“We need to get educated”: lessons from physicians certifying cannabis as an alternative to opioids in the Illinois Opioid Alternative Patient Program

INTRODUCTION: Despite efforts to curtail prescribing, prescribing opioids remains common. With the impacts of the United States opioid epidemic continuing to multiply, effective and acceptable alternatives to opioids (and reduce opioid use) are needed. The Illinois' Opioid Alternative Patient Program (OAPP) is a novel program developed and implemented specifically to increase access to cannabis as an alternative to opioids. The current study aimed to: (1) characterize early adopters' attitudes toward cannabis as an alternative therapy and the OAPP; and (2) identify implementation barriers and facilitators to inform the refinement of future programming and program adaptations. METHODS: OAPP certifying physicians were invited to participate in an anonymous, cross-sectional online, survey, including 28 closed‑ended items assessing demographics, practice characteristics, attitudes toward cannabis, and perceptions of the OAPP, as well as one open‑ended question soliciting additional feedback. Guided by Diffusion of Innovations Theory, data analysis included descriptive statistics and deductive thematic analysis. RESULTS: Participants were 199 physicians, 81 of whom provided write-in responses (40.7%). Attitudes about cannabis and the OAPP were mixed. Four cross-cutting qualitative themes were identified. Participants desired more education/training to guide their clinical practice and expressed concerns about dispensary staff acting as proxy clinicians. DISCUSSION: Alternatives to opioids, such as cannabis, are desired by patients and physicians alike. However, to increase the acceptability and uptake of this sort of programing, more research and provider training is needed to broach conversations around cannabis and opioid use in a way that mitigates stigma and maximizes patients' opportunities to have their needs met.