As medical marijuana becomes more available in communities across the country, patients and their clinicians are increasingly seeking information about its efficacy and potential use in care. Accredited continuing medical education (CME) providers can serve as a trusted source, giving clinicians the accurate information they need to deliver safe and effective care and to answer their patients’ questions.
We encourage accredited providers to embrace the opportunity to address controversial topics; CME is an ideal place for discussions about evolving issues in medicine. When considering how to construct activities about medical marijuana, CME providers should apply the same prudent planning process that they do for other activities that address areas of medicine that are evolving, unproven, or experimental. It’s important for recommendations to be rooted in science, evidence, and data. The validity of clinical recommendations is not determined by legislation or advocacy; just because a product is legal, this doesn’t necessarily mean that it’s appropriate to prescribe, or that it is effective.
While it is important and appropriate to help clinicians learn about issues such as medical marijuana, it’s not allowable to train clinicians how to recommend therapies and treatments unless they are accepted by the medical profession and are based on scientifically valid evidence.
Here are key points to consider if you plan to construct CME activities about controversial topics such as the use of medical marijuana. We also provide a list of resources at the end of this article.
Relevant Rules
When managing CME about controversial topics, it will be helpful to review the Standards for Integrity and Independence in Accredited Continuing Education. This Standard applies whether you directly provide or jointly provide activities.
Ensure Independence from Ineligible Companies
Companies whose primary business is the production, marketing, selling, reselling, or distribution of medical marijuana fall under the definition of ineligible companies. That means that all the rules related to ineligible companies apply. For example, these companies are not eligible for accreditation, and accredited providers cannot engage in joint providership with them.
In addition, as described in Standard 2, all decisions related to the planning, faculty selection, delivery, and evaluation of accredited education must be made without any influence or involvement from the owners or employees of ineligible companies such as marijuana growers, processers, distributors, and dispensaries. Similarly, under Standard 3.2, providers must exclude ineligible company owners and employees from controlling accredited CME content, unless their participation would meet one of the exceptions described in Standard 3.2.
Mitigate Relevant Financial Relationships
In addition to prohibiting or constraining the role of ineligible company owners and employees, it is your responsibility to meet the expectations of Standard 3.4. You need to identify and mitigate relevant financial relationships of anyone in a position to control content, including your planners or faculty, and disclose to learners if they have relevant financial relationships with medical marijuana companies, just as you would with other ineligible companies.
Ensure Balance
As with any accredited CME activity, an activity discussing medical marijuana must meet the content validity expectations outlined in Standard 1. Remember that when information about treatments is emerging, highly publicized, and controversial, there can be a tendency to prematurely embrace clinical recommendations that are not justified by science. It’s important to ensure that your content experts review the most recent data relevant to your learners. They need to apply the same level of scrutiny to evidence about benefits as they do to harms and risks. The ACCME provides Tools to Ensure that Clinical Content is Valid which CME providers may use to help ensure that they meet content validity requirements.
Be aware that many experts are also advocates, and it is your responsibility as an accredited provider to maintain the boundary between accredited CME and advocacy. Ensure that your activities present a balanced perspective and cover the range of diagnostic or therapeutic options for a given scenario. Discussion of unconventional treatments or therapies can shift the focus away from the appropriate discussion of benefits and risks of conventional management. Shifting the focus away from potentially effective care by offering an unproven alternative can be harmful to patients. Activities addressing the potential use of a controversial agent such as marijuana should present a comparison of relative merits and risks of a variety of approaches for the symptom or problem being addressed.
Take Responsibility for Joint Providership
If you engage in joint providership, you, as the accredited provider, are responsible for the content of a jointly provided activity, just as you are for activities that you directly provide. You are accountable for making sure the activity adheres to requirements for independence and content validity.
Make sure that you do not jointly provide with an organization that advocates for unscientific approaches to diagnosis or therapy, or promotes recommendations, treatment, or manners of practicing healthcare in their education that are determined to have risks or dangers that outweigh the benefits or are known to be ineffective in the treatment of patients.
No Exceptions for Content Validity
Again, all activities offered by accredited providers must comply with content validity requirements. It is not acceptable to offer education that does not meet content validity standards even if those activities are not accredited or certified for credit. Providers who do this may risk noncompliance with Standard 1.4 and may therefore risk their accreditation. Remember, our clinician learners and their patients expect the content offered by accredited CME providers to be valid and reliable.
We’re Here to Help
If you have questions about identifying or managing controversial topics or would like more information, please contact us at info@accme.org.
Resources
FDA and Marijuana webpage, US Food and Drug Administration, provides an overview and links to related information including FAQs and warning letters.
Marijuana webpage, National Institute on Drug Abuse, National Institutes of Health, provides information on health effects of marijuana and links to resources.
“Clinical Approaches to Cannabis: A Narrative Review” outlines the risks and potential utility of cannabis for a variety of conditions in a comprehensive review published in 2022.
Another article on managing controversial and emerging topics in CE, “Dealing with Controversial Topics in Your CME Program,” is available on our website. You are welcome to share these articles with your staff, volunteers, and other stakeholders.
