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Ganna S, Daggolu J, Sansgiry SS. Understanding Pharmacy Students' Preparedness towards Counseling over Cannabis Use Disorder. PHARMACY 2024; 12:77. [PMID: 38804469 PMCID: PMC11130912 DOI: 10.3390/pharmacy12030077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2024] [Revised: 04/30/2024] [Accepted: 05/11/2024] [Indexed: 05/29/2024] Open
Abstract
The rise in cannabis use prompts significant concerns regarding pharmacy students' abilities to counsel patients over cannabis use disorder. This study aims to understand pharmacy students' preparedness to counsel patients with cannabis use disorder (CUD) and evaluate the relationship between knowledge, attitudes towards medical cannabis (MC) and recreational cannabis (RC), and behavior intention (BI) to counsel over CUD. A cross-sectional survey was administered to pharmacy students. Descriptive analyses of sample characteristics were assessed with the t-test and one-way ANOVA test. Pearson correlation and linear regression were conducted, measuring the strength and direction of relationships. The average scores for knowledge, attitudes towards MC use and RC, and behavioral intention were 81% (SD 16%), 4.13 (SD 0.75), 3.28 (0.80), and 2.74 (1.00). Significant correlations were observed between knowledge-attitudes toward MC, knowledge-attitudes towards RC, and attitudes towards RC-behavioral intentions. Linear regression indicated attitudes towards MC use and RC, academic year, awareness of MC use legality, obtained knowledge, and past patient interaction were significantly associated with behavioral intention on confidence in counseling over CUD. There is a gap in students' behavioral intention to counsel. These findings emphasize the importance of ample preparation that enables student pharmacists to address patient needs related to cannabis use confidently.
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Affiliation(s)
| | | | - Sujit S. Sansgiry
- Department of Pharmaceutical Health Outcomes and Policy, College of Pharmacy, University of Houston, Houston, TX 77204, USA; (S.G.); (J.D.)
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Schuhmacher S, Gaid D, Bishop LD, Fleming L, Donnan J. Planting the seeds for success: A qualitative study exploring primary healthcare providers' perceptions about medical cannabis. PLoS One 2024; 19:e0295858. [PMID: 38451984 PMCID: PMC10919677 DOI: 10.1371/journal.pone.0295858] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Accepted: 11/30/2023] [Indexed: 03/09/2024] Open
Abstract
BACKGROUND In Canada, cannabis legalization altered the way that the public can access cannabis for medical purposes. However, Canadians still struggle with finding healthcare professionals (HCPs) who are involved in medical cannabis counselling and authorization. This raises questions about the barriers that are causing this breakdown in care. Our study explored the perceptions of primary care providers regarding cannabis in their practice. METHODS Semi-structured interviews were conducted by Zoom with HCPs in Newfoundland and Labrador (NL) to discuss their experiences with medical and non-medical cannabis in practice. Family physicians and nurse practitioners who were practicing in primary care in NL were included. The interview guide and coding template were developed using the Theoretical Domains Framework (TDF). A thematic analysis across the TDF was then conducted. RESULTS Twelve participants with diverse demographic backgrounds and experience levels were interviewed. Five main themes emerged including, knowledge acquisition, internal influences, patient influences, external HCP influences, and systemic influences. The TDF domain resulting in the greatest representation of codes was environmental context and resources. INTERPRETATION The findings suggested that HCPs have significant knowledge gaps in authorizing medical cannabis, which limited their practice competence and confidence in this area. Referring patients to cannabis clinics, while enforcing harm-reduction strategies, was an interim option for patients to access cannabis for medical purposes. However, developing practice guidelines and educational resources were suggested as prominent facilitators to promote medical cannabis authorization within the healthcare system.
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Affiliation(s)
- Sandi Schuhmacher
- School of Pharmacy, Memorial University of Newfoundland, St. John’s, Newfoundland and Labrador, Canada
| | - Dina Gaid
- School of Pharmacy, Memorial University of Newfoundland, St. John’s, Newfoundland and Labrador, Canada
| | - Lisa D. Bishop
- School of Pharmacy, Memorial University of Newfoundland, St. John’s, Newfoundland and Labrador, Canada
| | - Laura Fleming
- School of Pharmacy, Memorial University of Newfoundland, St. John’s, Newfoundland and Labrador, Canada
| | - Jennifer Donnan
- School of Pharmacy, Memorial University of Newfoundland, St. John’s, Newfoundland and Labrador, Canada
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Denneler T, Mahling M, Hermann S, Stengel A, Zipfel S, Herrmann-Werner A, Festl-Wietek T. Medical students' attitudes and perceived competence regarding medical cannabis and its suggestibility. BMC MEDICAL EDUCATION 2024; 24:149. [PMID: 38360743 PMCID: PMC10867999 DOI: 10.1186/s12909-024-05089-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Accepted: 01/23/2024] [Indexed: 02/17/2024]
Abstract
INTRODUCTION The global trend of legalizing medical cannabis (MC) is on the rise. In Germany, physicians have prescribed MC at the expense of health insurers since 2017. However, the teaching on MC has been scant in medical training. This study investigates medical students' attitudes and perceived competence regarding MC and evaluates how varying materials (videos/articles) impact their opinions. METHODS Fourth-year medical students were invited to participate in the cross-sectional study. During an online session, students viewed a video featuring a patient with somatoform pain discussing her medical history, plus one of four randomly assigned MC-related materials (each an article and a video depicting a positive or negative perspective on MC). Students' opinions were measured at the beginning [T0] and the end of the course [T1] using a standardized questionnaire with a five-point Likert scale. We assessed the influence of the material on the students' opinions using paired-sample t-tests. One-way analysis of variance and Tukey post-hoc tests were conducted to compare the four groups. Pearson correlations assessed correlations. RESULTS 150 students participated in the course, the response rate being 75.3% [T0] and 72.7% [T1]. At T0, students felt a little competent regarding MC therapy (M = 1.80 ± 0.82). At T1, students in groups 1 (positive video) and 3 (positive article) rated themselves as more capable in managing MC therapy [Formula: see text], and students in groups 3 (positive article) and 4 (negative article) felt more skilled in treating patients with chronic pain [Formula: see text]. Compared to the other groups, group 2 students (negative video) felt significantly less competent. They perceived cannabis as addictive, hazardous and unsuitable for medical prescription. DISCUSSION This study showed that medical students lack knowledge and perceived competence in MC therapy. Material influences their opinions in different ways, and they seek more training on MC. This underlines that integrating MC education into medical curricula is crucial to address this knowledge gap.
