Exploring Perceptions of Cannabis Use and Employment Implications Among Healthcare Workers: A Single-Institution Experience

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Lichtenberg, Ramy El Mankabady, Monica Mansour, Annette Wang, and 3 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6508603/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 06 Feb, 2026 Read the published version in Journal of Cannabis Research → Version 1 posted 11 You are reading this latest preprint version Abstract Background Cannabis use is becoming increasingly prevalent in the United States, and its implications extend into many facets of society, including healthcare. Despite legal and societal shifts toward the acceptance of cannabis, healthcare professionals face ethical and legal complexities related to cannabis use. Understanding perceptions of cannabis use within the healthcare community is essential for developing informed drug policies in healthcare settings. The objective of this study was to better understand the changing perceptions of recreational and medical cannabis use on employment within the healthcare community. Methods In September 2023, a team of residents and faculty conducted an anonymous descriptive survey study targeting residents, attending physicians, and administrative staff at HonorHealth in the Phoenix metropolitan area (Arizona, USA). The survey included questions on participants' roles in the healthcare community, their knowledge of cannabis and cannabis testing policies, and their opinions on the permissibility of cannabis use in various workplace scenarios. The survey results were summarized via descriptive statistics, and interesting findings were highlighted. Results The survey received 80 responses from 258 potential respondents, yielding a 31% response rate. The survey indicated familiarity among respondents with cannabis products, opposition to mandatory cannabis screening, and disapproval of employment termination following positive tests, particularly for medical cannabis use. Conclusions The findings suggest that healthcare institutions need more information about cannabis use in these environments and highlight areas for policy review and further research to inform evidence-based approaches to drug policies that balance ethical considerations and the well-being of healthcare professionals. Healthcare workers cannabis use attitudes survey research Figures Figure 1 BACKGROUND Cannabis use has experienced a dramatic surge across the United States in recent years, with over 52 million Americans reporting using cannabis in 2021 (Substance Abuse and Mental Health Services Administration 2022). This significant uptake follows the rapidly evolving legal landscape, where recreational use is now permitted in numerous states alongside widespread medical cannabis programs. This societal shift raises essential questions about cannabis use within professional contexts, particularly in healthcare environments where there is a complex intersection of patient safety concerns, professional standards, and legal obligations. Understanding perceptions of cannabis use within the healthcare professional community is important for developing informed drug policies in healthcare settings as well as driving accurate research related to cannabis use in this population. While some studies have reported that cannabis use among nurses and physicians is comparable to that of the general population (Naillon et al. 2023 ; Rainbow et al. 2024 ), cannabis use among healthcare professionals remains understudied. Healthcare professionals operate in a uniquely challenging position of legal ambiguity with cannabis use as institutional policies are often zero-tolerance, even in states with legalized recreational access. This environment creates substantial barriers to accurate research, as healthcare workers may justifiably fear professional censure, licensure consequences, or career limitations if they disclose cannabis use, even for research purposes. Courts have generally maintained that if a state does not expressly protect the use of medical cannabis, there is no protection against negative employment action. However, this stance is subject to change as societal attitudes toward cannabis continue to evolve and more states enact protection for cannabis users. Given that 10 out of 21 state laws legalizing adult cannabis use were enacted in or after 2020 (National Conference of State Legislatures 2024), and that the United States government has recently moved to reschedule marijuana (Friedman et al. 2024 ), there is a need to reassess the implications of cannabis use for both medical and recreational purposes on employment in the healthcare sector. The extant literature was published either prior to noteworthy changes in cannabis legislation (Raskin 1993; Donohoe 2005 ; Lemon et al. 1992 ) or only focused on attitudes towards the use of cannabis or its legalization (Jacobs et al. 2022 ; Makki et al. 2022 ; Weisman and Rodriguez 2021), leaving a gap in understanding how these changes in beliefs affect employment among healthcare stakeholders. Our study aimed to address this critical knowledge gap by investigating the understanding and attitudes toward both recreational and medical cannabis use as they specifically relate to employment considerations among stakeholders in the healthcare professional community. By examining perceptions across different roles and specialties, we aimed to identify emerging consensus points that can inform more evidence-based employment policies in this rapidly changing environment. METHODS Study Overview This study was conducted within the HonorHealth (HH) healthcare professional community in the Phoenix metropolitan area (Arizona, USA). The participant population included residents, attending physicians, and administrative staff within the HH network. Before commencing data collection, on August 10, 2023, we received Institutional Review Board (IRB) exemption status from the HH IRB (Study #: IRB-23-008). Study Design The research team designed a 32-question survey to explore perceptions of cannabis use and its implications for employment within the HH healthcare professional community. The survey was structured to collect knowledge and opinions about cannabis, cannabis employment testing policies, and case scenarios regarding the necessity of medical cannabis to function. It was initially reviewed for face and content validity by an expert panel prior to its use. The respondents’ participation was voluntary and anonymous, with informed consent obtained electronically at the beginning of the survey. The availability period spanned from September 4, 2023, to October 4, 2023, with weekly reminders to maximize response rates. This questionnaire included multiple-choice, Likert scale, and comment sections for quantitative and qualitative analysis. Questions were developed on the basis of literature review and discussions with stakeholders in the HH healthcare professional community to ensure the relevance of questions and comprehensive coverage of topics. Study Outcomes The primary outcomes of the survey included respondents’ familiarity with cannabis products, awareness of cannabis testing policies, and opinions on mandatory cannabis