The Endocannabinoid System: The Most Important Part of Your Body Doctors Ignore

Ignoring Cannabis Isn’t Neutral—It’s Neglectful

Healthcare Providers: Your Patients Are Lighting Up. Shouldn’t You Know?

Picture this: a patient sits in the doctor’s office, nodding politely as the provider reviews their medications. The doctor talks through blood pressure pills, statins, maybe a sleep aid. The patient nods again. What they don’t mention? The CBD gummies they pop before bed or the tincture they’ve started using for their arthritis. It’s not an intentional omission—just something they assume isn’t worth bringing up. And maybe they’re right. Too many doctors still don’t ask.

But here’s the thing: ignoring cannabis isn’t just a missed conversation—it’s a glaring omission in modern medical practice. At a time when cannabis consumption is at an all-time high, with an estimated 15% of seniors and 42% of younger adults using it regularly, failing to engage with patients about cannabis use sends a clear message: We don’t care about the solutions you’re finding outside these walls.

It’s not just about patient preferences, either. Cannabis is addressing real, unmet needs—needs that conventional medicine often fails to handle effectively. Pain relief, anxiety, sleep—these are everyday struggles, not niche concerns. Ignoring cannabis use suggests disinterest in learning about the tools patients are turning to, a refusal to lead on matters of everyday well-being, and, perhaps most egregiously, a disregard for the endocannabinoid system—a fundamental aspect of human physiology that many medical schools continue to leave out of the curriculum entirely.

Here’s where the ethical issue becomes unavoidable: Medicine is meant to be rooted in curiosity, leadership, and a commitment to understanding the whole person. When healthcare providers ignore cannabis use, they turn a blind eye to the solutions patients are seeking outside their office, disregard a critical physiological system, and—at a time when cannabis use has surpassed alcohol use among adults—fail to lead on one of the most pressing health topics of our time.

The stats on the acceptance and curiosity around cannabis use are also telling us that it’s high time to stop pretending that cannabis is fringe (pun intended!) Screening for its use isn’t just good practice—it’s an ethical imperative.

The ECS that still isn’t taught in Med School

Let’s be clear: this isn’t about hopping on a wellness bandwagon or chasing the latest influencer-approved fad. The endocannabinoid system (ECS)—a complex network of receptors and signaling molecules found in every human body—has been quietly orchestrating vital processes since the dawn of our species. In fact, almost all animals have their own version of this system. And its role? Nothing short of essential. The ECS regulates key functions like mood, pain, inflammation, memory, sleep, stress, metabolism, cancer growth, and appetite—and that’s just scratching the surface.

So why isn’t the endocannabinoid system taught in medical school? The blame is widespread. Part of it lies with a history shaped by racist socialites and politicians who entrenched prohibitionist policies. Another share rests with generations of academics who, like many today, inherited and upheld the status quo, rarely questioning outdated narratives or pushing the boundaries of established knowledge. The result? Decades of stigma have rippled through social, political, scientific, and academic spheres, leaving us in the midst of a slow and hard-fought revolution. Those of us working to correct the narrative often face an uphill battle: blocked social media accounts, skeptical glances from professionals, dismissive criticism from the peanut gallery, and economic challenges from marching against the grain. Cannabis—and by extension, the ECS—has been systematically sidelined in both medical education and modern life. This is a grave oversight—one we can no longer afford to ignore.

Cannabis use has surged, with a recent Gallup poll reporting that 1 in 6 Americans now use it regularly. This isn’t some marginal trend—it’s part of the mainstream. And yet, many doctors remain unprepared to address it, leaving patients to navigate the complexities of cannabis on their own.

Cannabis Screening: Because Guesswork Isn’t Medicine

Imagine a doctor prescribing a blood thinner without knowing the patient is using THC, which could amplify its effects and increase the risk of bleeding. Or offering advice, medications, or referrals to help a patient manage anxiety, unaware that the patient is self-medicating with cannabis every night. These aren’t hypothetical scenarios—they’re real risks that unfold when cannabis use is left out of the conversation in clinical care. As a physician who works closely with patients navigating cannabis use, it’s baffling to me that many of my medical colleagues not only fail to screen for cannabis use but often avoid engaging with their patients on the topic altogether. Even worse, some dismiss the issue entirely, leaving patients to fend for themselves in a chaotic, unsupervised marketplace.