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Affiliation(s)
- Tatjana Denneler
- Deanery of Students' Affairs, Faculty of Medicine, University of Tuebingen, Tuebingen, Germany
| | - Moritz Mahling
- TIME- Tuebingen Institute for Medical Education, University of Tuebingen, Tuebingen, Germany
- Department of Diabetology, Endocrinology, Nephrology, Section of Nephrology and Hypertension, University Hospital Tuebingen, Tuebingen, Germany
| | - Sabine Hermann
- University Department of Anaesthesiology and Intensive Care Medicine, University Hospital of Tuebingen, Tuebingen, Germany
| | - Andreas Stengel
- Department of Psychosomatic Medicine and Psychotherapie, University Hospital of Tuebingen, Tuebingen, Germany
- German Center for Mental Health (DZPG), site Tuebingen, Tuebingen, Germany
- Center for Internal Medicine and Dermatology, Deparment of Psychosomatic Medicine, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Stephan Zipfel
- Department of Psychosomatic Medicine and Psychotherapie, University Hospital of Tuebingen, Tuebingen, Germany
| | - Anne Herrmann-Werner
- TIME- Tuebingen Institute for Medical Education, University of Tuebingen, Tuebingen, Germany
- Department of Psychosomatic Medicine and Psychotherapie, University Hospital of Tuebingen, Tuebingen, Germany
| | - Teresa Festl-Wietek
- TIME- Tuebingen Institute for Medical Education, University of Tuebingen, Tuebingen, Germany.
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Balneaves LG, Watling CZ, Strus JA, Boscow M, Davis L, Graveline K, Harrigan T, Henriquez N, Mitchell K, Thompson G. Baccalaureate nursing students' knowledge, attitudes, educational needs, and use of medical and non-medical cannabis at five institutions in Manitoba, Canada: A cross-sectional analysis. NURSE EDUCATION TODAY 2023; 130:105955. [PMID: 37677985 DOI: 10.1016/j.nedt.2023.105955] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/20/2023] [Revised: 08/15/2023] [Accepted: 08/30/2023] [Indexed: 09/09/2023]
Abstract
BACKGROUND With the legalization of non-medical cannabis in Canada, cannabis is commonly used in the community and nurses and nursing students are likely to engage in clinical practice discussions around cannabis use for both medical and non-medical purposes. However, whether having previous experience using cannabis influences nursing students' knowledge and attitudes towards cannabis remains unclear. OBJECTIVE The aim of this study was to describe nursing students' knowledge, attitudes, educational needs, and use of cannabis. DESIGN Cross-sectional survey. SETTING Five academic undergraduate nursing programs in Manitoba, Canada. PARTICIPANTS Nursing students in Manitoba. METHODS Students were asked about their use of cannabis, knowledge and attitudes regarding cannabis, clinical experiences and educational needs related to cannabis. Students' current knowledge was compared to their desired knowledge using paired t-tests. Using t-tests, attitudes towards cannabis were compared between students who had ever taken cannabis versus those with no experience. Descriptive statistics were utilized for all other questions. RESULTS A total of 327 nursing students participated in the survey with 220 students (67.3 %) reporting they had used cannabis in the past, and 123 students (37.6 %) reporting monthly use of cannabis. Students who previously used cannabis held more positive attitudes towards both medical and non-medical cannabis use in comparison to those with no experience. Students recognised that their current knowledge around cannabis was insufficient and indicated the need for greater knowledge on both medical and non-medical cannabis-related topics. Only 37.7 % of students reported receiving any education on cannabis in their nursing program. Nearly all students (92.2 %) agreed if they had more education on medical cannabis use that they would feel more comfortable discussing this in their clinical practice. CONCLUSION Education on both medical and non-medical cannabis is needed to support future nurses addressing cannabis use in their clinical practice. Nursing institutions must implement and evaluate curricula to ensure nursing students are adequately prepared to address cannabis use in their clinical practice and their own fitness to practice.
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Affiliation(s)
- Lynda G Balneaves
- 89 Curry Place, College of Nursing, University of Manitoba, Winnipeg, MB R3T 2N2, Canada.
| | - Cody Z Watling
- 89 Curry Place, College of Nursing, University of Manitoba, Winnipeg, MB R3T 2N2, Canada.
| | | | - Megan Boscow
- 436 7 St E, Faculty of Nursing, University College of the North, Thompson and The Pas, MB R9A 1T4, Canada.
| | - Lori Davis
- 89 Curry Place, College of Nursing, University of Manitoba, Winnipeg, MB R3T 2N2, Canada.
| | - Kellie Graveline
- 436 7 St E, Faculty of Nursing, University College of the North, Thompson and The Pas, MB R9A 1T4, Canada.
| | - Tom Harrigan
- 2055 Notre Dame Avenue, Nursing Department, Red River College Polytechnic, Winnipeg, MB R3H 0J9, Canada.
| | - Nadine Henriquez
- 270-18th Street, Faculty of Health Studies, Brandon University, Brandon, MB R7A 6A9, Canada.
| | - Kimberley Mitchell
- 89 Curry Place, College of Nursing, University of Manitoba, Winnipeg, MB R3T 2N2, Canada; 2055 Notre Dame Avenue, Nursing Department, Red River College Polytechnic, Winnipeg, MB R3H 0J9, Canada.
| | - Genevieve Thompson
- 89 Curry Place, College of Nursing, University of Manitoba, Winnipeg, MB R3T 2N2, Canada.
