Now that Japan's Cannabis Control Law has changed, is it okay to remain "cannabis illiterate"? - Bridging the "education gap" surrounding medical cannabis

"Should Doctors Remain Ignorant About Cannabis?"—From the Frontlines of New Medical Education

Medical cannabis is becoming an "unavoidable theme" in the global medical field.

The state of Maryland is one of the 38 states and three territories in the U.S., along with Washington D.C., that have legalized medical cannabis. Additionally, 24 states have also approved recreational cannabis for adults.Medical Xpress

Nevertheless, many doctors and medical students are unable to adequately respond when patients ask, "What about cannabis?" In response to this situation, a paper proposing the "mandatory inclusion of medical cannabis" in the curriculum was published in the medical journal JAMA Network Open in October 2025.JAMA Network

An article based on this paper is featured on the science news site "Medical Xpress." The main figure in the article is Professor David Gorelick, a psychiatrist at the University of Maryland School of Medicine (UMSOM). He states, "Regardless of the department you work in, you cannot avoid confronting patients' cannabis use."Medical Xpress

So, how is medical education specifically changing? And what does this trend mean for Japanese healthcare and medical students?

The Expansion of Medical Cannabis and the "Education Gap"

In the U.S., since California legalized medical cannabis in 1996, its use has steadily expanded. However, medical education has not kept pace with this speed.

According to the JAMA paper and existing surveys, as of 2015-2016, "less than 10% of medical schools included medical cannabis in their curriculum," and about two-thirds of curriculum directors reported that "graduates are not prepared to prescribe or advise on medical cannabis."Medical Xpress

Around the same time, a research team at the University of Maryland focused on cannabis use among pregnant women. They found that the self-reported rate of cannabis use among pregnant women increased by 170% between 2009 and 2016.Medical Xpress

This is not just an issue in the U.S. In countries like Israel and Canada, where medical cannabis is widely recognized, the phenomenon of "increasing patients but lagging education" is also noted. The RADAR Center at Ben-Gurion University in Israel has reported through multinational surveys that there is a significant gap in knowledge and attitudes among healthcare providers, advocating for the need for international educational guidelines.bgu.ac.il

In other words, globally, we are seeing a situation where "patients using cannabis" are increasing first, and "healthcare providers who understand cannabis" are scrambling to catch up.

The "Six Core Competencies" Highlighted in the JAMA Paper

Against this backdrop of urgency, 23 clinical and research experts gathered online to discuss "the skills medical students should acquire regarding medical cannabis before graduation." The result was the formulation of the following six core competencies.JAMA Network

1. Understand the Basics of the Endocannabinoid System
   The human body is equipped with cannabinoid receptors (such as CB1 and CB2) and endogenous cannabinoids, which are involved in pain, appetite, mood, and memory. Without knowledge of this physiological mechanism, one cannot discuss the effects of THC or CBD.

2. Explain the Main Components of the Cannabis Plant and Their Effects on the Body
   Cannabis contains numerous cannabinoids and terpenes, including THC, which has strong psychoactive effects, and CBD, which has weaker psychoactive effects but is expected to have anticonvulsant properties. The clinical effects and side effects vary depending on concentration, ratio, and formulation.

3. Understand U.S. Legal Regulations and Historical Background
   While federal law still classifies cannabis as Schedule I (the strictest category, deemed to have "no medical value"), legalization for both medical and recreational use is progressing at the state level. Understanding how this "legal contradiction" impacts research, education, and clinical practice is necessary.

4. Grasp the Evidence for Diseases Where Medical Cannabis is Commonly Used
   Chronic pain, cancer-related nausea and vomiting, seizure disorders, insomnia, appetite loss, and inflammatory bowel disease are among the wide range of potential indications, but the strength of evidence varies. It is essential to critically evaluate not just "what is said to work," but "for which diseases, and how strong the evidence is."

5. Understand the Risks of Medical Cannabis
   Learning about the latest findings on risks such as dependency, cognitive effects, psychosis risk, effects during pregnancy and on young people, and interactions with other drugs, and being able to explain these clearly to patients is required.

6. Understand Basic Clinical Management
   Learning about specific clinical processes such as determining indications, selecting formulations, deciding on dosage and administration, follow-up, and determining when to stop treatment.

These six competencies are not just "knowledge" but are further broken down into 26 sub-competencies and organized as educational objectives.JAMA Network

In the same JAMA Network Open, an editorial emphasizing that "cannabis education is an ethical obligation as a professional" while evaluating these competencies was also published.JAMA Network

Before debating whether one is for or against cannabis, it is unacceptable as a professional to speak about substances that patients actually use without scientific knowledge.

What is the University of Maryland Teaching?

According to the Medical Xpress article, the University of Maryland School of Medicine has already "relatively thoroughly" incorporated lectures on cannabis into the first two years of pre-clerkship (before clinical practice).Medical Xpress

• Endocannabinoid System

• Types of Cannabis Products and Pharmacology

• Risks of Addiction and Abuse

• Effects on Vulnerable Groups such as Pregnant Women and Young People

• Differences Between State and Federal Laws

These topics are covered, and as students progress to clinical practice, they gain experience interacting with patients using various substances, including cannabis.Medical Xpress

Additionally, Professor Gorelick serves as a member of the Maryland Cannabis Public Health Advisory Committee. It is reported that the committee plans to recommend in a report to be released in December 2025 that "cannabis core competencies should be introduced not only for doctors but for all healthcare professionals."Medical Xpress

This means that they are envisioning "cross-disciplinary cannabis education" that includes not only medical school education but also fields like nursing, pharmacy, rehabilitation, and even public health.

The "Welcoming Mood" and Cautious Perspectives Seen on Social Media

The JAMA paper and the Medical Xpress news article introducing it have spread not only in academia but also on social media.

On X (formerly Twitter), the JAMA and American Medical Association (AMA) educational platforms repeatedly introduced this paper as a continuing education (CME) content, sharing learning links as "the first roadmap for doctors to systematically learn about cannabis."X (formerly Twitter)

Posts with links also followed from researchers' accounts in Canada, Israel, and the U.S. One researcher commented, "This is a step to end the era when clinicians would say 'I don't know, so no,'" while another doctor welcomed it by saying, "Finally, cannabis is being discussed based on competencies rather than emotions."X (formerly Twitter)

On the other hand,

"Will industry lobbies use the structured education as 'endorsement'?"
"Education should also teach how to prevent expansion into indications with weak evidence"

such cautious voices are also seen.

Additionally, one American doctor reflected in their post, "My father has been advocating for doctors to properly learn about cannabis for 50 years," expressing a sentiment of "history finally catching up."X (formerly Twitter)

In the social media space,

• there are both optimists who see it as "a positive reform filling a long-standing gap"

• and cautious individuals who are concerned about "the blurring line between medical and commercial use."
  These perspectives coexist.
  
  
  

"Cannabis Education" from the Japanese Context

What does this movement mean for Japan?

In Japan, the Cannabis Control Act underwent significant revision for the first time since its enactment in 2023, and the revised law was implemented in December 2024. The revision opened the way for cannabis-derived medical products to be treated as "medicines" that can be prescribed under a framework similar to opioid analgesics.ResearchGate

On the other hand, Japan maintains one of the world's strictest stances on recreational use and high-THC products, simultaneously strengthening regulations, including the establishment of a new offense for use.Euromonitor##HTML_TAG