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Patient Experience with Medical Cannabis: Development of the Utah Medical Cannabis Prospective Cohort Evaluation

Alan Taylor Kelley
University of Utah

Co-Authors: Clinton J. Hardy1, Michael A. Incze1, Adam J. Gordon12, Kathryn Szcotka1, Kristi Carlston1, Rajiv Radhakrishnan3, Samuel T. Wilkinson3, Gerald Cochran12
1University of Utah 2VA Salt Lake City Healthcare System 3Yale University

Medical cannabis (MC) use is expanding across the US and is now authorized in 37 states and the District of Columbia. States have authorized cannabis for a wide variety of medical conditions, including chronic pain, post-traumatic stress disorder (PTSD), and cancer. However, knowledge about patient experience with MC and its effects on long-term health are limited. To address this gap, we sought to partner with a state MC program (Utah) to develop an evaluation responsive to program needs.

We used a formative process based on a community-based participatory research (CBPR) paradigm to develop a proposal to evaluate Utah\’s MC program. This involved engaging stakeholders, including state officials, clinicians, and evaluation experts, in iterative discussions to identify evaluation needs and obtain funding.

Stakeholders raised concerns in four areas: (1) patient experience of program enrollees; (2) barriers to MC access; (3) patient-reported effects of MC over time, especially among patients with chronic pain, PTSD, and cancer; and (4) recommendations for program improvement. We then developed a three-stage mixed-methods evaluation responsive to these concerns. In the first stage, we establish an evaluation advisory board comprised of program enrollees, providers, state officials, and other stakeholders to provide feedback on the evaluation design and implementation. In the second stage, we recruit a cohort of 334 patients, including MC program enrollees and comparable non-enrollees, to assess patient-reported outcomes with sufficient power to detect differences between enrollee and non-enrollee groups with chronic pain, PTSD, or cancer. Patient outcomes will be collected at 6, 12, and 18 months using surveys of patient experience with cannabis use and patient-reported measures of access to MC and physical/behavioral health. We also conduct in-depth interviews for 20 MC program enrollees in the cohort. In the third stage, evaluation advisory board members and a subset of cohort patients meet to discuss barriers and facilitators for long-term extension of the prospective cohort evaluation.

Stakeholders identified patient-reported program experience, treatment effectiveness, access to care, opportunities for improvement as evaluation priorities. Our evaluation is responsive to these priorities and will lay the groundwork to assess long-term outcomes related to MC use.

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