Centering Patient Health Over Legal Status: A Student-Driven Cannabis Risk Stratification Framework for Undergraduate Medical Education.

Abstract

Background: Cannabis use is increasing worldwide, both for evidence-supported indications and conditions with limited evidence such as anxiety, depression, and chronic pain. Although incongruence between state and federal cannabis laws has delayed expanding cannabis education within medical schools, patients will continue to use cannabis and physicians must be prepared to counsel them. Therefore, evidence-informed cannabis education is needed to prepare medical students to discuss cannabis use using a patient-centered and harm reduction-oriented framework rather than relying on legal status alone.

Methods: We convened a student-faculty working group in addiction psychiatry, addiction medicine, and pain medicine to develop a practical teaching framework grounded in peer-reviewed literature on cannabis-related risks, patterns of use, and patient counseling. We reviewed existing cannabis curricula and identified points within medical school courses where this content could be incorporated without major restructuring.

Results: We developed a Cannabis Use Risk Stratification Framework intended to help medical students organize cannabis-related health benefits and risks into teachable categories based on use-related (frequency, potency, and route) and patient-related (age, comorbidities, and functional impact) factors. The framework is taught in two 1-hour sessions: a preclinical lecture introducing the framework, and a preclerkship session using cases and simulations to apply it. By centering discussion on patient health and harm reduction rather than legality alone, the framework remains applicable across jurisdictions and provides students with a role in clinical encounters: obtaining a cannabis history, identifying benefits and potential risk factors, and delivering brief, educational counseling to promote shared decision-making.

Discussion: This framework addresses a foundational gap in undergraduate medical education by providing an educational approach to discussing cannabis-related benefit and risk that is adaptable across institutions, resource settings, and jurisdictions. The risk categories are pragmatic and teachable, offering learners a conceptual framework for recognizing when cannabis use warrants monitoring, brief counseling, or escalation to formal intervention.