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Poisblaud L, Kröger E, Jauvin N, Pelletier-Jacob J, Bélanger RE, Foldes-Busque G, Aubin M, Pluye P, Guillaumie L, Amiri M, Dagenais P, Dionne CE. Perceptions and Preoccupations of Patients and Physicians Regarding Use of Medical Cannabis as an Intervention Against Chronic Musculoskeletal Pain: Results from a Qualitative Study. J Pain Res 2023; 16:3463-3475. [PMID: 37873024 PMCID: PMC10590559 DOI: 10.2147/jpr.s413450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Accepted: 08/27/2023] [Indexed: 10/25/2023] Open
Abstract
Objective Explore perceptions and preoccupations regarding use of medical cannabis against chronic musculoskeletal pain, among patients and physicians. Design Qualitative study using interviews with patients and physicians, based on the Theory of Planned Behavior (TPB). Setting The study was conducted in Quebec, Canada, in spring 2020. Subjects We included 27 adult patients and 11 physicians (GPs, anesthesiologists, psychiatrists, and a rheumatologist); the mean age of patients was 48.2 years; 59.3% of patients and 36.4% of physicians were women; 59.3% of patients used no medical cannabis at the time of study; 45.5% of physicians had never authorized it. Methods Semi-structured interviews were conducted, transcribed and for the qualitative analysis codes were developed in a hybrid, inductive and deductive approach. Guided by the TPB, facilitators and barriers, perceived benefits and harms, and perceived norms that may influence cannabis use or authorization were documented. Results Although medical cannabis is an interesting avenue for the relief of chronic musculoskeletal pain, doctors and patients agreed that it remained a last line option, due to the lack of scientific evidence regarding its safety and efficacy. The norms surrounding medical cannabis also play an important role in the social and professional acceptance of this therapeutic option. Conclusion Medical cannabis is seen as a last line option among interventions in the management of chronic pain, and attitudes and prior experiences play a role in the decision to use it. Study results may contribute to improved shared decision making between patients and physicians regarding this option.
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Affiliation(s)
- Lise Poisblaud
- Centre d’excellence sur le vieillissement de Québec (CEVQ), Centre Intégré Universitaire de Santé et de Services Sociaux de la Capitale-Nationale (CIUSSSCN), Québec, Quebec, Canada
- Centre de Recherche du CHU de Québec, Université Laval, Québec, Quebec, Canada
| | - Edeltraut Kröger
- Centre d’excellence sur le vieillissement de Québec (CEVQ), Centre Intégré Universitaire de Santé et de Services Sociaux de la Capitale-Nationale (CIUSSSCN), Québec, Quebec, Canada
- Centre de Recherche du CHU de Québec, Université Laval, Québec, Quebec, Canada
- Faculty of Pharmacy, Université Laval, Québec, Quebec, Canada
| | - Nathalie Jauvin
- Institut national de santé publique du Québec, Québec, Quebec, Canada
| | - Julie Pelletier-Jacob
- Centre d’excellence sur le vieillissement de Québec (CEVQ), Centre Intégré Universitaire de Santé et de Services Sociaux de la Capitale-Nationale (CIUSSSCN), Québec, Quebec, Canada
| | - Richard E Bélanger
- Centre de Recherche du CHU de Québec, Université Laval, Québec, Quebec, Canada
- School of Psychology, Université Laval, Québec, Quebec, Canada
| | - Guillaume Foldes-Busque
- School of Psychology, Université Laval, Québec, Quebec, Canada
- Research Centre, Centre Intégré de Santé et de Services Sociaux (CISSS) de Chaudière-Appalaches, Lévis, Quebec, Canada
| | - Michèle Aubin
- Centre d’excellence sur le vieillissement de Québec (CEVQ), Centre Intégré Universitaire de Santé et de Services Sociaux de la Capitale-Nationale (CIUSSSCN), Québec, Quebec, Canada
- Centre de Recherche du CHU de Québec, Université Laval, Québec, Quebec, Canada
- School of Psychology, Université Laval, Québec, Quebec, Canada
| | - Pierre Pluye
- Faculty of Medicine, McGill University, Montréal, Quebec, Canada
| | | | - Malek Amiri
- Faculty of Nursing, Université Laval, Québec, Quebec, Canada
| | - Pierre Dagenais
- Faculty of Medicine, Université de Sherbrooke, Sherbrooke, Quebec, Canada
| | - Clermont E Dionne
- Centre d’excellence sur le vieillissement de Québec (CEVQ), Centre Intégré Universitaire de Santé et de Services Sociaux de la Capitale-Nationale (CIUSSSCN), Québec, Quebec, Canada
- Centre de Recherche du CHU de Québec, Université Laval, Québec, Quebec, Canada
- School of Psychology, Université Laval, Québec, Quebec, Canada
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Kitchen C, Kabba JA, Nelson EU, Adu-Gyamfi S, Ssekamatte T, Mametja M, Yang C, Chang J, Fang Y. Medicinal use of cannabis: A qualitative study of the perspectives of doctors and pharmacists from six African countries. J Ethn Subst Abuse 2023:1-25. [PMID: 37791493 DOI: 10.1080/15332640.2023.2259830] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/05/2023]
Abstract
We conducted a qualitative study to examine the enablers and barriers influencing the implementation of medical cannabis from the perspectives of practicing doctors and pharmacists within the African context. Interviews were conducted to investigate medical professionals' perceptions and concerns regarding medicinal cannabis. Three major themes were identified: beliefs about consequences, optimism, and environmental resources and context. Depending on the context of use, medical professionals described cannabis as potentially useful as an adjunct medicine and yet problematic owing to knowledge and social barriers, particularly religion. Implementation strategies tailored to address structural and social concerns to providing optimal care are needed to ensure that medical professionals are well versed in policy and clinical aspects.