screening and employment termination following positive cannabis tests, particularly for medical cannabis use. The survey also explored respondents’ attitudes toward cannabis use in professional healthcare settings using case-based scenario questions. Details of all survey questions and their responses can be found in the provided supplemental data (Supplemental Data S1 – Cannabis Survey Questions, Supplemental Data S2 – Cannabis Survey Data). Planned Analysis The research team calculated percentages and frequencies for multiple-choice questions. By summarizing and reviewing the open-ended responses, we identified common themes and insights related to participants' perceptions of cannabis use in the healthcare setting. Response rate estimates and confidence percentages were calculated based on a population of 500 individuals with 95% confidence ± 10% of the surveyed value. Responses to case scenarios were also compared across different participant roles. SPSS Statistics v. 28.0 (IBM Corp., Armonk, New York, USA) and GraphPad Prism v 10.4.0 (Dotmatics, Boston, Massachusetts, USA) were used to analyze and present the data. RESULTS Respondent Summary Responses were received from 80 out of 258 potential respondents, demonstrating a 31% response rate. Among these participants, 40% identified as residents or fellows, 43.8% as attending physicians, 15% as administrative staff, and 1.3% fell into the 'other' category (Fig. 1 A). Most respondents reported undergoing pre-employment drug screening during their hiring process. Respondents indicated some familiarity with cannabis products and an unawareness of cannabis testing policies. Overall, the results leaned toward opposition to mandatory cannabis screening and disapproval of employment termination policies following positive tests, particularly in cases involving medical cannabis use (Table 1 ). Table 1 – Opinions on Cannabis Screening and Employment Termination Policies [n (%)] Policy Aspect Strongly Disagree Disagree Neutral Agree Strongly Agree Mandatory cannabis screening for employment 22 (27.5%) 24 (30%) 12 (15%) 15 (18.8%) 7 (8.7%) Employment termination after a positive cannabis test 22 (27.5%) 24 (30%) 18 (22.5%) 10 (12.5%) 6 (7.5%) Termination with a medical cannabis card 33 (41.3%) 29 (36.3%) 10 (12.5%) 5 (6.3%) 3 (3.8%) Termination with FDA-approved treatment 26 (32.5%) 33 (41.3%) 12 (15%) 6 (7.5%) 3 (3.8%) Exclude cannabis from pre-employment screenings 20 (25%) 23 (28.8%) 21 (26.3%) 9 (11.3%) 7 (8.8%) Awareness and Knowledge of Cannabis Use Most respondents (75.6%) reported being at least “somewhat familiar” with cannabis products (Fig. 1 B). They were highly aware of the legal status of both medical and recreational cannabis use in Arizona and accurately identified the effects of THC and the non-euphoric properties of CBD (Supplemental Data S2 – Cannabis Survey Data). Screening Policies and Employment Most respondents across all roles opposed mandatory cannabis screening for pre-employment and believed that a positive cannabis drug test should not influence employment status. The majority disagreed with policies that would lead to employment termination after a positive drug test for cannabis, especially in instances where employees possessed a medical cannabis card (Table 1 ). Responses to specific case-based scenarios revealed varying levels of support for continued employment based on the circumstances of cannabis use (Table 2 ). Table 2 – Summary of Responses for Case-Based Scenarios Case # Scenario Percent Results 1 28 y/o female Medical Assistant failed gold standard tx for refractory spasticity symptoms and self-prescribed a THC and CBD regimen. 64% There was no statistical difference by healthcare role, with more than half of the respondents supporting continued employment. Additional comments included the need to measure potential impairment objectively regarding direct patient care. 2 54 y/o male Nurse uses Edpidiolex for refractory seizures approved for children by the FDA. 75.3% There was no statistical difference by healthcare role, with three-quarters of the respondents supporting continued employment. Additional comments included the need for objective measurement of potential impairment. 3 30 y/o female Family Medicine resident on dronabinol (synthetic form of THC) for chemotherapy-induced nausea and vomiting. 82.4% There was no statistical difference by healthcare role, with most respondents supporting continued employment. Some comments suggested adjusting clinical duties or considering medical leave for medication-related impairments. 4 General Surgery resident on dronabinol under similar conditions. 62.7% There was no statistical difference by healthcare role, with slightly over half of the respondents supporting employment. The lower support for continued employment may be due to the skill involved with surgery and comments called for objective impairment measurement and possible adjustments to duties. 5 34 y/o attending physician screens positive for recreational marijuana during post-offer employment drug testing. 72.5% There was no statistical difference by healthcare role, with slightly over half of the respondents supporting employment. There were comparisons made to alcohol, and the focus should be on preventing impairment rather than punitive measures. DISCUSSION This descriptive study revealed a complex variety of opinions and attitudes toward cannabis use in professional healthcare settings that both align with and diverge from findings in the prevailing literature. Most individuals surveyed demonstrated opposition to mandatory cannabis employment screening and critical views on employment termination following positive cannabis tests. A majority of the HH healthcare community surveyed expressed opposition to mandatory cannabis screening for employment. This sentiment aligns with a growing societal shift toward the decriminalization and legalization of cannabis and reflects an evolving understanding of cannabis use within professional contexts (Martins et al. 2022 ). The opposition to employment termination policies following a positive drug test, particularly in cases involving medical cannabis cards, suggests a call for more nuanced, compassionate approaches to drug policies in healthcare settings. When presented with specific case-based scenarios involving healthcare workers and cannabis use, respondents consistently favored nuanced approaches focusing on observable impairment and job performance metrics rather than blanket policies. This preference for contextualized assessment over strict prohibition suggests that healthcare professionals increasingly view cannabis through a harm-reduction lens rather than a prohibitionist framework. Some respondents compared cannabis-related policies to those governing alcohol, noting the broader need for consistency in addressing legalized substance use. However, the absence of a widely accepted standardized test to detect impairment from cannabis complicates this approach, as THC metabolites remain in the bloodstream long after intoxication (Huestis 2015 ), making it a poor indicator of impairment (Arkell et al. 2021 ). Although researchers have identified ratios of active compounds to metabolites as potential indicators of