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Dobson O, Barber M, Graham M, Carter A, Savic M. 'The wild west of medicine': A qualitative investigation of the factors influencing Australian health-care practitioners' delivery of medicinal cannabis. Drug Alcohol Rev 2024; 43:1280-1293. [PMID: 38630896 DOI: 10.1111/dar.13847] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Revised: 03/13/2024] [Accepted: 03/19/2024] [Indexed: 04/19/2024]
Abstract
INTRODUCTION Strong patient interest in the use of medicinal cannabis to treat various clinical indications has sparked global legislative changes. Practitioners are vital in implementing regulatory changes and facilitating patient access to medicinal cannabis, however, little is currently known about the factors influencing practitioners' uptake. Recent rapid increases in practitioner applications to prescribe medicinal cannabis in Australia provides a unique backdrop to examine the current factors influencing prescribing behaviours. This qualitative study examined Australian practitioners' perspectives on prescribing medicinal cannabis to provide a comprehensive exploration of the potential factors influencing uptake in clinical practice. METHODS Seventeen semi-structured interviews were conducted with Australian health-care practitioners. Transcripts were analysed using the Framework approach to thematic analysis and cross-mapped to appropriate domains of the Theoretical Domains Framework. RESULTS We identified four themes related to the barriers and facilitators to prescribing medicinal cannabis: (i) clinical capabilities needed to prescribe; (ii) prescribing an unapproved therapeutic good; (iii) negative attitudes towards prescribers in the medical community; and (iv) divergent beliefs about clinical utility. DISCUSSION AND CONCLUSIONS Practitioners face multiple pervasive barriers to prescribing medicinal cannabis. Beliefs about clinical utility appear to be highly influential in shaping prescribing behaviours. Moreover, our findings suggest that a medicinal cannabis 'specialisation' has emerged within the Australian medical community. Findings demonstrate that a range of complex and multifaceted factors influence practitioners' medicinal cannabis prescribing behaviours. We highlight several considerations for policy and practice to support safe and appropriate patient access to medicinal cannabis in this emerging area of clinical practice.
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Affiliation(s)
- Olivia Dobson
- School of Psychological Sciences and the Turner Institute for Brain and Mental Health, Monash University, Melbourne, Australia
| | - Michaela Barber
- School of Psychological Sciences and the Turner Institute for Brain and Mental Health, Monash University, Melbourne, Australia
| | - Myfanwy Graham
- Monash Addiction Research Centre, Eastern Health Clinical School, Monash University and Turning Point, Melbourne, Australia
| | - Adrian Carter
- School of Psychological Sciences and the Turner Institute for Brain and Mental Health, Monash University, Melbourne, Australia
- Monash Bioethics Centre, School of Philosophy, History and International Studies, Monash University, Melbourne, Australia
| | - Michael Savic
- Monash Addiction Research Centre, Eastern Health Clinical School, Monash University and Turning Point, Melbourne, Australia
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Nielsen SSR, Pedersen JAZ, Sharma N, Wasehuus PK, Hansen MS, Møller AMJ, Borggaard XG, Rauch A, Frost M, Sondergaard TE, Søe K. Human osteoclasts in vitro are dose dependently both inhibited and stimulated by cannabidiol (CBD) and Δ9-tetrahydrocannabinol (THC). Bone 2024; 181:117035. [PMID: 38342278 DOI: 10.1016/j.bone.2024.117035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2023] [Revised: 01/12/2024] [Accepted: 01/31/2024] [Indexed: 02/13/2024]
Abstract
Legalized use of cannabis for medical or recreational use is becoming more and more common. With respect to potential side-effects on bone health only few clinical trials have been conducted - and with opposing results. Therefore, it seems that there is a need for more knowledge on the potential effects of cannabinoids on human bone cells. We studied the effect of cannabidiol (CBD) and Δ9-tetrahydrocannabinol (THC) (dose range from 0.3 to 30 μM) on human osteoclasts in mono- as well as in co-cultures with human osteoblast lineage cells. We have used CD14+ monocytes from anonymous blood donors to differentiate into osteoclasts, and human osteoblast lineage cells from outgrowths of human trabecular bone. Our results show that THC and CBD have dose-dependent effects on both human osteoclast fusion and bone resorption. In the lower dose ranges of THC and CBD, osteoclast fusion was unaffected while bone resorption was increased. At higher doses, both osteoclast fusion and bone resorption were inhibited. In co-cultures, both osteoclastic bone resorption and alkaline phosphatase activity of the osteoblast lineage cells were inhibited. Finally, we observed that the cannabinoid receptor CNR2 is more highly expressed than CNR1 in CD14+ monocytes and pre-osteoclasts, but also that differentiation to osteoclasts was coupled to a reduced expression of CNR2, in particular. Interestingly, under co-culture conditions, we only detected the expression of CNR2 but not CNR1 for both osteoclast as well as osteoblast lineage nuclei. In line with the existing literature on the effect of cannabinoids on bone cells, our current study shows both stimulatory and inhibitory effects. This highlights that potential unfavorable effects of cannabinoids on bone cells and bone health is a complex matter. The contradictory and lacking documentation for such potential unfavorable effects on bone health as well as other potential effects, should be taken into consideration when considering the use of cannabinoids for both medical and recreational use.
