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Tanco K, Lopez G, Koyyalagunta L, Fellman B, Halm J, Ignatius J, Bruera E. Comparison of Health Care Providers Attitudes and Beliefs Regarding Medical Marijuana and Cannabidiol in the Management of Pain and Other Symptoms in Cancer Patients. J Palliat Med 2022; 26:539-543. [PMID: 36576904 DOI: 10.1089/jpm.2022.0433] [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: 12/29/2022] Open
Abstract
Background: Medical marijuana (MM) and cannabidiol (CBD) have received increasing attention to manage pain and other symptoms even with limited scientific evidence. Objectives: We examined the attitudes and beliefs of health care providers toward MM and CBD compared to standard treatments for cancer-associated pain and various symptoms. Design: Two sets of anonymous surveys (MM and CBD) containing similar items were completed by clinicians of four symptom-focused specialties. Results: A minority of respondents preferred recommending MM (9%) and CBD (13%), respectively, over opioids for cancer pain, while 11% and 22% felt that MM and CBD, respectively, would be useful to combine with opioids to treat cancer pain. Respondents did not favor MM or CBD over common treatment options for nonpain symptoms. Conclusion: MM and CBD were not preferred over current standard treatments for pain and other symptoms. Responses from the four specialties aligned with unique aspects of their clinical practice.
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Affiliation(s)
- Kimberson Tanco
- Department of Palliative, Rehabilitation, and Integrative Medicine, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Gabriel Lopez
- Department of Palliative, Rehabilitation, and Integrative Medicine, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Lakshmi Koyyalagunta
- Department of Pain Medicine, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Bryan Fellman
- Department of Biostatistics, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Josiah Halm
- Department of Hospital Medicine, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Jerry Ignatius
- Department of Psychiatry, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Eduardo Bruera
- Department of Palliative, Rehabilitation, and Integrative Medicine, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
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2
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Cheng KYC, Harnett JE, Davis SR, Eassey D, Law S, Smith L. Healthcare professionals' perspectives on the use of medicinal cannabis to manage chronic pain: A systematic search and narrative review. Pain Pract 2022; 22:718-732. [PMID: 36055965 PMCID: PMC9826162 DOI: 10.1111/papr.13161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2022] [Revised: 07/22/2022] [Accepted: 08/22/2022] [Indexed: 01/11/2023]
Abstract
RATIONALE, AIMS, AND OBJECTIVES Chronic pain is a global public health problem that negatively impacts individuals' quality of life and imposes a substantial economic burden on societies. The use of medicinal cannabis (MC) is often considered by patients to help manage chronic pain as an alternative or supplement to more conventional treatments, given enabling legalization in a number of countries. However, healthcare professionals involved in providing guidance for patients related to MC are often doing so in the absence of strong evidence and clinical guidelines. Therefore, it is crucial to understand their perspectives regarding the clinical use and relevance of MC for chronic pain. As little is known about attitudes of HCPs with regard to MC use for chronic pain specifically, the aim of this review was to identify and synthesize the published evidence on this topic. METHODS A systematic search was conducted across six databases: MEDLINE, EMBASE, CINAHL, Scopus, Web of Science, and PubMed from 2001 to March 26, 2021. Three authors independently performed the study selection and data extraction. Thematic analysis was undertaken to identify key themes. RESULTS A total of 26 studies were included, involving the United States, Israel, Canada, Australia, Ireland, and Norway, and the perspectives of physicians, nurses, and pharmacists. Seven key themes were identified: MC as a treatment option for chronic pain, and perceived indicated uses; willingness to prescribe MC; legal issues; low perceived knowledge and the need for education; comparative safety of MC versus opioids; addiction and abuse; and perceived adverse effects; CONCLUSION: To support best practice in the use of MC for chronic pain, healthcare professionals require education and training, as well as clinical guidelines that provide evidence-based information about efficacy, safety, and appropriate dosage of products for this indication. Until these gaps are addressed, healthcare professionals will be limited in their capacity to make treatment recommendations about MC for people/patients with chronic pain.