recent marijuana consumption (Kosnett et al. 2023 ), further research is needed to develop tests that can rapidly and accurately assess workplace intoxication. This survey revealed knowledge and awareness gaps among respondents regarding cannabis products and the consequences of positive cannabis tests, which aligns with findings from previous studies (Bell et al. 2015 ; Philbrick et al. 2020 ; Rønne et al. 2021 ). The findings from this study highlight the ongoing need in the healthcare community for education about cannabis-related employment policies, the legal landscape surrounding cannabis, and the use of medical cannabis while protecting patient safety. By increasing awareness of cannabis and related policies, healthcare institutions can potentially reduce issues related to employment termination, prompt changes to outdated policies, and improve patient care. As research in this field continues, the development of a reliable test to assess cannabis impairment may soon become available, potentially addressing some of these challenges. Limitations of this study include the small sample size and geographic focus limited to one healthcare center, which may restrict the generalizability of the presented findings. Although our response rate appeared low at 31%, the list of individuals who received the survey included many minimally active email addresses. Consequently, the actual response rate for this study is likely higher than it appears, and our responses provide a fair assessment of the views of the community. The study captures opinions only at a single point in time, and attitudes toward cannabis use are likely to continue to change over time. Finally, the survey may not have covered all aspects of cannabis use and employment policies relevant to the healthcare community, potentially limiting the scope of our findings. Future research should include broader demographic and geographic representations and develop reliable impairment assessment tools for cannabis use in healthcare settings. Longitudinal studies could provide insight into evolving perceptions of cannabis use and its impact on professional performance and patient care outcomes. CONCLUSION These survey results from the HH healthcare community provide insight into how evolving public consensus surrounding cannabis use can be integrated into professional practice. The respondents supported moving away from punitive measures toward more nuanced, performance-based assessments and reflected a desire to align cannabis policies with those for other legal substances and with the prevailing legal and medical standards. Establishing research-based guidelines and developing reliable impairment assessment tools for cannabis use in healthcare settings would support the creation of policies that ensure both patient safety and fair treatment of healthcare professionals. Abbreviations HonorHealth (HH) Institutional Review Board (IRB) Declarations Ethics approval and consent to participate This study was granted exemption status by the HonorHealth Institutional Review Board on August 10, 2023 (Study #: IRB-23-008). Consent for publication Not applicable. Availability of data and materials All relevant data are provided within the manuscript or supplemental data files. Competing interests All authors declare that they have no conflicts of interest. Funding Not applicable. Author’s contributions All authors contributed to the conception and design of the study, administration of the survey, and manuscript preparation. CB performed the statistical analysis and contributed to interpretation of the data. ABL and FB led the literature review, data collection, interpretation, and drafting of the manuscript. REM, MM, ALi, and CW contributed to manuscript revision and provided critical feedback on the study design and findings. All authors read and approved of the final manuscript and agree to be accountable for all aspects of the work. Acknowledgments We would like to thank all the staff members at HonorHealth for their time and effort in participating in this study. Additionally, we thank Dr. Jacqueline M. Garrick (HonorHealth Research Institute, Scottsdale, Arizona) for providing scientific writing assistance. References Substance Abuse and Mental Health Services Administration. Key Substance Use and Mental Health Indicators in the United States: Results from the 2021 National Survey on Drug Use and Health. Center for Behavioral Health Statistics and Quality, Substance Abuse and Mental Health Services Administration. 2022. p. 17. https://www.samhsa.gov/data/report/2021-nsduh-annual-national-report . Accessed 9 Mar 2024. Naillon PL, Flaudias V, Brousse G, Laporte C, Baker JS, Brusseau V, et al. Cannabis Use in Physicians: A Systematic Review and Meta-Analysis. Medicines. 2023;10(5):29. Rainbow JG, Arnold M, Richter S, Zhao M, Medvescek K, Gallagher S, et al. Uncovering Trends in U.S. Nurse Cannabis Use in Relation to Patient Care. J Nurs Regul. 2024;15(2):5–16. National Conference of State Legislatures. State Medical Cannabis Laws. 2024. https://www.ncsl.org/health/state-medical-cannabis-laws . Accessed 2 Apr 2024. Friedman B, Oyster J, Peloquin D, Fruchterman E, Ryan H, GRAY. DOJ Proposes Rescheduling Marijuana, But the Outlook for Finalization Is Hazy. ROPES &. 2024. https://www.ropesgray.com/en/insights/alerts/2024/05/doj-proposes-rescheduling-marijuana-but-the-outlook-for-finalization-is-hazy . Accessed 6 Jun 2024. Raskin C, United, Nations, Office on Drugs and Crime. 1993. Drug and alcohol testing in the workplace: morthical and legal issues. https://www.unodc.org/unodc/en/data-and-analysis/bulletin/bulletin_1993-01-01_2_page003.html#s0014 . Accessed 14 Nov 2024. Donohoe M, Urine Trouble. Practical, Legal, and Ethical Issues Surrounding Mandated Drug Testing of Physicians. J Clin Ethics. 2005;16(1):85–96. Lemon SJ, Sienko DG, Alguire PC. Physicians’ Attitudes Toward Mandatory Workplace Urine Drug Testing. Arch Intern Med. 1992;152(11):2238–42. Jacobs RJ, Colon J, Kane MN. Medical Students’ Attitudes, Knowledge, and Beliefs about Medical Cannabis: A Qualitative Descriptive Study. Cureus. 2022;14(8):e28336. Makki I, Zheng-Lin B, Kohli M. Medical marijuana knowledge and attitudes amongst internal medicine residents. BMC Prim Care. 2022;23(1):38. Weisman JM, Rodríguez M. A systematic review of medical students’ and professionals’ attitudes and knowledge regarding medical cannabis. J Cannabis Res. 2021;3(1):47. Martins SS, Levy NS, Bruzelius E, Segura LE. Cannabis legalization in the US. Where do we go from here? Trends Psychiatry Psychother. 2022;44(Suppl 1):e20220001. Huestis MA. Cannabis-impaired driving: a public health and safety concern. Clin Chem. 2015;61(10):1223–5. Arkell TR, Spindle TR, Kevin RC, Vandrey R, McGregor IS. The failings of per se limits to detect cannabis-induced driving impairment: Results from a simulated driving study. Traffic Inj Prev. 2021;22(2):102–7. Kosnett MJ, Ma M, Dooley G, Wang GS, Friedman K, Brown T, et al. Blood cannabinoid molar metabolite ratios are superior to blood THC as an indicator of recent cannabis smoking. Clin Toxicol. 