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Affiliation(s)
- Chenai Kitchen
- Xi'an Jiaotong University, Xi'an, China
- Western Technological Innovation Harbour, Xi'an, China
| | - John Alimamy Kabba
- Xi'an Jiaotong University, Xi'an, China
- Western Technological Innovation Harbour, Xi'an, China
| | | | | | | | | | - Caijun Yang
- Xi'an Jiaotong University, Xi'an, China
- Western Technological Innovation Harbour, Xi'an, China
| | - Jie Chang
- Xi'an Jiaotong University, Xi'an, China
- Western Technological Innovation Harbour, Xi'an, China
| | - Yu Fang
- Xi'an Jiaotong University, Xi'an, China
- Western Technological Innovation Harbour, Xi'an, China
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Galvin SL, Coulson CC. Addressing cannabis consumption among patients with hyperemesis gravidarum. AJOG GLOBAL REPORTS 2023; 3:100180. [PMID: 36911236 PMCID: PMC9992753 DOI: 10.1016/j.xagr.2023.100180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2023] Open
Abstract
Severe nausea and vomiting of pregnancy and hyperemesis gravidarum affect up to 3% of all pregnant people, causing substantial maternal and neonatal morbidity, suffering, and financial cost. Evidence supports the association of cannabis consumption with symptoms of severe nausea and vomiting of pregnancy or hyperemesis gravidarum as the general public has come to believe that cannabis is a natural, safe antiemetic. Cannabis consumption in pregnancy is discouraged strongly by the Surgeon General of the United States and the American College of Obstetricians and Gynecologists because of evidence of potential harms. Symptoms of intractable, severe nausea and vomiting of pregnancy or hyperemesis gravidarum associated with cannabis consumption may be unrecognized cannabinoid hyperemesis syndrome, and this syndrome may be more common than previously thought. Cannabis consumption is especially detrimental when causing or exacerbating debilitating symptoms such as the intense, persistent, recurrent, or cyclic vomiting and associated dehydration and other sequelae of cannabinoid hyperemesis syndrome. Open discussion of cannabis consumption during pregnancy is very challenging for patients and maternity care providers in our current environment of variable legal status across states and variable degrees of personal and societal acceptance. Evidence-based medical knowledge, guidance, tools, and skills are needed to differentially diagnose and treat cannabinoid hyperemesis syndrome in pregnancy. Researchers, clinicians, and medical specialty organizations must work together to strengthen the evidence base and develop or refine the necessary guidelines and tools for maternity care provider skill development, and to increase public and patient awareness of cannabinoid hyperemesis syndrome, specifically during pregnancy.
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Affiliation(s)
- Shelley L Galvin
- Department of Obstetrics and Gynecology, Mountain Area Health Education Center, Asheville, NC.,Department of Obstetrics and Gynecology, The University of North Carolina School of Medicine at Chapel Hill, Chapel Hill, NC
| | - Carol C Coulson
- Department of Obstetrics and Gynecology, Mountain Area Health Education Center, Asheville, NC.,Department of Obstetrics and Gynecology, The University of North Carolina School of Medicine at Chapel Hill, Chapel Hill, NC
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Bazzari FH, Bazzari AH. Attitudes and Knowledge Regarding the Therapeutic Use of Cannabinoids among Community Pharmacists: A Pilot Cross-Sectional Study in Amman, Jordan. Healthcare (Basel) 2023; 11:healthcare11050694. [PMID: 36900699 PMCID: PMC10000482 DOI: 10.3390/healthcare11050694] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Revised: 02/02/2023] [Accepted: 02/24/2023] [Indexed: 03/02/2023] Open
Abstract
There is an increasing interest in the therapeutic use of cannabis worldwide, with a number of cannabinoid-derived drugs currently approved by the Food and Drug Administration (FDA) for certain indications. This study was conducted via a printed questionnaire and aimed to explore the attitudes and knowledge regarding the therapeutic use of cannabis and cannabinoids among community pharmacists residing in Amman, Jordan. The results revealed a neutral to low agreement level regarding the medical usefulness of cannabis; however, a higher agreement level was observed for FDA-approved cannabinoid-derived drugs. The majority of the participants reported that they did not learn enough regarding cannabinoids, do not adequately remember what they have learned, and do not actively look for information after graduation. The average percentages of correct identification of cannabis/cannabinoid FDA-approved drug indications, common adverse effects, interacting drugs, and cautions/contraindications were 40.6%, 53%, 49.4%, and 57.3%, respectively, with an overall correct identification rate of 51.1% of the participants. In conclusion, the results indicate an inadequate level of knowledge with a significant room for improvement regarding the various aspects of cannabinoid pharmacology.