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Affiliation(s)
- Katherine Y. C. Cheng
- School of Pharmacy, Faculty of Medicine and HealthThe University of SydneyCamperdownNew South WalesAustralia
| | - Joanna E. Harnett
- School of Pharmacy, Faculty of Medicine and HealthThe University of SydneyCamperdownNew South WalesAustralia
| | - Sharon R. Davis
- School of Pharmacy, Faculty of Medicine and HealthThe University of SydneyCamperdownNew South WalesAustralia
| | - Daniela Eassey
- School of Pharmacy, Faculty of Medicine and HealthThe University of SydneyCamperdownNew South WalesAustralia
| | - Susan Law
- Institute of Health Policy, Management and EvaluationUniversity of TorontoTorontoOntarioCanada
| | - Lorraine Smith
- School of Pharmacy, Faculty of Medicine and HealthThe University of SydneyCamperdownNew South WalesAustralia
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Olson RE, Smith A, Huggett G, Good P, Dudley M, Hardy J. Using a qualitative sub-study to inform the design and delivery of randomised controlled trials on medicinal cannabis for symptom relief in patients with advanced cancer. Trials 2022; 23:752. [PMID: 36064621 PMCID: PMC9444122 DOI: 10.1186/s13063-022-06691-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Accepted: 08/24/2022] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Recruitment for randomised controlled trials in palliative care can be challenging; disease progression and terminal illness underpin high rates of attrition. Research into participant decision-making in medicinal cannabis randomised controlled trials (RCTs) is very limited. Nesting qualitative sub-studies within RCTs can identify further challenges to participation, informing revisions to study designs and recruitment practices. This paper reports on findings from a qualitative sub-study supporting RCTs of medicinal cannabis for symptom burden relief in patients with advanced cancer in one Australian city. METHODS Semi-structured qualitative interviews were conducted with 48 patients with advanced cancer, eligible to participate in a medicinal cannabis RCT (n=28 who consented to participate in an RCT; n=20 who declined). An iterative and abductive approach to thematic analysis and data collection fostered exploration of barriers and enablers to participation. RESULTS Key enablers included participants' enthusiasm and expectations of medicinal cannabis as beneficial (to themselves and future patients) for symptom management, especially after exhausting currently approved options, and a safer alternative to opioids. Some believed medicinal cannabis to have anti-cancer effects. Barriers to participation were the logistical challenges of participating (especially due to driving restrictions and fatigue), reluctance to interfere with an existing care plan, cost, and concerns about receiving the placebo and the uncertainty of the benefit. Some declined due to concerns about side-effects or a desire to continue accessing cannabis independent of the study. CONCLUSIONS The findings support revisions to subsequent medicinal cannabis RCT study designs, namely, omitting a requirement that participants attend weekly hospital appointments. These findings highlight the value of embedding qualitative sub-studies into RCTs. While some challenges to RCT recruitment are universal, others are context (population, intervention, location) specific. A barrier to participation found in research conducted elsewhere-stigma-was not identified in the current study. Thus, findings have important implications for those undertaking RCTs in the rapidly developing context of medical cannabis.
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Affiliation(s)
- Rebecca E Olson
- School of Social Science, The University of Queensland, Michie Building #9, St Lucia, QLD, 4072, Australia.
| | - Alexandra Smith
- School of Social Science, The University of Queensland, Michie Building #9, St Lucia, QLD, 4072, Australia
| | - Georgie Huggett
- Department of Palliative and Supportive Care Mater Health Services, Mater Research-University of Queensland, Raymond Terrace, South Brisbane, QLD, Australia
| | - Phillip Good
- Department of Palliative and Supportive Care Mater Health Services, Mater Research-University of Queensland, Raymond Terrace, South Brisbane, QLD, Australia
- Department of Palliative Care, St. Vincent's Private Hospital Brisbane, 411 Main Street, Kangaroo Point, QLD, Australia
| | - Morgan Dudley
- School of Social Science, The University of Queensland, Michie Building #9, St Lucia, QLD, 4072, Australia
| | - Janet Hardy
- Department of Palliative and Supportive Care Mater Health Services, Mater Research-University of Queensland, Raymond Terrace, South Brisbane, QLD, Australia
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Kalonji P, Revol A, Broers B, Ljuslin M, Pautex S. Patient-Related Barriers to the Prescription of Cannabinoid-Based Medicines in Palliative Care: A Qualitative Approach. Palliat Med Rep 2022; 3:200-205. [PMID: 36203714 PMCID: PMC9531874 DOI: 10.1089/pmr.2022.0021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/17/2022] [Indexed: 11/13/2022] Open
Affiliation(s)
- Pauline Kalonji
- Department of Readaptation and Geriatrics, University of Geneva, Geneva, Switzerland
| | - Aurélie Revol
- Palliative Medicine Division and University Hospital Geneva, Geneva, Switzerland
| | - Barbara Broers
- Department of Readaptation and Geriatrics, University of Geneva, Geneva, Switzerland
- Primary Care Division, University Hospital Geneva, Geneva, Switzerland
| | - Michael Ljuslin
- Palliative Medicine Division and University Hospital Geneva, Geneva, Switzerland
| | - Sophie Pautex
- Department of Readaptation and Geriatrics, University of Geneva, Geneva, Switzerland
- Palliative Medicine Division and University Hospital Geneva, Geneva, Switzerland
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Kurtzman ET, Greene J, Begley R, Drenkard KN. Nurse Leaders’ Attitudes Toward and Experiences With Medical Marijuana. JOURNAL OF NURSING REGULATION 2022. [DOI: 10.1016/s2155-8256(22)00063-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Lazris D, Gaur D, Curseen K, Kavalieratos D, Maxwell M, Quest T, Zarrabi AJ. Integrated Medical Cannabis Consultations in a Palliative Care Program: Policies, Procedures, and Progress after Six Years of Practice. J Palliat Med 2022; 25:802-806. [PMID: 35319304 DOI: 10.1089/jpm.2021.0577] [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: 11/12/2022] Open
Abstract
Introduction: Our academic ambulatory palliative care program has counseled, monitored, and certified patients for cannabis as part of routine palliative care practice for six years. Objective: We describe the population certified for cannabis and policies, procedures, and medicolegal challenges in our palliative care clinic. Methods: We performed a retrospective review of patients, qualifying diagnoses for cannabis certification, reasons for referral, and number of annual certifications. Results: Between 2015 and 2021, we certified 1711 patients for cannabis. The most common indications were cancer (64%), pain (24%), and neuropathy (9%). Other three months in 2021, 28% of new referrals to our practice were certified for cannabis and 15% of patients were referred explicitly for cannabis certification. Conclusion: Despite legal and practical challenges to implementing a medical cannabis program, our palliative care program has fully integrated cannabis as part of our standard outpatient clinical practice.