2023;61(5):355–62. Bell PF, Semelka MW, Bigdeli L. Drug Testing Incoming Residents and Medical Students in Family Medicine Training: A Survey of Program Policies and Practices. J Graduate Med Educ. 2015;7(1):59–64. Philbrick A, Danner C, Oyenuga A, Pereira C, Ricco J, Wendling A. Education and Attitudes on Medical Cannabis in Family Medicine Residency Programs. Fam Med. 2020;52(10):730–5. Rønne ST, Rosenbæk F, Pedersen LB, Waldorff FB, Nielsen JB, Riisgaard H, et al. Physicians’ experiences, attitudes, and beliefs towards medical cannabis: a systematic literature review. BMC Fam Pract. 2021;22(1):212. SUPPLEMENTAL DATA. Name F. S1 Cannabis Survey Questions.docx. Title of Data. Cannabis Survey Questions. Description of Data. A Microsoft Word document listing all the survey questions used. Name F. S2 Cannabis Survey Data.xlsx. Title of Data. Cannabis Survey Data. Description of Data. An excel spreadsheet displaying the answers to each survey question with written comments from participants (if applicable) included below each question. Each question has its own tab within the spreadsheet, with a total of 32 questions. Additional Declarations No competing interests reported. Supplementary Files S1CannabisSurveyQuestions.docx SUPPLEMENTAL DATA File Name: S1 Cannabis Survey Questions.docx Title of Data: Cannabis Survey Questions Description of Data: A Microsoft Word document listing all the survey questions used. S2CannabisSurveyData.xlsx File Name: S2 Cannabis Survey Data.xlsx Title of Data: Cannabis Survey Data Description of Data: An excel spreadsheet displaying the answers to each survey question with written comments from participants (if applicable) included below each question. Each question has its own tab within the spreadsheet, with a total of 32 questions. Cite Share Download PDF Status: Published Journal Publication published 06 Feb, 2026 Read the published version in Journal of Cannabis Research → Version 1 posted Editorial decision: Revision requested 17 Jul, 2025 Reviews received at journal 16 Jul, 2025 Reviews received at journal 13 Jul, 2025 Reviewers agreed at journal 03 Jul, 2025 Reviewers agreed at journal 03 Jul, 2025 Reviews received at journal 20 Jun, 2025 Reviewers agreed at journal 30 May, 2025 Reviewers invited by journal 01 May, 2025 Editor assigned by journal 30 Apr, 2025 Submission checks completed at journal 25 Apr, 2025 First submitted to journal 22 Apr, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-6508603","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":452063533,"identity":"c31c2589-ce4e-4b33-b3a5-cccc459e64a7","order_by":0,"name":"Axel B. 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Each question has its own tab within the spreadsheet, with a total of 32 questions.\u003c/p\u003e","description":"","filename":"S2CannabisSurveyData.xlsx","url":"https://assets-eu.researchsquare.com/files/rs-6508603/v1/8eb1336a4819af7ad8769938.xlsx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Exploring Perceptions of Cannabis Use and Employment Implications Among Healthcare Workers: A Single-Institution Experience","fulltext":[{"header":"BACKGROUND ","content":"\u003cp\u003eCannabis use has experienced a dramatic surge across the United States in recent years, with over 52\u0026nbsp;million Americans reporting using cannabis in 2021 (Substance Abuse and Mental Health Services Administration 2022). This significant uptake follows the rapidly evolving legal landscape, where recreational use is now permitted in numerous states alongside widespread medical cannabis programs. This societal shift raises essential questions about cannabis use within professional contexts, particularly in healthcare environments where there is a complex intersection of patient safety concerns, professional standards, and legal obligations. Understanding perceptions of cannabis use within the healthcare professional community is important for developing informed drug policies in healthcare settings as well as driving accurate research related to cannabis use in this population.\u003c/p\u003e \u003cp\u003eWhile some studies have reported that cannabis use among nurses and physicians is comparable to that of the general population (Naillon et al. \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2023\u003c/span\u003e; Rainbow et al. \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e2024\u003c/span\u003e), cannabis use among healthcare professionals remains understudied. Healthcare professionals operate in a uniquely challenging position of legal ambiguity with cannabis use as institutional policies are often zero-tolerance, even in states with legalized recreational access. This environment creates substantial barriers to accurate research, as healthcare workers may justifiably fear professional censure, licensure consequences, or career limitations if they disclose cannabis use, even for research purposes.\u003c/p\u003e \u003cp\u003eCourts have generally maintained that if a state does not expressly protect the use of medical cannabis, there is no protection against negative employment action. However, this stance is subject to change as societal attitudes toward cannabis continue to evolve and more states enact protection for cannabis users. Given that 10 out of 21 state laws legalizing adult cannabis use were enacted in or after 2020 (National Conference of State Legislatures 2024), and that the United States government has recently moved to reschedule marijuana (Friedman et al. \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e2024\u003c/span\u003e), there is a need to reassess the implications of cannabis use for both medical and recreational purposes on employment in the healthcare sector. The extant literature was published either prior to noteworthy changes in cannabis legislation (Raskin 1993; Donohoe \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e2005\u003c/span\u003e; Lemon et al. \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e1992\u003c/span\u003e) or only focused on attitudes towards the use of cannabis or its legalization (Jacobs et al. \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e2022\u003c/span\u003e; Makki et al. \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e2022\u003c/span\u003e; Weisman and Rodriguez 2021), leaving a gap in understanding how these changes in beliefs affect employment among healthcare stakeholders.\u003c/p\u003e \u003cp\u003eOur study aimed to address this critical knowledge gap by investigating the understanding and attitudes toward both recreational and medical cannabis use as they specifically relate to employment considerations among stakeholders in the healthcare professional community. By examining perceptions across different roles and specialties, we aimed to identify emerging consensus points that can inform more evidence-based employment policies in this rapidly changing environment.\u003c/p\u003e"},{"header":"METHODS","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStudy Overview\u003c/h2\u003e \u003cp\u003eThis study was conducted within the HonorHealth (HH) healthcare professional community in the Phoenix metropolitan area (Arizona, USA). The participant population included residents, attending physicians, and administrative staff within the HH network. Before commencing data collection, on August 10, 2023, we received Institutional Review Board (IRB) exemption status from the HH IRB (Study #: IRB-23-008).