Some of the excuses patients say they hear from healthcare providers:

“We’re not allowed to discuss cannabis here—it’s clinic policy.”

“Honestly, I don’t know enough about it to guide you.”

“I can’t recommend anything, but you could check out one of those cannabis clinics.”

“Why not try CBD? That’s the safe option.”

Screening isn’t just about knowing what your patients are doing—it’s about improving outcomes and addressing risks that might otherwise go unnoticed. When cannabis use is left out of the conversation, care becomes incomplete, and patients are left to navigate their health alone.

Mental health support: Many patients turn to cannabis for anxiety, depression, or sleep issues, often experimenting without professional guidance. A patient struggling with insomnia might rely on high-THC edibles, unaware that they could worsen their anxiety or lead to grogginess and dependence. Understanding these habits allows for tailored, safer approaches that meet the patient where they are.

Medication safety: Cannabis interacts with common prescriptions like sedatives, anticoagulants, and blood pressure medications. A patient using THC alongside blood thinners, for example, could unknowingly increase their risk of dangerous bleeding, while another using CBD with a sedative might find themselves struggling with excessive drowsiness or confusion.

Accurate diagnoses: Symptoms like fatigue, mood swings, or changes in appetite might be attributed to a medical condition or medication side effect—but could actually be influenced by cannabis use. Screening helps untangle these factors, ensuring patients get the right diagnosis and treatment plan.

Building trust and reducing stigma: When doctors engage openly about cannabis, they signal to patients that their choices and concerns are valid. This builds trust, encourages honesty about other health behaviors, and reduces the stigma patients may feel about discussing alternative therapies.

Ignoring cannabis use in clinical settings is like trying to complete a puzzle with half the pieces missing. Guesswork isn’t medicine, and it shouldn’t be the standard of care. Patients deserve providers who take the time to see the full picture—and cannabis is an increasingly important piece of all of our lives, either directly or indirectly.

A Little Screening Goes a Long Way

The benefits of cannabis screening ripple far beyond the exam room, fostering stronger connections, better health outcomes, and a more informed community.

Stronger doctor-patient relationships: When conversations about cannabis are normalized, trust flourishes. Patients feel seen and heard, which encourages them to be more honest about other health behaviors—from alcohol use to mental health struggles. A simple question about cannabis use can open the door to a deeper, more holistic understanding of your patient’s well-being.

Improved symptom management: Patients often turn to cannabis for conditions like chronic pain, anxiety, or insomnia. By screening for use, providers can assess what’s working, suggest safer or more effective alternatives, and ensure cannabis is used as part of a comprehensive care plan.

Reduced risk of adverse events: Cannabis can interact with a range of medications, from sedatives to blood pressure drugs. Screening helps prevent potentially dangerous interactions, ensuring treatments are as safe and effective as possible.

Promoting health equity: Communities that have historically borne the brunt of the War on Drugs—such as people of color and those in lower socioeconomic groups—may also be those most hesitant to disclose cannabis use. By initiating compassionate, nonjudgmental conversations, providers can address these inequities and help all patients access better care.

Addressing misinformation: Patients are inundated with conflicting advice from social media, friends, and haphazard products. Providers who screen for cannabis use can step in as trusted sources of accurate, evidence-based information, cutting through the noise.

Encouraging safe cannabis practices: Screening offers a chance to educate patients about safer methods of use, such as dosing, avoiding high-risk products, and choosing non-smoking options to protect lung health.

And let’s face it: your patients are already Googling cannabis advice. They’re navigating Reddit threads, TikTok influencers, and half-baked blog posts to figure out dosing and safety. Wouldn’t you rather be their trusted source of guidance—the one who separates fact from fiction and turns uncertainty into clarity?