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Affiliation(s)
- Simone S R Nielsen
- Clinical Cell Biology, Pathology Research Unit, Department of Clinical Research, University of Southern Denmark, Campusvej 55, 5230 Odense M, Denmark; Department of Pathology, Odense University Hospital, J.B. Winsløws Vej 15, 5000 Odense C, Denmark.
| | - Juliana A Z Pedersen
- Clinical Cell Biology, Pathology Research Unit, Department of Clinical Research, University of Southern Denmark, Campusvej 55, 5230 Odense M, Denmark; Department of Pathology, Odense University Hospital, J.B. Winsløws Vej 15, 5000 Odense C, Denmark.
| | - Neha Sharma
- Clinical Cell Biology, Pathology Research Unit, Department of Clinical Research, University of Southern Denmark, Campusvej 55, 5230 Odense M, Denmark; Department of Pathology, Odense University Hospital, J.B. Winsløws Vej 15, 5000 Odense C, Denmark; Department of Molecular Medicine, University of Southern Denmark, Campusvej 55, 5230 Odense M, Denmark.
| | - Pernille K Wasehuus
- Department of Chemistry and Bioscience, Aalborg University, Fredrik Bajers Vej 7H, 9220 Aalborg, Denmark
| | - Morten S Hansen
- Molecular Endocrinology Laboratory (KMEB), Department of Endocrinology, Odense University Hospital, J.B. Winsløws Vej 4, 5000 Odense C, Denmark; Department of Clinical Research, University of Southern Denmark, Campusvej 55, 5230 Odense M, Denmark.
| | - Anaïs M J Møller
- Clinical Cell Biology, Pathology Research Unit, Department of Clinical Research, University of Southern Denmark, Campusvej 55, 5230 Odense M, Denmark; Department of Clinical Biochemistry and Immunology, Lillebaelt Hospital, University Hospital of Southern Denmark, Kabbeltoft 25, 7100 Vejle, Denmark.
| | - Xenia G Borggaard
- Department of Pathology, Odense University Hospital, J.B. Winsløws Vej 15, 5000 Odense C, Denmark; Molecular Bone Histology, Pathology Research Unit, Department of Clinical Research, University of Southern Denmark, Campusvej 55, 5230 Odense M, Denmark.
| | - Alexander Rauch
- Molecular Endocrinology Laboratory (KMEB), Department of Endocrinology, Odense University Hospital, J.B. Winsløws Vej 4, 5000 Odense C, Denmark; Department of Clinical Research, University of Southern Denmark, Campusvej 55, 5230 Odense M, Denmark; Steno Diabetes Centre Odense, Odense University Hospital, Kløvervænget 10, 5000 Odense C, Denmark.
| | - Morten Frost
- Molecular Endocrinology Laboratory (KMEB), Department of Endocrinology, Odense University Hospital, J.B. Winsløws Vej 4, 5000 Odense C, Denmark; Department of Clinical Research, University of Southern Denmark, Campusvej 55, 5230 Odense M, Denmark; Steno Diabetes Centre Odense, Odense University Hospital, Kløvervænget 10, 5000 Odense C, Denmark.
| | - Teis E Sondergaard
- Department of Chemistry and Bioscience, Aalborg University, Fredrik Bajers Vej 7H, 9220 Aalborg, Denmark.
| | - Kent Søe
- Clinical Cell Biology, Pathology Research Unit, Department of Clinical Research, University of Southern Denmark, Campusvej 55, 5230 Odense M, Denmark; Department of Pathology, Odense University Hospital, J.B. Winsløws Vej 15, 5000 Odense C, Denmark; Department of Molecular Medicine, University of Southern Denmark, Campusvej 55, 5230 Odense M, Denmark.
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