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Affiliation(s)
- Firas H. Bazzari
- Faculty of Pharmacy, Jerash University, Jerash 26150, Jordan
- Correspondence:
| | - Amjad H. Bazzari
- Department of Basic Scientific Sciences, Faculty of Arts & Sciences, Applied Science Private University, Amman 11931, Jordan
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Withanarachchie V, Rychert M, Wilkins C. The role of cannabis clinics in the health system: a qualitative study of physicians' views in New Zealand. BMC Health Serv Res 2023; 23:10. [PMID: 36600251 DOI: 10.1186/s12913-022-09021-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Accepted: 12/30/2022] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Privately-owned cannabis clinics have sprung up in many jurisdictions where medicinal cannabis has been legalised and provide an alternative pathway for patients who are unable or unwilling to access a prescription for cannabis-based medicinal products from their usual healthcare providers. AIMS This study aimed to explore physicians' views on cannabis clinics, including their perceptions of the role cannabis clinics play in the wider health system. METHODS A qualitative study using in-depth, semi-structured interviews with thirty-one physicians affiliated with private and community clinics in New Zealand (including cannabis clinicians, GPs, and specialist doctors). The interviews were conducted from July to December 2021. Data were transcribed and analysed using inductive thematic analysis. RESULTS Cannabis clinicians positioned themselves as (1) "service providers", facilitating consumer access to cannabis prescriptions and products, and (2) "educators", providing advice to patients and the wider physician community. While general practitioners and specialists recognised the benefits of specialised cannabis clinics (i.e., knowledge of products and a non-judgmental environment), they questioned the limited evidence of clinical efficacy for cannabis, potential financial conflicts of interests of cannabis clinicians that may blur their clinical judgement, and the risk of compartmentalising patients' healthcare. CONCLUSIONS Our paper raises a number of challenges with attempting to integrate cannabis clinics into the wider health system.
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Affiliation(s)
- Vinuli Withanarachchie
- Shore & Whāriki Research Centre, College of Health, Massey University, Auckland, New Zealand.
| | - Marta Rychert
- Shore & Whāriki Research Centre, College of Health, Massey University, Auckland, New Zealand
| | - Chris Wilkins
- Shore & Whāriki Research Centre, College of Health, Massey University, Auckland, New Zealand
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Clobes TA, Palmier LA, Gagnon M, Klaiman C, Arellano M. The impact of education on attitudes toward medical cannabis. PEC INNOVATION 2022; 1:100009. [PMID: 37364019 PMCID: PMC10194214 DOI: 10.1016/j.pecinn.2021.100009] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Revised: 11/22/2021] [Accepted: 11/23/2021] [Indexed: 06/28/2023]
Abstract
Objective This research explores the impact of patient education on reducing historical and current stigma. Methods Participants were recruited through social media, parenting with community organizations, and snowball sampling. A pretest posttest method was utilized. Participants viewed five balanced educational videos about medicinal cannabis. Attitudes toward medical cannabis were measured with a modified version of the medical component of the Recreational and Medical Cannabis Attitudes Scale (RMCAS). In total, 111 participants completed all requirements of the study. Results Results of a Wilcoxon Sign Rank Test demonstrated a significant increase in the modified medical component of the RMCAS (1.18, p = 0.029). Conclusion Health education is an effective intervention to reduce stigma associated with medical cannabis. Future health policies must take a balanced, education-focused, and proactive stance in reducing barriers to care that exist due to the negative stigma associated with cannabis use.Innovation: Historically, patient education has focused on areas such as tobacco, automobile safety, vaccinations, obesity, and the like. This research applied patient education to the area of medical cannabis to improve attitudes toward it and improve patient access.
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Affiliation(s)
- Thomas A. Clobes
- California State University, Channel Islands 1 University Dr., Camarillo, CA 93012, USA
| | - Lauren A. Palmier
- The University of Health Sciences and Pharmacy in St. Louis 1 Pharmacy, Pl, St. Louis, MO 63110, USA
| | - Matin Gagnon
- California State University, Channel Islands 1 University Dr., Camarillo, CA 93012, USA
| | - Colby Klaiman
- California State University, Channel Islands 1 University Dr., Camarillo, CA 93012, USA
| | - Mya Arellano
- California State University, Channel Islands 1 University Dr., Camarillo, CA 93012, USA
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Klein TA, Clark CS. Therapeutic use of cannabis in the US. Nurse Pract 2022; 47:16-25. [PMID: 36399143 PMCID: PMC9674439 DOI: 10.1097/01.npr.0000884880.81603.c5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
ABSTRACT NPs are likely to encounter patients using cannabis with therapeutic intent, with or without legal authorization. During the clinical history and assessment process, NPs need to engage in frank discussion about cannabis therapeutics, including the risks and benefits, evidence for use, dosing considerations, potential drug interactions, and harm reduction.
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12
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Jochen A, Holben D. School Nurse Perspectives of Medical Cannabis Policy in K-12 Schools: An Exploratory Descriptive Study. J Sch Nurs 2022:10598405221136288. [PMID: 36377286 DOI: 10.1177/10598405221136288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2024] Open
Abstract
As states legalize medical cannabis, school nurses face increased parent questions about administration at school. Although school nurses frequently collaborate on the development and implementation of medication administration policies, their perceptions of barriers to school-based medical cannabis administration are not well-documented. To explore these perceptions, we surveyed school nurses (n = 379) in sixteen states about their beliefs related to school-based medical cannabis administration policy development. Findings revealed school nurses from states completely legalizing cannabis expressed significantly fewer concerns about the safety, stigma, and federal status of medical cannabis than their peers in more restrictive states. Implications for practice include (a) education of key stakeholders, (b) collaboration with stakeholders to formulate medication administration policy; and (c) development of state-level guidance for school professionals.