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Affiliation(s)
- David Lazris
- Emory University School of Medicine, Atlanta, Georgia, USA
| | - Dhruv Gaur
- Brown University, Providence, Rhode Island, USA
| | - Kimberly Curseen
- Division of Palliative Medicine, Department of Family and Preventive Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Dio Kavalieratos
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia, USA.,Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Meredith Maxwell
- Division of Palliative Medicine, Department of Family and Preventive Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Tammie Quest
- Division of Palliative Medicine, Department of Family and Preventive Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Ali John Zarrabi
- Division of Palliative Medicine, Department of Family and Preventive Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
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Rønne ST, Rosenbæk F, Pedersen LB, Waldorff FB, Nielsen JB, Riisgaard H, Søndergaard J. Physicians' experiences, attitudes, and beliefs towards medical cannabis: a systematic literature review. BMC FAMILY PRACTICE 2021; 22:212. [PMID: 34674661 PMCID: PMC8532330 DOI: 10.1186/s12875-021-01559-w] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Accepted: 10/05/2021] [Indexed: 11/25/2022]
Abstract
Background An increasing number of countries legalise the use of medical cannabis or allow it for a narrow range of medical conditions. Physicians, and often the patients’ general practitioner, play a major role in implementing this policy. Many of them, however, perceive a lack of evidence-based knowledge and are not confident with providing patients with medical cannabis. The objectives of this review are to synthesise findings about hospital physicians’ and GPs’ experiences, attitudes, and beliefs towards the use of medical cannabis with the purpose of identifying barriers and facilitators towards providing it to their patients. Methods Peer-reviewed articles addressing hospital physicians’ and GPs’ experiences, attitudes, and beliefs towards the use of medical cannabis were searched systematically in PubMed, Scopus, EMBASE, and the Cochrane Library. Results Twenty-one articles were included from five different countries in which the medical cannabis laws varied. The studied physicians experienced frequent inquiries about medical cannabis from their patients (49–95%), and between 10 and 95% of the physicians were willing to prescribe and/or provide it to the patients, depending on setting, specialty and experience among the physicians. This review found that physicians experienced in prescribing medical cannabis were more convinced of its benefits and less worried about adverse effects than non-experienced physicians. However, physicians specialized in addiction treatment and certain relevant indication areas seemed more sceptical compared to physicians in general. Nevertheless, physicians generally experienced a lack of knowledge of clinical effects including both beneficial and adverse effects. Conclusion This review indicates that GPs and hospital physicians from various specialties frequently experience patient demands for medical cannabis and to some degree show openness to using it, although there was a wide gap between studies in terms of willingness to provide. Hospital physicians and GPs’ experienced in prescribing are more convinced of effects and less worried of adverse effects. However, most physicians experience a lack of knowledge of beneficial effects, adverse effects and of how to advise patients, which may comprise barriers towards prescribing. More research, including larger studies with cohort designs and qualitative studies, is needed to further examine facilitators and barriers to physicians’ prescribing practices.
