with their patient effectively about their cannabinoid use [15]. At times, the HCP is not prepared to discuss cannabinoid topics due to a lack of general cannabinoid knowledge [16], or their perspective may differ with that of their patients [13]. In the absence of evidence-based guidelines, the HCP may tend to generally categorize cannabinoid use as either “harmful or helpful” [15] or as a “risk versus benefit” [17].

Since cannabinoids are often compared to and perceived safer than opioids [1], this survey also asked two different questions pertaining to the perceived safety of cannabinoids when compared to other substances. First, the survey asked the respondent about the perceived safety of taking or consuming alcohol, CBD, products containing THC, OTC pain medications, and anxiety/depression medications. Second, the survey then asked how safe each respondent perceived alcohol, CBD, products containing THC, OTC pain medications, and anxiety/depression medications when taken with other prescription medications.

This Lion Poll cannabinoid survey provides information on the prevalence of cannabinoid use among adult-aged Pennsylvanians, underreporting of that use to their HCPs, and perceptions on safety. This survey also illustrates that there is poor communication between patients and HCPs regarding cannabinoid use, and these findings are consistent with other studies [18, 19]. Therefore, it remains vital that HCPs have open communications with their patients about cannabinoid use.