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Affiliation(s)
- Alison Jochen
- Ross and Carol Nese College of Nursing, The Pennsylvania State University, University Park, Pennsylvania, USA
| | - Diane Holben
- Secondary Education Department, East Stroudsburg University in the Professional, East Stroudsburg University, Pennsylvania, USA
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Hachem Y, Abdallah SJ, Rueda S, Wiese JL, Mehra K, Rup J, Cowan J, Vigano A, Costiniuk CT. Healthcare practitioner perceptions on barriers impacting cannabis prescribing practices. BMC Complement Med Ther 2022; 22:237. [PMID: 36076191 PMCID: PMC9453734 DOI: 10.1186/s12906-022-03716-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Accepted: 09/02/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Canadians seeking medical cannabis (MC) may encounter difficulties in finding a healthcare provider (HCP) who authorizes their access to it. Barriers that HCPs face in authorizing MC are unclear. The objectives of this study were to evaluate HCP opinions, knowledge, comfort, and practice in MC prescribing and counseling on recreational cannabis use, and whether the COVID-19 pandemic affected MC prescribing practices.
Methods
Eligible participants included HCPs (e.g., attending physicians, nurses, pharmacists) in Canada. A questionnaire evaluating their knowledge, comfort, and practice in medical and recreational cannabis was designed based on instruments developed in previous studies. Between April 13th-December 13th 2021, ninety-one healthcare associations were asked to distribute the survey to their members, and an advertisement was placed in the online Canadian Medical Association Journal. Descriptive statistics were used to analyze the results.
Results
Twenty-four organizations agreed to disseminate the survey and 70 individuals completed it. Of respondents, 71% were attending physicians or medical residents, while the remainder were nurses, pharmacists or other HCPs. Almost none (6%) received training in MC in professional school but 60% did receive other training (e.g., workshops, conferences). Over half (57%) received more questions regarding MC since recreational cannabis was legalized, and 82% reported having patients who use MC. However, 56% felt uncomfortable or ambivalent regarding their knowledge of MC, and 27% were unfamiliar with the requirements for obtaining MC in Canada. The most common symptoms for recommending MC were pain and nausea, whereas the most common conditions for recommending it were cancer and intractable pain. The strongest barrier to authorizing MC was uncertainty in safe and effective dosage and routes of administration. The strongest barrier to recommending or authorizing MC was the lack of research evidence demonstrating its safety and efficacy. During the pandemic, many respondents reported that a greater number of their patients used cannabis to relieve anxiety and depression.
Conclusions
Our results suggest that HCPs across Canada who responded to our survey are unfamiliar with topics related to MC. The strongest barriers appear to be lack of clinical research, and uncertainty in safe and effective MC administration. Increasing research, training, and knowledge may help HCPs feel more equipped to make informed treatment/prescribing decisions, which may help to improve access to MC.
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Manoharan R, Kemper J, Young J. Exploring the medical cannabis prescribing behaviours of New Zealand physicians. Drug Alcohol Rev 2022; 41:1355-1366. [PMID: 35604868 PMCID: PMC9544511 DOI: 10.1111/dar.13476] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Revised: 03/31/2022] [Accepted: 04/03/2022] [Indexed: 12/20/2022]
Abstract
INTRODUCTION Many countries are changing their regulations for prescribing medical cannabis. As gatekeepers, physicians significantly impact patient access to cannabis treatments. It is important to explore how physicians view prescribing cannabis in terms of their existing beliefs, knowledge, possible concerns and personal perceptions. METHODS Individual, semi-structured telephone interviews were undertaken with 14 New Zealand physicians from various specialties. The interviews were thematically analysed using a phenomenological approach. RESULTS The physician-patient relationship was of extreme importance in making prescription decisions, driven largely by trust in the patient. Barriers to prescribing included concern over possible side effects, the quality and standardisation of medication, uncertainty about indications and equity concerns from the high cost for lower socio-economic patients. Some physicians held concerns over their liability and risks to their reputation if issues arose for patients. DISCUSSION AND CONCLUSION The way physicians regard prescribing medical cannabis is based on their personal beliefs and knowledge built up over their medical career. It is important that these are taken into consideration in the design of future guidelines to help alleviate uncertainties and reduce barriers for informed prescribing. While our research and previous research find that physicians generally will follow clinical guidelines based on institutional logics (i.e. the standardised approach to medicine), we find that physicians often allow their personal construals to determine their perceptions and prescribing behaviour to a considerable extent when they practice medicine. Our findings have implications for Continuing Medical Education, marketing and regulation for medical cannabis, especially about the wording of guideline adherence.