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Affiliation(s)
- Sabrina Trappaud Rønne
- Research Unit of General Practice, Department of Public Health, University of Southern Denmark, J.B. Winsløws Vej 9A, 5000, Odense C, Denmark
| | - Frederik Rosenbæk
- Research Unit of General Practice, Department of Public Health, University of Southern Denmark, J.B. Winsløws Vej 9A, 5000, Odense C, Denmark.
| | - Line Bjørnskov Pedersen
- Research Unit of General Practice, Department of Public Health, University of Southern Denmark, J.B. Winsløws Vej 9A, 5000, Odense C, Denmark.,DaCHE - Danish Centre for Health Economics, Department of Public Health, University of Southern Denmark, Winsløws Vej 9B, 5000, Odense C, Denmark
| | - Frans Boch Waldorff
- Research Unit of General Practice, Department of Public Health, University of Southern Denmark, J.B. Winsløws Vej 9A, 5000, Odense C, Denmark.,The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Jesper Bo Nielsen
- Research Unit of General Practice, Department of Public Health, University of Southern Denmark, J.B. Winsløws Vej 9A, 5000, Odense C, Denmark
| | - Helle Riisgaard
- Research Unit of General Practice, Department of Public Health, University of Southern Denmark, J.B. Winsløws Vej 9A, 5000, Odense C, Denmark
| | - Jens Søndergaard
- Research Unit of General Practice, Department of Public Health, University of Southern Denmark, J.B. Winsløws Vej 9A, 5000, Odense C, Denmark
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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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Zolotov Y, Grinstein Cohen O, Findley PA, Reznik A, Isralowitz R, Willard S. Attitudes and knowledge about medical cannabis among Israeli and American nursing students. NURSE EDUCATION TODAY 2021; 99:104789. [PMID: 33571928 DOI: 10.1016/j.nedt.2021.104789] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/22/2020] [Revised: 12/06/2020] [Accepted: 01/20/2021] [Indexed: 06/12/2023]
Abstract
BACKGROUND Although medical cannabis regulations are emerging in many places around the world, a contentious conundrum remains within the medical establishment regarding the appropriate part that cannabis may have in the provision of health care. Nurses have an indispensable role in the care management of patients, and given the consideration of cannabis as a possible treatment, they are warranted to be aware of its medical properties, as well as to be able to adequately answer patient queries. Nevertheless, very little is currently known about nurses' perceptions related to medical cannabis. OBJECTIVE To assess attitudes, beliefs and knowledge about medical cannabis among nursing students. METHODS Cross-sectional study in two universities: Rutgers University (RU) in New Jersey and Ben Gurion University of the Negev (BGU) in Israel. In addition to demographic data, the survey instrument included questions about attitudes, beliefs, knowledge, and training. RESULTS Overall, 387 students participated, mainly females (87.8%). The vast majority from both sub-groups stated they would recommend cannabis to their patients if allowed to do so (91.2%), and were in agreement that medical cannabis is associated with significant benefits for physical (93.5%) and mental (87.8%) health. Compared to the BGU sub-group, more students from RU stated that they feel prepared to answer patient questions about medical cannabis (19.5% vs. 33.5%, respectively; χ2 = 9.74, p < 0.01). While the majority of respondents stated they have not received any formal education related to medical cannabis, they expressed endorsement for such training and education. CONCLUSIONS In light of the expanding number of patients who use medical cannabis, this study highlights the importance of incorporating medical cannabis education for nurses in academic and clinical curricula.
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Affiliation(s)
- Yuval Zolotov
- Regional Alcohol and Drug Abuse Research Center, Ben Gurion University of the Negev, Beer Sheva, Israel.
| | - Orli Grinstein Cohen
- Department of Nursing, Faculty of Health Sciences, Ben Gurion University of the Negev, Beer Sheva, Israel
| | - Patricia A Findley
- Graduate School of Social Work, Rutgers University, New Brunswick, NJ, USA
| | - Alexander Reznik
- Regional Alcohol and Drug Abuse Research Center, Ben Gurion University of the Negev, Beer Sheva, Israel
| | - Richard Isralowitz
- Regional Alcohol and Drug Abuse Research Center, Ben Gurion University of the Negev, Beer Sheva, Israel
| | - Suzanne Willard
- School of Nursing, Rutgers University, New Brunswick, NJ, USA
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10
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Medical cannabis education among healthcare trainees: A scoping review. Complement Ther Med 2021; 58:102675. [PMID: 33539943 DOI: 10.1016/j.ctim.2021.102675] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Revised: 01/24/2021] [Accepted: 01/24/2021] [Indexed: 02/07/2023] Open
Abstract
OBJECTIVES It has been previously demonstrated that healthcare professionals would like additional education on medical cannabis. However, there has not yet been a review of the status of medical cannabis curriculum for medical and allied healthcare trainees worldwide, even though future healthcare workers will be placed on the forefront of patient care and must be prepared to counsel patients. This study was designed to address this gap in knowledge. DESIGN A search syntax was generated and databases PubMed, ERIC, CINAHL, and Web of Science were searched for relevant articles. A grey literature search of Google Scholar, MedEd, Medline, and the Proquest Dissertations and Theses section was also performed. All titles and abstracts were screened. Selected articles were subsequently screened using predetermined inclusion and exclusion criteria. RESULTS Allied healthcare trainees lacked sufficient knowledge about medical cannabis and did not feel prepared to counsel patients on this subject. Additionally, they expressed a growing interest in medical cannabis and would like more standardized education on the topic. Finally, faculty and deans in various institutions agreed on the need to educate students on the subject, and aimed to implement courses on medical cannabis or expand their existing curricula. CONCLUSIONS While the medical cannabis landscape is developing, medical and allied health students are not properly educated and knowledgeable on this emerging field of clinical care. The findings suggest that the implementation of competencies-based curricula on medical cannabis is essential for medical and allied healthcare trainees to have the appropriate level of knowledge to counsel and educate their patients.