\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eStudy Design\u003c/h3\u003e\n\u003cp\u003eThe research team designed a 32-question survey to explore perceptions of cannabis use and its implications for employment within the HH healthcare professional community. The survey was structured to collect knowledge and opinions about cannabis, cannabis employment testing policies, and case scenarios regarding the necessity of medical cannabis to function. It was initially reviewed for face and content validity by an expert panel prior to its use. The respondents\u0026rsquo; participation was voluntary and anonymous, with informed consent obtained electronically at the beginning of the survey.\u003c/p\u003e \u003cp\u003eThe availability period spanned from September 4, 2023, to October 4, 2023, with weekly reminders to maximize response rates. This questionnaire included multiple-choice, Likert scale, and comment sections for quantitative and qualitative analysis. Questions were developed on the basis of literature review and discussions with stakeholders in the HH healthcare professional community to ensure the relevance of questions and comprehensive coverage of topics.\u003c/p\u003e\n\u003ch3\u003eStudy Outcomes\u003c/h3\u003e\n\u003cp\u003eThe primary outcomes of the survey included respondents\u0026rsquo; familiarity with cannabis products, awareness of cannabis testing policies, and opinions on mandatory cannabis screening and employment termination following positive cannabis tests, particularly for medical cannabis use. The survey also explored respondents\u0026rsquo; attitudes toward cannabis use in professional healthcare settings using case-based scenario questions. Details of all survey questions and their responses can be found in the provided supplemental data (Supplemental Data S1 \u0026ndash; Cannabis Survey Questions, Supplemental Data S2 \u0026ndash; Cannabis Survey Data).\u003c/p\u003e\n\u003ch3\u003ePlanned Analysis\u003c/h3\u003e\n\u003cp\u003eThe research team calculated percentages and frequencies for multiple-choice questions. By summarizing and reviewing the open-ended responses, we identified common themes and insights related to participants' perceptions of cannabis use in the healthcare setting. Response rate estimates and confidence percentages were calculated based on a population of 500 individuals with 95% confidence\u0026thinsp;\u0026plusmn;\u0026thinsp;10% of the surveyed value. Responses to case scenarios were also compared across different participant roles. SPSS Statistics v. 28.0 (IBM Corp., Armonk, New York, USA) and GraphPad Prism v 10.4.0 (Dotmatics, Boston, Massachusetts, USA) were used to analyze and present the data.\u003c/p\u003e"},{"header":"RESULTS","content":"\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eRespondent Summary\u003c/h2\u003e \u003cp\u003eResponses were received from 80 out of 258 potential respondents, demonstrating a 31% response rate. Among these participants, 40% identified as residents or fellows, 43.8% as attending physicians, 15% as administrative staff, and 1.3% fell into the 'other' category (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003eA). Most respondents reported undergoing pre-employment drug screening during their hiring process. Respondents indicated some familiarity with cannabis products and an unawareness of cannabis testing policies. Overall, the results leaned toward opposition to mandatory cannabis screening and disapproval of employment termination policies following positive tests, particularly in cases involving medical cannabis use (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003e\u0026ndash; Opinions on Cannabis Screening and Employment Termination Policies [n (%)]\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePolicy Aspect\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eStrongly Disagree\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eDisagree\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eNeutral\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eAgree\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eStrongly Agree\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMandatory cannabis screening for employment\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e22 (27.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e24 (30%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e12 (15%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e15 (18.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e7 (8.7%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEmployment termination after a positive cannabis test\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e22 (27.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e24 (30%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e18 (22.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e10 (12.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e6 (7.5%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTermination with a medical cannabis card\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e33 (41.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e29 (36.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e10 (12.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e5 (6.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e3 (3.8%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTermination with FDA-approved treatment\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e26 (32.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e33 (41.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e12 (15%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e6 (7.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e3 (3.8%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eExclude cannabis from pre-employment screenings\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e20 (25%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e23 (28.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e21 (26.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e9 (11.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e7 (8.8%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eAwareness and Knowledge of Cannabis Use\u003c/h3\u003e\n\u003cp\u003eMost respondents (75.6%) reported being at least \u0026ldquo;somewhat familiar\u0026rdquo; with cannabis products (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003eB). They were highly aware of the legal status of both medical and recreational cannabis use in Arizona and accurately identified the effects of THC and the non-euphoric properties of CBD (Supplemental Data S2 \u0026ndash; Cannabis Survey Data).