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Affiliation(s)
- Rachel Manoharan
- School of Biological SciencesUniversity of AucklandAucklandNew Zealand
| | - Joya Kemper
- Department of Management, Marketing and EntrepreneurshipUniversity of Canterbury, UC Business SchoolChristchurchNew Zealand
| | - Jenny Young
- Plant and Food Research LtdAucklandNew Zealand
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Jacobs RJ, Colon J, Kane MN. Medical Students’ Attitudes, Knowledge, and Beliefs about Medical Cannabis: A Qualitative Descriptive Study. Cureus 2022; 14:e28336. [PMID: 36168342 PMCID: PMC9502535 DOI: 10.7759/cureus.28336] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Accepted: 08/24/2022] [Indexed: 11/25/2022] Open
Abstract
Background There has been increased attention given to understanding the uses of medical cannabis (MC) for symptom management of various medical conditions. Physicians receive minimal training in medical school and rely mostly on anecdotal evidence; by proxy, medical students generally do receive formal training in MC. It is unknown how medical students perceive MC, including its efficacy, appropriateness in medicine, its possible adverse effects, and its value for patients. This study investigated medical students’ perceived knowledge, beliefs, and attitudes toward MC to better understand their knowledge about and attitudes toward MC. Method Using a semi-structured interview guide, eight focus groups were conducted with 83 medical students via Zoom virtual meeting platform (Zoom Video Communications, Inc., San Jose, California, United States) in June 2022. The interviews were guided by the following content areas: (1) beliefs about cannabis' therapeutic utility, (2) perceived knowledge about MC, (3) the role of the physician regarding MC, (4) concern for cannabis’ adverse effects, and (5) MC education in the school curriculum. Data were analyzed using thematic analysis, an iterative, systematic process of coding patterns, and emerged themes in the interview data to explore medical students’ perceptions about MC. Themes were validated based on whether each theme captured distinct parts of the interview data and whether their content cohered meaningfully. Results Four themes emerged from the focus group interviews investigating medical students’ perceptions of MC: (1) erroneous beliefs about MC, (2) unreliable sources of information, (3) mixed attitudes toward legalization, and (4) desire for MC education while in medical school. Attitudes regarding MC in general, including legalization, varied by United States state of origin of the student and exposure to MC (e.g., use by family member). Conclusion MC seems to be a significant issue for medical trainees who might be required to recommend it to patients and manage coexisting therapies. Cultivating new knowledge about students’ perceptions and perceived knowledge about medicinal options and dosing of MC is critical for medical educators as they design undergraduate curricular initiatives for future physicians.
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Purcell JM, Passley TM, Leheste JR. The cannabidiol and marijuana research expansion act: Promotion of scientific knowledge to prevent a national health crisis. LANCET REGIONAL HEALTH. AMERICAS 2022; 14:100325. [PMID: 36777382 PMCID: PMC9903742 DOI: 10.1016/j.lana.2022.100325] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
While the use of medical and recreational cannabis is rapidly expanding under state jurisdiction, the convolution of federal regulations is obstructing research progress to the detriment of healthcare equity and the protection of vulnerable populations, such as the underaged. U.S. Senate bill S.253 is designed to accelerate the development of trusted preclinical and clinical principles based on scientific data to guide physicians in their daily practice, inform lawmakers, and thereby protect public health. This goes together with a reinforcement of the legal protection that practitioners have acquired over years of litigation with the federal government when working with their patients. S.253 supports open communication between physicians and their patients when discussing cannabis as a treatment option. The bill passed the U.S. Senate on March 24, 2022. Funding This work was supported by intramural funding (NYIT College of Osteopathic Medicine) to the corresponding author, Dr. Joerg R. Leheste.
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Affiliation(s)
- John M. Purcell
- Department of Basic Sciences, New York Institute of Technology College of Osteopathic Medicine at Arkansas State University, Jonesboro, AR 72401, USA
| | - Tija M. Passley
- Department of Basic Sciences, New York Institute of Technology College of Osteopathic Medicine at Arkansas State University, Jonesboro, AR 72401, USA
| | - Joerg R. Leheste
- Department of Biomedical Sciences, New York Institute of Technology College of Osteopathic Medicine, Old Westbury, NY 11568, USA,Corresponding author at: New York Institute of Technology College of Osteopathic Medicine, Old Westbury, NY 11568, USA.
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Vaillancourt R, Dhalla R, Merks P, Lougheed T, Goldfield G, Mansell H, Cameron J. Concerns, beliefs and attitudes of pharmacists and pharmacy students on cannabis use in Canada. Can Pharm J (Ott) 2022; 155:219-229. [PMID: 35813525 PMCID: PMC9266375 DOI: 10.1177/17151635221102143] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2023]
Abstract
BACKGROUND Since cannabis has been legalized in Canada for medical and recreational use, there has been an increased demand on pharmacists for cannabis counselling. The objective of this study was to determine the concerns, beliefs and attitudes of Canadian pharmacists and pharmacy students towards using cannabis. METHODS An online survey was synthesized under 3 broad themes: concerns, beliefs and attitudes about cannabis, consisting of 27 questions capturing demographics and Likert scale responding to survey questions. We examined whether there were differences in responses by geographic location (i.e., Ontario, Quebec, Canada), sex or practice setting (i.e., community, hospital). RESULTS Across Canada, there were 654 survey respondents, with 399 in Ontario and 95 in Quebec. Approximately 24% indicated they had used cannabis since legalization, 69% indicated they believed cannabis should be available for medical and recreational use and 34% indicated their perceptions towards cannabis had become more positive since legalization. Relative to Quebec or the rest of Canada, respondents from Ontario were significantly more likely to be comfortable providing counselling to and answering questions of patients on the safety and efficacy of medical cannabis use. Examining sex differences across Canada, male respondents were more comfortable than female counselling patients on the safety and efficacy of medical cannabis. CONCLUSION The current results reinforce the perceived need by pharmacists and pharmacy students for targeted education, and future research in cannabis education should consider potential gender differences in attitudes and beliefs surrounding cannabis therapy.