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11
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Zolotov Y, Eshet L, Morag O. Preliminary assessment of medical cannabis consumption by cancer survivors. Complement Ther Med 2020; 56:102592. [PMID: 33197667 DOI: 10.1016/j.ctim.2020.102592] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 08/29/2020] [Accepted: 09/30/2020] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVES To assess the motivation of cancer survivors to consume medical cannabis and to assess the patterns of use, perceived efficacy, as well as side and adverse effects. METHODS Cross-sectional survey among 190 Israeli cancer survivors who were licensed to use medical cannabis in a single institution. In addition to demographic information, the questionnaire examined patterns of use (including dosage, type of cannabis and way of administration), motivation for medical cannabis consumption, perceived efficacy, adverse and side effects, motivation for ceasing cannabis consumption, and tobacco smoking. RESULTS The mean monthly dosage of cannabis consumed was 42.4 grams; 95.8% of respondents reported not consuming cannabis regularly before being diagnosed with cancer; the most common way of administration was smoking, and most of the participants reported taking cannabis throughout the day. The most common symptoms for which participants took medical cannabis were pain (n = 169, 88.9%), sleeping disorder (n = 144, 75.8%) and anxiety (n = 79, 41.6%). Twenty patients (10.5%) reported on mild side (or adverse) effects. CONCLUSIONS This study indicates that cancer survivors may indeed consume cannabis for symptom relief, and not merely for recreational purposes. Although our findings point to perceived safety and efficacy of medical cannabis for cancer survivors, more research is needed to study the adequate role that cannabis may have for treating symptoms associated with cancer survivorship.
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Affiliation(s)
- Yuval Zolotov
- Regional Drug and Alcohol Research Center, Ben Gurion University of the Negev, RADAR Center, Building #17, 84105 Beer Sheva Israel.
| | - Lia Eshet
- Supportive Care Unit, The Cancer Center at Sheba Medical Center, Israel
| | - Ofir Morag
- Supportive Care Unit, The Cancer Center at Sheba Medical Center, Israel; Cancer Pain Unit, The Cancer Center at Sheba Medical Center, Israel
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12
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Edelstein OE, Wacht O, Isralowitz R, Reznik A, Bachner YG. Beliefs and Attitudes of Graduate Gerontology Students about Medical Marijuana Use for Alzheimer’s and Parkinson’s Disease. Complement Ther Med 2020; 52:102418. [DOI: 10.1016/j.ctim.2020.102418] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Revised: 04/23/2020] [Accepted: 04/24/2020] [Indexed: 01/06/2023] Open
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13
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Slawnych M. Management of the Dying Cardiac Patient in the Last Days and Hours of Life. Can J Cardiol 2020; 36:1061-1067. [DOI: 10.1016/j.cjca.2020.02.085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2019] [Revised: 02/06/2020] [Accepted: 02/14/2020] [Indexed: 11/26/2022] Open
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Mirelman D, Waissengrin B, Goldway N, Sharon H, Brill S, Wolf I. Use of medical cannabis: perceptions of Israeli oncologists. Lancet Oncol 2020; 20:475-477. [PMID: 30942172 DOI: 10.1016/s1470-2045(19)30077-4] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Revised: 02/10/2019] [Accepted: 02/11/2019] [Indexed: 11/30/2022]
Affiliation(s)
- Dan Mirelman
- Institute of Oncology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Barliz Waissengrin
- Institute of Oncology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Noam Goldway
- Sagol Brain Institute, Wohl Institute for Advanced Imaging, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, Israel
| | - Haggai Sharon
- Sagol Brain Institute, Wohl Institute for Advanced Imaging, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; Institute of Pain Medicine, Department of Anesthesiology and Critical Care Medicine, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Silviu Brill
- Institute of Pain Medicine, Department of Anesthesiology and Critical Care Medicine, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ido Wolf
- Institute of Oncology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
