Visiting the doctor can be nerve-wracking. On top of the general anxieties associated with these appointments, the idea of having to disclose cannabis use to a medical team can add another layer of stress to patients. While it may be tempting to leave this aspect of medical history undisclosed, patients should be aware of the risks of not telling their doctor about their cannabis use.
When doctors ask patients about their cannabis use, it’s to inform their medical care, not to get them in trouble with the law. What patients share with their doctors is confidential – and doctors are not law enforcement. The Health Insurance Portability and Accountability Act, or HIPAA, ensures this promise. If a doctor does violate HIPAA, patients may file a complaint with the Department of Health and Human Services or their state Board of Medicine.
Patient-doctor confidentiality is in effect across all states, not just ones where cannabis is legal. These confidentiality laws span far beyond cannabis, covering the use of many illegal substances. Patients can feel safe sharing their full medical history, including any drug use, with their doctors, knowing that the information will remain between the patient and doctor.
“Our main focus is on your health and how to partner with you to improve your health. We really have no interest in getting anyone in trouble,” writes Rachael McGuirk, MD, in a blog posted on The Ohio State University Wexner Medical Center website.
However, if a patient discloses drug use that indicates serious harm to the patient or others, including children, dependents, or unborn fetuses, doctors may be legally obligated to make a report to the proper authorities. If the patient is pregnant and has a positive urine drug screen, then this may even include arrest or mandatory social services reporting.
Doctors ask about cannabis use to inform the medical care they provide. While some people opt not to disclose their cannabis use, leaving out crucial medical history can be dangerous and negatively impact the care they receive. Here’s why:
Cannabis and anesthesia both affect the central nervous system, which can impact the amount of anesthesia needed for sedation and pain prevention. Studies have suggested that regular cannabis users require more anesthesia than those who do not consume cannabis–up to 220% more.
Cannabis users should be honest about their usage before any medical procedures to ensure they receive an adequate dose of anesthesia. In fact, the American Society of Anesthesiologists lists cannabis use as one of the eight things to tell your physician or anesthesiologist about before surgery.
While many non-drowsy medications do not pose a significant risk of complications when paired with cannabis. However, there are some prescription drugs that, when taken with cannabis, can cause unwanted side effects or risks.
Most commonly, cannabis may enhance side effects like drowsiness or dizziness with CNS depressants like sedatives and alcohol. This is of particular concern to elderly and fragile persons at risk of falls and fractures.
Research indicates that cannabinoids may also interfere with the activity of enzymes that break down and eliminate several common medications. This can result in decreased effectiveness of the drug as well as increased risk of negative side effects.
For example, the blood-thinning drug Warfarin is shown to interact poorly with cannabis. Cannabis may interfere with the metabolism of the drug, which can increase the risk of bleeding.
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Generally speaking, doctors ask about cannabis use to ensure they have a full picture of their patient’s medical history and can provide the right care. They don’t ask to pass judgment on their patients.
“We are not here to judge someone’s character or behavior. If someone comes to me with a certain issue or something that’s bothering them, I try to address it. I try to put myself in the patient’s shoes and see why they went down that route,” writes Mohab Ibrahim, MD, PhD, in a blog posted on the University of Arizona Health Sciences website.
Unfortunately, while HIPAA guarantees patient-doctor privacy, it doesn’t always guarantee a positive, productive conversation outcome. Even with cannabis use becoming more normalized across the United States, the stigma around its use persists, especially in certain healthcare settings. A recent 2024 study finds that “patients who use cannabis experience stigmatization in the healthcare setting that may limit disclosure of cannabis use history.”
Doctors have historically reported low levels of cannabis knowledge, indicating that they need additional cannabis-related education to provide better patient recommendations. This lack of knowledge stems from doctors having no formal cannabis education in medical school, a topic that our very own Dr. Abraham Benavides, MD, studied and pioneered. The research acknowledges that this can often lead to a disconnect between doctors and patients, which can cause tense or uncomfortable conversations about cannabis use.
Despite the risk of potentially uncomfortable conversations with their doctors, patients can rest assured knowing their provider cannot report or get them in trouble for cannabis use as long as they are not pregnant. While not always possible with insurance and other factors, patients should aim to work with a doctor who makes them feel safe, comfortable, and free from judgment.
Whether asking about potentially using cannabis for a medical condition or simply disclosing its recreational use, patients should remember that doctors have these sorts of conversations frequently. Doctors should react professionally and non-judgmentally, with the patient’s well-being at the forefront of their minds.
Patients should know that doctors do not typically have extensive knowledge about medical cannabis for certain conditions. Often, they’ll need to seek out a doctor who is well-informed and comfortable about discussing the topic in depth.
But for those simply disclosing cannabis use as part of their medical history, the discussion should be as simple as that—a part of their medical history. Once patients have disclosed their cannabis use, doctors can assess if there are any potential risks related to the medical care they plan to provide.
Until cannabis is federally legal and doctors have more access to comprehensive research, patients will have to navigate a healthcare system where some doctors know more about cannabis than others.
While conversations about cannabis can be nerve-wracking for some patients, they are important in a medical setting. Doctors need to know if their patients will require more anesthesia for surgeries or anticipate potential complications from prescription medication.
Patients can take comfort in the knowledge that their medical history, including their use of cannabis and other drugs, is protected under HIPAA privacy laws. Simply disclosing cannabis use to a doctor will not result in legal trouble as long as they are not pregnant and pose no threat to themselves or others, such as a child or dependent.
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