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Affiliation(s)
- Régis Vaillancourt
- Department of Pharmacy, Children’s Hospital of Eastern Ontario, Ottawa
- Department of Family Medicine, University of Ottawa Faculty of Medicine, Ottawa
| | | | - Piotr Merks
- Cardinal Stefan Wyszyński University, Faculty of Medicine, Warsaw and the Department of Pharmaceutical Technology, Faculty of Pharmacy, Collegium, Medicum, Bydgoszcz, Poland
| | - Taylor Lougheed
- Section of Emergency Medicine, Northern Ontario School of Medicine, Sudbury
| | - Gary Goldfield
- Healthy Active Living and Obesity (HALO) Research Group, Children’s Hospital of Eastern Ontario, Ottawa
| | - Holly Mansell
- College of Pharmacy and Nutrition, University of Saskatchewan, Saskatoon, Saskatchewan
| | - Jameason Cameron
- Department of Pharmacy, Children’s Hospital of Eastern Ontario, Ottawa
- Department of Family Medicine, University of Ottawa Faculty of Medicine, Ottawa
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Ng JY, Homayouni P, Usman S, Gomes Z. The medical cannabis regulatory framework in Canada: A narrative review. Eur J Integr Med 2022. [DOI: 10.1016/j.eujim.2022.102104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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19
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Ng JY, Abrams A, Pathak A, Tahir U, Jomy J. What are the experiences of patients using cannabis for pain? A systematic review of qualitative studies. Eur J Integr Med 2022. [DOI: 10.1016/j.eujim.2021.102098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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A systematic review of medical students' and professionals' attitudes and knowledge regarding medical cannabis. J Cannabis Res 2021; 3:47. [PMID: 34641976 PMCID: PMC8507207 DOI: 10.1186/s42238-021-00100-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Accepted: 08/30/2021] [Indexed: 12/17/2022] Open
Abstract
Background Recently, the renewed global interest in cannabis’ therapeutic properties has resulted in shifting attitudes and legislative policies worldwide. The aim of this systematic review is to explore the existing literature on medical professionals’ and students’ attitudes and knowledge regarding medicinal cannabis (MC) to assess any relevant and significant trends. Methods This systematic review was conducted in accordance with PRISMA guidelines. Using PubMed and Google Scholar, a literature search was performed to identify studies pertaining to healthcare professionals’ and medical students’ knowledge and attitudes regarding MC. There were no search limits on the year of publication; however, studies without primary data (e.g., abstracts, systematic reviews, meta-analyses) and non-English language papers were excluded. Studies were coded according to the following research questions: (1) Do respondents believe that cannabis should be legalized (for medicinal and/or recreational purposes)? (2) Are respondents confident in their level of knowledge regarding cannabis’ clinical applications? (3) Are respondents convinced of cannabis’ therapeutic potential? 4) What current gaps in knowledge exist, and how can the medical community become better informed about cannabis’ therapeutic uses? and (5) Are there significant differences between the knowledge and opinions of healthcare students versus healthcare professionals with respect to any of the aforementioned queries? Chi-square tests were used to assess differences between medical students and medical professionals, and Pearson’s bivariate correlations were used to analyze associations between survey responses and year of publication—as a proxy measurement to assess change over time. Results Out of the 741 items retrieved, 40 studies published between 1971 and 2019 were included in the final analyses. In an evaluation of 21 qualified studies (8016 respondents), 49.9% of all respondents favored legalization (SD = 25.7, range: 16–97%). A correlational analysis between the percentage of survey respondents who support MC legalization and year of publication suggests that both medical students’ and professionals’ support for MC legalization has increased from 1991 to 2019 (r(19) = .44, p = .045). Moreover, medical professionals favor the legalization of MC at a significantly higher rate than students (52% vs. 42%, respectively; χ2 (1, N = 9019) = 50.72 p < .001). Also, respondents consistently report a strong desire for more education about MC and a substantial concern regarding MC’s potential to cause dependence and addiction. Pearson’s correlations between year of publication and survey responses for both of these queried variables suggest minimal changes within the last decade (2011–2019 for addiction and dependence, 2012-2019 for additional education; r(13) = − .10, p = .713 and r(12) = − .12, p = .678, respectively). Conclusion The finding that both medical students’ and professionals’ acceptance of MC has significantly increased in recent decades—in conjunction with their consistent, strong desire for more educational material—suggests that the medical community should prioritize the development of MC educational programs. MC is far more likely to succeed as a safe and viable therapy if the medical professionals who administer it are well-trained and confident regarding its clinical effects. Limitations include a lack of covariate-based analyses and the exclusion of studies published after the literature search was performed (June 2019). Future research should analyze studies published post-2019 to draw temporal comparisons and should investigate the effect of numerous covariates (e.g., gender, religiosity, prior cannabis use) as newer studies gather data on these factors [PROSPERO Registration: CRD42020204382].
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Cross national comparison of medical students' attitudes and beliefs about medical cannabis and its application for pain management. Complement Ther Med 2021; 59:102720. [PMID: 33864906 DOI: 10.1016/j.ctim.2021.102720] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Revised: 04/10/2021] [Accepted: 04/12/2021] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVES To examine attitudes and beliefs about medical cannabis (MC), and specifically about its application for pain management, across medical students in Israel and Thailand. DESIGN Cross-sectional survey which measured attitudes and beliefs about MC. Participants were additionally asked to rate the perceived efficacy of MC for different medical conditions that are related to pain (arthritis, chronic pain, fibromyalgia and multiple sclerosis). Pearson's Chi-squared test was used to compare between students from the participating universities. RESULTS 430 medical students participated, 37.9 % (n = 163) from Israel and 62.1 % (n = 267) from Thailand. Personal cannabis use was reported by 55.6 % of the Israeli and only by 6.9 % of the Thai students (p < .001). Israeli secular students, compared to those from Thailand, were more likely to recommend MC for patient treatment, less concerned about serious physical and mental health risks, and more inclined to support legalization of recreational cannabis. Israeli students reported more permissive attitudes toward MC, but reported feeling less prepared to answer patient/client questions about MC than their Thai counterparts. CONCLUSIONS The findings of this study accentuate the need for curriculum designed around MC use to promote students' preparedness to serve patients in pain or with other medical conditions that may benefit from MC use.
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