Table 2.

Major influences on expert response to marijuana use and exemplary quotes

Theme	Quotes
Benefits and harms of marijuana for the individual patient	[It is] important to understand how/why [the] patient is using marijuana; what the effects are and how it is used in relation to opioids.
	It would be important to clarify exactly what these benefits are for this patient … . If on a given day, I do not believe the patient is experiencing significant harms, I remain concerned about future harms and repeat this decision-making process with each refill and each visit.
	While I don’t necessarily agree this is ideal, if they are not experiencing harm, do not appear to have addiction, and I have counseled them appropriately, I would be willing to work with the patient and try to minimize but not necessarily stop opioids if overall the benefits seem to outweigh the harms/risks.
Belief about the overall riskiness of marijuana use	I would not mix opioids and marijuana.
	Since there are drug/drug interactions with the cannabis and opioids, the opioids should be tapered if [the patient] continues with the marijuana.
	[I] consider marijuana much lower risk than other illicit drugs.
	I do not believe that tapering opioids is an appropriate clinical response to nondisordered marijuana use.
State laws or practice policy	[It] depends on the laws regarding marijuana use in the state that the patient lives in. If recreational marijuana is legal there, I do not think that it should factor in to the opioid decision as long as there is no evidence of harm. However, if it is only approved for medicinal uses and it is not being certified/authorized/prescribed by me, then this represents increased risk. Similarly, if the use of marijuana is illegal in the state in which the patient lives, it needs to be treated as an illicit substance and other controlled substances should be prescribed with caution, if at all.
	My toleration for marijuana in a [urine toxicology test] is related, in part, to whether MJ is legal in the state where I am practicing and/or, in the case of medical marijuana, whether the patient has a medical MJ card.
	[I] consider marijuana much lower risk than other illicit drugs. However, if there is a clinic policy then [I] would adhere to this.