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Kaplan L, Klein T, Wilson M, Graves J. Knowledge, Practices, and Attitudes of Washington State Health Care Professionals Regarding Medical Cannabis. Cannabis Cannabinoid Res 2020; 5:172-182. [PMID: 32656349 DOI: 10.1089/can.2019.0051] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Introduction: Health care providers in Washington State practice in a unique environment where both medical and recreational cannabis use are legal. Five types of health care providers can authorize medical cannabis. State-certified medical cannabis consultants may advise patients in a cannabis retail store regarding use and consumption. Washington State's health care professionals' perspectives about medical cannabis can inform policy-makers nationwide who are navigating challenges posed by legalization of medical and recreational cannabis. Materials and Methods: A cross-sectional mixed-mode survey using a 26-item questionnaire was administered to a random sample of actively licensed health care professionals legally permitted to provide medical cannabis authorizations in Washington State. We describe participant demographics and summarize responses to survey questions. We report comparisons across provider types using Fisher's exact tests with a level of significance of p<0.01. Results: Among the 1440 health care professionals invited to participate in the study, 310 respondents met eligibility criteria (response rate 24%). Only 57 respondents (18.4%) indicated having ever issued a medical cannabis authorization. Among them, 6, all naturopaths, had provided more than 500. Over half (58%) reported that they did not feel they had the knowledge and skills necessary to provide authorizations. Depending on the condition, 29-93% of respondents correctly identified conditions that qualified a patient to receive a medical cannabis authorization. Very few knew that employers are not required to provide accommodations for medical cannabis. Health care professionals (64.8%) served as the most frequent source of information regarding cannabis risks and benefits. Over half (62%) strongly or somewhat agreed that the Drug Enforcement Agency should reschedule cannabis to make it legal at the federal level. Conclusion: A wide range of knowledge was exhibited within our sample of health care professionals regarding qualifying conditions for medical cannabis. As more states adopt comprehensive medical cannabis laws, health care professionals must be prepared to provide information to patients regarding the effects, risks, and benefits of cannabis. Standardized education could ensure that health care professionals are prepared to responsibly promote the use of cannabis when indicated for medically appropriate symptoms and conditions. A rational approach to medical cannabis is needed to assure that unforeseen consequences are mitigated.
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Affiliation(s)
- Louise Kaplan
- College of Nursing, Washington State University Vancouver, Vancouver, Washington, USA
| | - Tracy Klein
- College of Nursing, Washington State University Vancouver, Vancouver, Washington, USA
| | - Marian Wilson
- College of Nursing, Washington State University Spokane, Spokane, Washington, USA
| | - Janessa Graves
- College of Nursing, Washington State University Spokane, Spokane, Washington, USA
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Melnikov S, Aboav A, Shalom E, Phriedman S, Khalaila K. The effect of attitudes, subjective norms and stigma on health-care providers' intention to recommend medicinal cannabis to patients. Int J Nurs Pract 2020; 27:e12836. [PMID: 32237017 DOI: 10.1111/ijn.12836] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2019] [Revised: 02/27/2020] [Accepted: 03/12/2020] [Indexed: 11/28/2022]
Abstract
AIM The aim of this study was to explore the effect of health-care providers' attitudes towards the medical use of cannabis, subjective norms and perceived stigma towards medicinal cannabis users on health-care providers' intention to recommend medicinal cannabis for patients with qualifying conditions. METHODS A cross-sectional correlational study included 221 health-care providers (mean age, 42.2 ± 11.2; 74.2% women and 76.5% nurses) who completed a questionnaire examining theory-based variables and stigma towards medicinal cannabis users. RESULTS More positive attitudes towards the medical use of cannabis were associated with lower stigma towards medicinal cannabis users, which, in turn, was associated with a higher intention of recommending medicinal cannabis for patients with qualifying conditions. The relationship between attitudes towards the medical use of cannabis and the intention to recommend medicinal cannabis varies according to subjective norms. CONCLUSIONS Among nurses and physicians, stigma towards medicinal cannabis users mediated the relationship between attitudes towards the medical use of cannabis and the intention to recommend medicinal cannabis for patients with qualifying conditions, whereas subjective norms moderated this relationship. Effective treatment with medicinal cannabis might be compromised by health-care providers' negative attitudes, stigma and subjective norms.