\u003c/p\u003e\n\u003ch3\u003eScreening Policies and Employment\u003c/h3\u003e\n\u003cp\u003eMost respondents across all roles opposed mandatory cannabis screening for pre-employment and believed that a positive cannabis drug test should not influence employment status. The majority disagreed with policies that would lead to employment termination after a positive drug test for cannabis, especially in instances where employees possessed a medical cannabis card (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). Responses to specific case-based scenarios revealed varying levels of support for continued employment based on the circumstances of cannabis use (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003e\u0026ndash; Summary of Responses for Case-Based Scenarios\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCase #\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eScenario\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePercent\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eResults\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e28 y/o female Medical Assistant failed gold standard tx for refractory spasticity symptoms and self-prescribed a THC and CBD regimen.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e64%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eThere was no statistical difference by healthcare role, with more than half of the respondents supporting continued employment. Additional comments included the need to measure potential impairment objectively regarding direct patient care.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e54 y/o male Nurse uses Edpidiolex for refractory seizures approved for children by the FDA.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e75.3%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eThere was no statistical difference by healthcare role, with three-quarters of the respondents supporting continued employment. Additional comments included the need for objective measurement of potential impairment.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e30 y/o female Family Medicine resident on dronabinol (synthetic form of THC) for chemotherapy-induced nausea and vomiting.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e82.4%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eThere was no statistical difference by healthcare role, with most respondents supporting continued employment. Some comments suggested adjusting clinical duties or considering medical leave for medication-related impairments.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eGeneral Surgery resident on dronabinol under similar conditions.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e62.7%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eThere was no statistical difference by healthcare role, with slightly over half of the respondents supporting employment. The lower support for continued employment may be due to the skill involved with surgery and comments called for objective impairment measurement and possible adjustments to duties.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e34 y/o attending physician screens positive for recreational marijuana during post-offer employment drug testing.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e72.5%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eThere was no statistical difference by healthcare role, with slightly over half of the respondents supporting employment. There were comparisons made to alcohol, and the focus should be on preventing impairment rather than punitive measures.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e"},{"header":"DISCUSSION","content":"\u003cp\u003eThis descriptive study revealed a complex variety of opinions and attitudes toward cannabis use in professional healthcare settings that both align with and diverge from findings in the prevailing literature. Most individuals surveyed demonstrated opposition to mandatory cannabis employment screening and critical views on employment termination following positive cannabis tests.\u003c/p\u003e \u003cp\u003eA majority of the HH healthcare community surveyed expressed opposition to mandatory cannabis screening for employment. This sentiment aligns with a growing societal shift toward the decriminalization and legalization of cannabis and reflects an evolving understanding of cannabis use within professional contexts (Martins et al. \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e2022\u003c/span\u003e). The opposition to employment termination policies following a positive drug test, particularly in cases involving medical cannabis cards, suggests a call for more nuanced, compassionate approaches to drug policies in healthcare settings. When presented with specific case-based scenarios involving healthcare workers and cannabis use, respondents consistently favored nuanced approaches focusing on observable impairment and job performance metrics rather than blanket policies. This preference for contextualized assessment over strict prohibition suggests that healthcare professionals increasingly view cannabis through a harm-reduction lens rather than a prohibitionist framework. Some respondents compared cannabis-related policies to those governing alcohol, noting the broader need for consistency in addressing legalized substance use. However, the absence of a widely accepted standardized test to detect impairment from cannabis complicates this approach, as THC metabolites remain in the bloodstream long after intoxication (Huestis \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e2015\u003c/span\u003e), making it a poor indicator of impairment (Arkell et al. \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e2021\u003c/span\u003e). Although researchers have identified ratios of active compounds to metabolites as potential indicators of recent marijuana consumption (Kosnett et al. \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e2023\u003c/span\u003e), further research is needed to develop tests that can rapidly and accurately assess workplace intoxication.\u003c/p\u003e \u003cp\u003eThis survey revealed knowledge and awareness gaps among respondents regarding cannabis products and the consequences of positive cannabis tests, which aligns with findings from previous studies (Bell et al. \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e2015\u003c/span\u003e; Philbrick et al. \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e2020\u003c/span\u003e; R\u0026oslash;nne et al. \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e2021\u003c/span\u003e). The findings from this study highlight the ongoing need in the healthcare community for education about cannabis-related employment policies, the legal landscape surrounding cannabis, and the use of medical cannabis while protecting patient safety. By increasing awareness of cannabis and related policies, healthcare institutions can potentially reduce issues related to employment termination, prompt changes to outdated policies, and improve patient care. As research in this field continues, the development of a reliable test to assess cannabis impairment may soon become available, potentially addressing some of these challenges.\u003c/p\u003e \u003cp\u003eLimitations of this study include the small sample size and geographic focus limited to one healthcare center, which may restrict the generalizability of the presented findings. Although our response rate appeared low at 31%, the list of individuals who received the survey included many minimally active email addresses. Consequently, the actual response rate for this study is likely higher than it appears, and our responses provide a fair assessment of the views of the community. The study captures opinions only at a single point in time, and attitudes toward cannabis use are likely to continue to change over time. Finally, the survey may not have covered all aspects of cannabis use and employment policies relevant to the healthcare community, potentially limiting the scope of our findings.