Why It Matters

Screening for cannabis use is more than a checkbox on a form; it’s a commitment to patient-centered care. It’s about meeting patients where they are, correcting misinformation, and ensuring their health choices are safe and supported.

Challenges, Schmallenges: Why Doctors Can’t Wait

For some doctors, talking about cannabis—especially with older patients—might feel unfamiliar or even uncomfortable. It’s not every day a senior casually mentions their THC gummies or CBD creams. But avoiding the topic entirely leaves patients to navigate an immature and often overwhelming marketplace on their own. Without clear guidance, they’re left to sort through misinformation, take risks with medication interactions, and experiment without professional oversight.

The stakes are too high to let these conversations slip through the cracks. Cannabis has become a go-to option for everyday struggles like pain, anxiety, and sleep, yet it often remains invisible to primary care. In fact, a recent study of the California healthcare system revealed that 17% of patients used cannabis without their doctor’s knowledge. Without open dialogue, the care these patients receive is inherently incomplete.

A simple question like “Have you used cannabis or CBD products in the past year?” or “Are you curious about how cannabis might fit into your health care?” can transform the conversation. These small but meaningful steps open the door to safer, more effective care while strengthening the doctor-patient relationship. By asking, providers validate their patients’ choices and ensure treatment plans reflect the full reality of their health and lives.

The time to address cannabis use isn’t “someday”—it’s now.

An Ethical Imperative in Modern Medicine

Medicine has always been about meeting patients where they are. And right now, many are turning to the cannabis aisle, faced with products like “Purple Haze” and “Grandma’s Relief Balm,” searching for relief from pain, anxiety, or insomnia.

Acknowledging cannabis use isn’t about endorsement—it’s about understanding. It’s about knowing what patients are using, why they’re using it, and how to help them do so safely and effectively. Without this dialogue, care remains incomplete, leaving patients to navigate their health with fragmented support.

The healthcare system doesn’t need to be perfect before these conversations begin. As the late Maya Angelou so aptly said: “Do the best you can until you know better. Then when you know better, do better.”

The endocannabinoid system has been ignored for too long. Understanding it isn’t just an opportunity—it’s a responsibility we can no longer afford to neglect.

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References

1. Endocannabinoid System (ECS) Overview

Mechoulam, R., Parker, L. A., & Gallily, R. (2002). “Cannabidiol: An overview of some pharmacological aspects.” Journal of Clinical Pharmacology, 42(S1), 11S-19S.

2. Cannabis Use Statistics

• Gallup. (2021). “Marijuana Use Steady in U.S., but Support for Legalization Dips.” Retrieved from Gallup News. What Percentage of Americans Smoke Marijuana

3. Therapeutic Potential of Cannabis

• Hill, K. P. (2015). “Medical marijuana for treatment of chronic pain and other medical and psychiatric problems: A clinical review.” JAMA, 313(24), 2474-2483.

4. Cannabis Use in Older Adults

• Han, B. H., Sherman, S., Mauro, P. M., Martins, S. S., Rotenberg, J., & Palamar, J. J. (2017). “Demographic trends among older cannabis users in the United States, 2006-2013.” Addiction, 112(3), 516-525.

5. Medical Ethics and the Role of Cannabis

• Beauchamp, T. L., & Childress, J. F. (2013). Principles of Biomedical Ethics (7th ed.). New York: Oxford University Press.

6. Risks and Interactions with Prescription Medications

• Huestis, M. A. (2007). “Human cannabinoid pharmacokinetics.” Chemistry & Biodiversity, 4(8), 1770-1804.

7. The Need for Screening and Patient Communication

• Bottorff, J. L., Bissell, L. J., Balneaves, L. G., et al. (2013). “Perceptions of cannabis as a stigmatized medicine: A qualitative descriptive study.” Harm Reduction Journal, 10(1), 2.

8. Cannabis in the Context of Modern Healthcare

• National Academies of Sciences, Engineering, and Medicine. (2017). The health effects of cannabis and cannabinoids: The current state of evidence and recommendations for research. Washington, DC: National Academies Press.

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