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Affiliation(s)
- Semyon Melnikov
- Nursing Department, Steyer School of Health Professions, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Anat Aboav
- Department of Medicine A, Wolfson Medical Center, Holon, Israel
| | - Ester Shalom
- Department of Medicine F, Wolfson Medical Center, Holon, Israel
| | | | - Khaled Khalaila
- Department of Medicine F, Wolfson Medical Center, Holon, Israel
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17
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Rousseau PC. Recent Literature. J Palliat Med 2019. [DOI: 10.1089/jpm.2019.0434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Zarrabi AJ, Welsh JW, Sniecinski R, Curseen K, Gillespie T, Baer W, McKenzie-Brown AM, Singh V. Perception of Benefits and Harms of Medical Cannabis among Seriously Ill Patients in an Outpatient Palliative Care Practice. J Palliat Med 2019; 23:558-562. [PMID: 31539298 DOI: 10.1089/jpm.2019.0211] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Introduction: Patients with serious illness often have pain, uncontrolled symptoms, and poor quality of life. Evidence continues to evolve regarding the role of cannabis to treat chronic pain, nausea, and anorexia. Little is known about how patients with serious illness perceive its benefits and harms. Given that an increasing number of clinicians across the United States are treating patients with medical cannabis, it is important for providers to understand patient beliefs about this modality. We assessed patient perceptions of benefits and harms of cannabis who obtained a medical cannabis card within an ambulatory palliative care (APC) practice. Methods: We recruited patients with a medical cannabis card, allowing for legal possession of cannabis oil, from an APC practice in Georgia. All participants reported using cannabis products. Patients completed an online survey that included questions about their cannabis use, concurrent opiate or controlled medication use, and perceptions of benefits and harms of cannabis. Results: All 101 patients invited to participate completed the survey. A majority had cancer (76%) and were married (61%), disabled or retired (75%), older than 50 years of age (64%), and men (56%). Most patients ingested (61%) or vaporized (49%) cannabis products. A majority of respondents perceived cannabis to be important for their pain (96%) management. They reported that side effects were minimally bothersome, and drowsiness was the most commonly reported bothersome harm (28%). A minority of patients reported cannabis withdrawal symptoms (19%) and concerns for dependency (14%). The majority of patients were using concurrent prescription opioids (65%). Furthermore, a majority of cancer patients reported cannabis as being important for cancer cure (59%). Conclusion: Patients living with serious illnesses who use cannabis in the context of a multidisciplinary APC practice use cannabis for curative intent and for pain and symptom control. Patients reported improved pain, other symptoms, and a sense of well-being with few reported harms.
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Affiliation(s)
- Ali John Zarrabi
- Department of Family and Preventive Medicine, Emory University, Atlanta, Georgia
| | - Justine W Welsh
- Department of Psychiatry and Behaviorial Sciences, Emory University, Atlanta, Georgia
| | - Roman Sniecinski
- Department of Anesthesiology, Emory University, Atlanta, Georgia
| | - Kimberly Curseen
- Department of Family and Preventive Medicine, Emory University, Atlanta, Georgia
| | | | - Wendy Baer
- Department of Psychiatry and Behaviorial Sciences, Emory University, Atlanta, Georgia
| | | | - Vinita Singh
- Department of Anesthesiology, Emory University, Atlanta, Georgia
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Casarett DJ, Beliveau JN, Arbus MS. Benefit of Tetrahydrocannabinol versus Cannabidiol for Common Palliative Care Symptoms. J Palliat Med 2019; 22:1180-1184. [PMID: 31386592 PMCID: PMC6776252 DOI: 10.1089/jpm.2018.0658] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Objectives: To determine the relative contributions of tetrahydrocannabinol (THC) and cannabidiol (CBD) to patients' self-ratings of efficacy for common palliative care symptoms. Design: This is an electronic record-based retrospective cohort study. Model development used logistic regression with bootstrapped confidence intervals (CIs), with standard errors clustered to account for multiple observations by each patient. Setting: This is a national Canadian patient portal. Participants: A total of 2,431 patients participated. Main Outcome Measures: Self-ratings of efficacy of cannabis, defined as a three-point reduction in neuropathic pain, anorexia, anxiety symptoms, depressive symptoms, insomnia, and post-traumatic flashbacks. Results: We included 26,150 observations between October 1, 2017 and November 28, 2018. Of the six symptoms, response was associated with increased THC:CBD ratio for neuropathic pain (odds ratio [OR]: 3.58; 95% CI: 1.32–9.68; p = 0.012), insomnia (OR: 2.93; 95% CI: 1.75–4.91; p < 0.001), and depressive symptoms (OR: 1.63; 95% CI: 1.07–2.49; p = 0.022). Increased THC:CBD ratio was not associated with a greater response of post-traumatic stress disorder (PTSD)-related flashbacks (OR: 1.43; 95% CI: 0.60–3.41; p = 0.415) or anorexia (OR: 1.61; 95% CI: 0.70–3.73; p = 0.265). The response for anxiety symptoms was not significant (OR: 1.13; 95% CI: 0.77–1.64; p = 0.53), but showed an inverted U-shaped curve, with maximal benefit at a 1:1 ratio (50% THC). Conclusions: These preliminary results offer a unique view of real-world medical cannabis use and identify several areas for future research.