\u003c/p\u003e \u003cp\u003eFuture research should include broader demographic and geographic representations and develop reliable impairment assessment tools for cannabis use in healthcare settings. Longitudinal studies could provide insight into evolving perceptions of cannabis use and its impact on professional performance and patient care outcomes.\u003c/p\u003e"},{"header":"CONCLUSION","content":"\u003cp\u003eThese survey results from the HH healthcare community provide insight into how evolving public consensus surrounding cannabis use can be integrated into professional practice. The respondents supported moving away from punitive measures toward more nuanced, performance-based assessments and reflected a desire to align cannabis policies with those for other legal substances and with the prevailing legal and medical standards. Establishing research-based guidelines and developing reliable impairment assessment tools for cannabis use in healthcare settings would support the creation of policies that ensure both patient safety and fair treatment of healthcare professionals.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eHonorHealth (HH)\u003c/p\u003e\n\u003cp\u003eInstitutional Review Board (IRB)\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was granted exemption status by the HonorHealth Institutional Review Board on August 10, 2023 (Study #: IRB-23-008).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll relevant data are provided within the manuscript or supplemental data files.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll authors declare that they have no conflicts of interest.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor’s contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll authors contributed to the conception and design of the study, administration of the survey, and manuscript preparation. CB performed the statistical analysis and contributed to interpretation of the data. ABL and FB led the literature review, data collection, interpretation, and drafting of the manuscript. REM, MM, ALi, and CW contributed to manuscript revision and provided critical feedback on the study design and findings. All authors read and approved of the final manuscript and agree to be accountable for all aspects of the work.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgments\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe would like to thank all the staff members at HonorHealth for their time and effort in participating in this study. Additionally, we thank Dr. Jacqueline M. Garrick (HonorHealth Research Institute, Scottsdale, Arizona) for providing scientific writing assistance.\u0026nbsp;\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eSubstance Abuse and Mental Health Services Administration. Key Substance Use and Mental Health Indicators in the United States: Results from the 2021 National Survey on Drug Use and Health. Center for Behavioral Health Statistics and Quality, Substance Abuse and Mental Health Services Administration. 2022. p. 17. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.samhsa.gov/data/report/2021-nsduh-annual-national-report\u003c/span\u003e\u003cspan address=\"https://www.samhsa.gov/data/report/2021-nsduh-annual-national-report\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e. Accessed 9 Mar 2024.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eNaillon PL, Flaudias V, Brousse G, Laporte C, Baker JS, Brusseau V, et al. Cannabis Use in Physicians: A Systematic Review and Meta-Analysis. Medicines. 2023;10(5):29.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRainbow JG, Arnold M, Richter S, Zhao M, Medvescek K, Gallagher S, et al. Uncovering Trends in U.S. Nurse Cannabis Use in Relation to Patient Care. J Nurs Regul. 2024;15(2):5\u0026ndash;16.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eNational Conference of State Legislatures. State Medical Cannabis Laws. 2024. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.ncsl.org/health/state-medical-cannabis-laws\u003c/span\u003e\u003cspan address=\"https://www.ncsl.org/health/state-medical-cannabis-laws\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e. Accessed 2 Apr 2024.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFriedman B, Oyster J, Peloquin D, Fruchterman E, Ryan H, GRAY. DOJ Proposes Rescheduling Marijuana, But the Outlook for Finalization Is Hazy. ROPES \u0026amp;. 2024. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.ropesgray.com/en/insights/alerts/2024/05/doj-proposes-rescheduling-marijuana-but-the-outlook-for-finalization-is-hazy\u003c/span\u003e\u003cspan address=\"https://www.ropesgray.com/en/insights/alerts/2024/05/doj-proposes-rescheduling-marijuana-but-the-outlook-for-finalization-is-hazy\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e. Accessed 6 Jun 2024.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRaskin C, United, Nations, Office on Drugs and Crime. 1993. Drug and alcohol testing in the workplace: morthical and legal issues. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.unodc.org/unodc/en/data-and-analysis/bulletin/bulletin_1993-01-01_2_page003.html#s0014\u003c/span\u003e\u003cspan address=\"https://www.unodc.org/unodc/en/data-and-analysis/bulletin/bulletin_1993-01-01_2_page003.html#s0014\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e. Accessed 14 Nov 2024.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDonohoe M, Urine Trouble. Practical, Legal, and Ethical Issues Surrounding Mandated Drug Testing of Physicians. J Clin Ethics. 2005;16(1):85\u0026ndash;96.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLemon SJ, Sienko DG, Alguire PC. Physicians\u0026rsquo; Attitudes Toward Mandatory Workplace Urine Drug Testing. Arch Intern Med. 1992;152(11):2238\u0026ndash;42.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eJacobs RJ, Colon J, Kane MN. Medical Students\u0026rsquo; Attitudes, Knowledge, and Beliefs about Medical Cannabis: A Qualitative Descriptive Study. Cureus. 2022;14(8):e28336.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMakki I, Zheng-Lin B, Kohli M. Medical marijuana knowledge and attitudes amongst internal medicine residents. BMC Prim Care. 2022;23(1):38.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWeisman JM, Rodr\u0026iacute;guez M. A systematic review of medical students\u0026rsquo; and professionals\u0026rsquo; attitudes and knowledge regarding medical cannabis. J Cannabis Res. 2021;3(1):47.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMartins SS, Levy NS, Bruzelius E, Segura LE. Cannabis legalization in the US. Where do we go from here? Trends Psychiatry Psychother. 2022;44(Suppl 1):e20220001.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHuestis MA. Cannabis-impaired driving: a public health and safety concern. Clin Chem. 2015;61(10):1223\u0026ndash;5.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eArkell TR, Spindle TR, Kevin RC, Vandrey R, McGregor IS. The failings of per se limits to detect cannabis-induced driving impairment: Results from a simulated driving study. Traffic Inj Prev. 2021;22(2):102\u0026ndash;7.