title: Storage and disposal of medical cannabis among patients with cancer: Assessing the risk of diversion and unintentional digestion.
abstract: BACKGROUND
  Increasingly more jurisdictions worldwide are legalizing medical cannabis. Major concerns related to such policies are that improper storage and disposal arrangements may lead to the diversion and unintentional digestion of cannabis. These concerns are particularly acute among patients with cancer because they take home medical cannabis for extended periods and have high rates of treatment termination and mortality shortly after the onset of treatment with medical cannabis. Therefore, leftover cannabis is potentially particularly prevalent, and potentially improperly stored, in households of current and deceased patients with cancer. The current study investigated the risk of medical cannabis diversion and unintentional digestion among oncology patients treated with medical cannabis and caregivers of recently deceased patients who were treated with medical cannabis.
  
  
  METHODS
  A total of 123 oncology patients treated with medical cannabis and 37 caregivers of deceased oncology patients treated with medical cannabis were interviewed regarding practices and the information received concerning the safe storage and disposal of medical cannabis, as well as experiences of theft, diversion, and unintentional digestion.
  
  
  RESULTS
  High rates of suboptimal storage were reported and caregivers were found to be particularly unlikely to have received information regarding the safe storage and disposal of medical cannabis. Few incidences of theft, diversion, and unintentional digestion were reported.
  
  
  CONCLUSIONS
  Oncologists and other health care providers have an important, yet unfilled, role to play with regard to educating patients and caregivers of the importance of the safe storage and disposal of medical cannabis. Interventions designed to alert patients treated with medical cannabis and their caregivers to the problem of diversion, along with strategies to limit it, have the potential to limit diversion and unintentional exposure to medical cannabis. Cancer 2016;122:3363-3370. © 2016 American Cancer Society.
authors.affiliation: Department of Health Promotion, School of Public Health, University of Haifa, Haifa, Israel.
authors.forename: Sharon R
authors.initials: SR
authors.lastname: Sznitman
authors.affiliation: Division of Oncology, Rambam Health Care Campus, Haifa, Israel.
authors.forename: Victoria
authors.initials: V
authors.lastname: Goldberg
authors.affiliation: Division of Oncology, Rambam Health Care Campus, Haifa, Israel.
authors.forename: Hedva
authors.initials: H
authors.lastname: Sheinman-Yuffe
authors.affiliation: Division of Oncology, Rambam Health Care Campus, Haifa, Israel.
authors.forename: Ezequiel
authors.initials: E
authors.lastname: Flechter
authors.affiliation: Division of Oncology, Rambam Health Care Campus, Haifa, Israel. g_barsela@rambam.health.gov.il.|Integrated Oncology and Palliative Care Unit, Rambam Health Care Campus, Technion-Israel Institute of Technology, Haifa, Israel. g_barsela@rambam.health.gov.il.
authors.forename: Gil
authors.initials: G
authors.lastname: Bar-Sela
mesh_terms: D017028:Caregivers; D004063:Digestion; D004356:Drug Storage / Q000592:standards*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D064086:Medical Marijuana / Q000009:adverse effects*; D008875:Middle Aged; D009369:Neoplasms / Q000188:drug therapy* / Q000473:pathology; D064226:Prescription Drug Diversion; D011379:Prognosis; D012037:Refuse Disposal / Q000592:standards*; D012107:Research Design; D018570:Risk Assessment; D015996:Survival Rate
chemical_list: D064086:Medical Marijuana
keywords: disposal; diversion; medical cannabis; oncology patients; storage; unintentional digestion