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Affiliation(s)
- David J Casarett
- Department of Medicine at Duke University, Durham, North Carolina
| | | | - Michelle S Arbus
- Research Department, Strainprint Technologies Ltd., Toronto, Ontario, Canada
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Gardiner KM, Singleton JA, Sheridan J, Kyle GJ, Nissen LM. Health professional beliefs, knowledge, and concerns surrounding medicinal cannabis - A systematic review. PLoS One 2019; 14:e0216556. [PMID: 31059531 PMCID: PMC6502454 DOI: 10.1371/journal.pone.0216556] [Citation(s) in RCA: 80] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Accepted: 04/23/2019] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND The number of jurisdictions allowing access to medicinal cannabis has been steadily increasing since the state of California introduced legislation in 1996. Although there is a high degree of legislative heterogeneity across jurisdictions, the involvement of a health professional is common among all. This places health professionals at the forefront of therapy, yet no systematic review of literature has offered insight into the beliefs, knowledge, and concerns of health professionals regarding medicinal cannabis. METHODS Using a predetermined study protocol, PubMed, EMBASE, PsycINFO, CINAHL, and Scopus databases were searched for studies indexed up to the 1st August 2018. Pre-defined inclusion and exclusion criteria were applied uniformly. Screening for relevancy, full-text review, data extraction, and risk of bias were completed by two independent investigators. Risk of bias was assessed using CASP criteria (qualitative) and a modified domain-based risk assessment tool (quantitative). RESULTS Of the 15,775 studies retrieved, 106 underwent full-text review and of these, 26 were included. The overall risk of bias was considered low across all included studies. The general impression was that health professionals supported the use of medicinal cannabis in practice; however, there was a unanimous lack of self-perceived knowledge surrounding all aspects of medicinal cannabis. Health professionals also voiced concern regarding direct patient harms and indirect societal harms. CONCLUSION This systematic review has offered a lens through which to view the existing literature surrounding the beliefs, knowledge, and concerns of health professionals regarding medicinal cannabis. These results are limited, however, by the implicit common-sense models of behaviour utilised by the included studies. Before strategies can be developed and implemented to change health professional behaviour, a more thorough understanding of the factors that underpin the delivery of medicinal cannabis is necessary.
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Affiliation(s)
- Kyle M. Gardiner
- Discipline of Pharmacy, School of Clinical Sciences, Queensland University of Technology, Brisbane, Australia
- * E-mail:
| | - Judith A. Singleton
- Discipline of Pharmacy, School of Clinical Sciences, Queensland University of Technology, Brisbane, Australia
| | - Janie Sheridan
- School of Pharmacy, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Gregory J. Kyle
- Discipline of Pharmacy, School of Clinical Sciences, Queensland University of Technology, Brisbane, Australia
| | - Lisa M. Nissen
- Discipline of Pharmacy, School of Clinical Sciences, Queensland University of Technology, Brisbane, Australia
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Tatterton MJ, Walker C. The Prevalence of Nonprescription Cannabinoid-Based Medicines in British Children's Hospices: Results of a National Survey. J Palliat Med 2019; 22:1185-1190. [PMID: 30715962 DOI: 10.1089/jpm.2018.0522] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: Almost 50,000 children and young people are affected by life-limiting conditions in the United Kingdom, around a third of which use children's hospices. Anecdotal evidence suggests that cannabinoid-based medicines (CBMs), specifically cannabis oil (CO), are being used by families with increasing frequency to manage distressing symptoms. The use of most nonprescription CBMs in the United Kingdom remains illegal. Objective: The objective of the study was to identify the prevalence of CO use by families who use children's hospices in the United Kingdom, and the approaches taken by those services to manage it. Design: An electronic survey was sent to each of the 54 children's hospices in the United Kingdom between May and July 2018, comprising 10 questions. Results: Forty children's hospices from across the four countries of the United Kingdom responded to the survey, representing 74% of British children's hospices. About 87.5% of hospices knew of children who use CO therapeutically. Sixty-nine percent of those hospices have received requests to administer CO during an episode of care. Approaches by organizations around CO management varied across the sectors, including arrangements for storage, administration, and recording of its use. Hospices highlighted how the lack of available guidance made decision making more challenging. Only a third of responding organizations routinely questioned families about the use of cannabis when prescribing medicines. Conclusion: CO is used extensively by children who use children's hospices. Despite recognizing the use of CO, many hospices are unable to support it. There is a need for clear guidelines on how hospices should approach the care needs of children, allowing hospices to meet the needs of children who use CO, and families in a safe, consistent, and relevant way, safeguarding all children, families, and professionals within the organization.
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