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKosnett MJ, Ma M, Dooley G, Wang GS, Friedman K, Brown T, et al. Blood cannabinoid molar metabolite ratios are superior to blood THC as an indicator of recent cannabis smoking. Clin Toxicol. 2023;61(5):355\u0026ndash;62.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBell PF, Semelka MW, Bigdeli L. Drug Testing Incoming Residents and Medical Students in Family Medicine Training: A Survey of Program Policies and Practices. J Graduate Med Educ. 2015;7(1):59\u0026ndash;64.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePhilbrick A, Danner C, Oyenuga A, Pereira C, Ricco J, Wendling A. Education and Attitudes on Medical Cannabis in Family Medicine Residency Programs. Fam Med. 2020;52(10):730\u0026ndash;5.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eR\u0026oslash;nne ST, Rosenb\u0026aelig;k F, Pedersen LB, Waldorff FB, Nielsen JB, Riisgaard H, et al. Physicians\u0026rsquo; experiences, attitudes, and beliefs towards medical cannabis: a systematic literature review. BMC Fam Pract. 2021;22(1):212.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSUPPLEMENTAL DATA.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eName F. S1 Cannabis Survey Questions.docx.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTitle of Data. Cannabis Survey Questions.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDescription of Data. A Microsoft Word document listing all the survey questions used.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eName F. S2 Cannabis Survey Data.xlsx.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTitle of Data. Cannabis Survey Data.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDescription of Data. An excel spreadsheet displaying the answers to each survey question with written comments from participants (if applicable) included below each question. Each question has its own tab within the spreadsheet, with a total of 32 questions.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"journal-of-cannabis-research","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"jcan","sideBox":"Learn more about [Journal of Cannabis Research](https://jcannabisresearch.biomedcentral.com/)","snPcode":"42238","submissionUrl":"https://submission.springernature.com/new-submission/42238/3","title":"Journal of Cannabis Research","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"BMC/SO AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Healthcare workers, cannabis use, attitudes, survey, research","lastPublishedDoi":"10.21203/rs.3.rs-6508603/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6508603/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eCannabis use is becoming increasingly prevalent in the United States, and its implications extend into many facets of society, including healthcare. Despite legal and societal shifts toward the acceptance of cannabis, healthcare professionals face ethical and legal complexities related to cannabis use. Understanding perceptions of cannabis use within the healthcare community is essential for developing informed drug policies in healthcare settings. The objective of this study was to better understand the changing perceptions of recreational and medical cannabis use on employment within the healthcare community.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eIn September 2023, a team of residents and faculty conducted an anonymous descriptive survey study targeting residents, attending physicians, and administrative staff at HonorHealth in the Phoenix metropolitan area (Arizona, USA). The survey included questions on participants' roles in the healthcare community, their knowledge of cannabis and cannabis testing policies, and their opinions on the permissibility of cannabis use in various workplace scenarios. The survey results were summarized via descriptive statistics, and interesting findings were highlighted.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eThe survey received 80 responses from 258 potential respondents, yielding a 31% response rate. The survey indicated familiarity among respondents with cannabis products, opposition to mandatory cannabis screening, and disapproval of employment termination following positive tests, particularly for medical cannabis use.\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e \u003cp\u003eThe findings suggest that healthcare institutions need more information about cannabis use in these environments and highlight areas for policy review and further research to inform evidence-based approaches to drug policies that balance ethical considerations and the well-being of healthcare professionals.\u003c/p\u003e","manuscriptTitle":"Exploring Perceptions of Cannabis Use and Employment Implications Among Healthcare Workers: A Single-Institution Experience","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-05-09 10:43:52","doi":"10.21203/rs.3.rs-6508603/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-07-17T09:04:21+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-07-16T19:41:47+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-07-13T21:51:12+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"332934549840169588565623376617743757944","date":"2025-07-03T12:57:59+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"285181343729405415622348436542846743229","date":"2025-07-03T12:04:37+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-06-20T14:02:08+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"333809662528982169585909255863610881776","date":"2025-05-30T16:01:06+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-05-01T09:56:40+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-04-30T23:30:28+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-04-25T07:42:48+00:00","index":"","fulltext":""},{"type":"submitted","content":"Journal of Cannabis Research","date":"2025-04-23T03:48:03+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"journal-of-cannabis-research","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"jcan","sideBox":"Learn more about [Journal of Cannabis Research](https://jcannabisresearch.biomedcentral.com/)","snPcode":"42238","submissionUrl":"https://submission.springernature.com/new-submission/42238/3","title":"Journal of Cannabis Research","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"BMC/SO AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"12254a33-80cd-448f-96a0-dacdcc390d41","owner":[],"postedDate":"May 9th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2026-02-09T16:04:43+00:00","versionOfRecord":{"articleIdentity":"rs-6508603","link":"https://doi.org/10.1186/s42238-026-00399-8","journal":{"identity":"journal-of-cannabis-research","isVorOnly":false,"title":"Journal of Cannabis Research"},"publishedOn":"2026-02-06 15:59:20","publishedOnDateReadable":"February 6th, 2026"},"versionCreatedAt":"2025-05-09 10:43:52","video":"","vorDoi":"10.1186/s42238-026-00399-8","vorDoiUrl":"https://doi.org/10.1186/s42238-026-00399-8","workflowStages":[]},"version":"v1","identity":"rs-6508603","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6508603","identity":"rs-6508603","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}