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Barré T, Testa D, Santos M, Marcellin F, Roux P, Carrieri P, Radoszycki L, Protopopescu C. Symptom severity is a major determinant of cannabis-based products use among people with multiple sclerosis. J Clin Nurs 2023; 32:6460-6473. [PMID: 36880273 DOI: 10.1111/jocn.16674] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 02/08/2023] [Accepted: 02/20/2023] [Indexed: 03/08/2023]
Abstract
AIMS AND OBJECTIVES We aimed to identify correlates of cannabinoid-based products (CBP) use in patients with multiple sclerosis (MS) in France and Spain. BACKGROUND MS is responsible for a wide range of symptoms, including pain. Access to CBP differs according to local legislation. The French context is more restrictive than the Spanish one, and no data regarding cannabis use among MS patients has yet been published. Characterizing MS patients who use CBP constitutes a first step toward identifying persons most likely to benefit from them. DESIGN An online cross-sectional survey was submitted to MS patients who were members of a social network for people living with chronic diseases and were living in France or Spain. METHODS Two study outcomes measured therapeutic CBP use and daily therapeutic CBP use. Seemingly unrelated bivariate probit regression models were used to test for associations between the outcomes and patients' characteristics while accounting for country-related differences. STROBE guidelines were followed in reporting this study. RESULTS Among 641 study participants (70% from France), the prevalence of CBP use was similar in both countries (23.3% in France vs. 20.1% in Spain). MS-related disability was associated with both outcomes, with a gradient observed between different degrees of disability. MS-related pain level was associated with CBP use only. CONCLUSIONS CBP use is common in MS patients from both countries. The more severe the MS, the more participants turned to CBP to alleviate their symptoms. Easier access to CBP should be ensured for MS patients in need of relief, especially from pain. RELEVANCE TO CLINICAL PRACTICE This study highlights the characteristics of MS patients using CBP. Such practices should be discussed by healthcare professional with MS patients.
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Affiliation(s)
- Tangui Barré
- Aix Marseille Univ, Inserm, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale, ISSPAM, Marseille, France
| | | | - Melina Santos
- Aix Marseille Univ, Inserm, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale, ISSPAM, Marseille, France
| | - Fabienne Marcellin
- Aix Marseille Univ, Inserm, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale, ISSPAM, Marseille, France
| | - Perrine Roux
- Aix Marseille Univ, Inserm, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale, ISSPAM, Marseille, France
| | - Patrizia Carrieri
- Aix Marseille Univ, Inserm, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale, ISSPAM, Marseille, France
| | | | - Camelia Protopopescu
- Aix Marseille Univ, Inserm, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale, ISSPAM, Marseille, France
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Boullosa CC, Vaddiparti K, Lopez-Quintero C, Varma DS, L Cook R. Clinical Decision Making by Medical Marijuana Physicians in Florida: A Qualitative Assessment. Subst Use Misuse 2022; 57:2042-2052. [PMID: 36305815 DOI: 10.1080/10826084.2022.2129995] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
Medical marijuana (MMJ) was legalized in November 2016 with the passing of Amendment 2 in the state of Florida. Since the legalization, many studies have been conducted to understand the direct effect medical marijuana has on specific medical conditions. Unlike most allopathic drugs, medical marijuana does not target single ailments or specific conditions and does not follow precise recommending guidelines. There is scarce knowledge on how patient characteristics, including medical conditions, affect a physician's direct recommendations and registry limits. To obtain insight on the effect patient characteristics have on the clinical decision-making process, we conducted ten qualitative interviews of medical marijuana physicians who are certified to order medical marijuana for patients in Florida. Interview topics ranged from typical daily practice to specific recommendations for patient histories. Each interview was transcribed and thematically analyzed. Five major patient characteristics that influence a physician's recommendation emerged from the interviews: patient medical history, co-medications, lifestyle, marijuana experience level and counter-indications. Each category was analyzed further to understand how the characteristics influenced the practice of recommending and ordering product. Physicians emphasized the equivalent importance of reviewing a patient's medical history, lifestyle, and past marijuana experiences while also expressing the need to look holistically at the individual patient. Instead of the characteristics determining what the physician recommends for the patient and orders through the registry, the characteristics dictate the education given to the patient so that the patient may lead and determine their own individual care.
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Affiliation(s)
| | - Krishna Vaddiparti
- Department of Epidemiology, University of Florida, Gainesville, Florida, USA
| | | | - Deepthi S Varma
- Department of Epidemiology, University of Florida, Gainesville, Florida, USA
| | - Robert L Cook
- Department of Epidemiology, University of Florida, Gainesville, Florida, USA
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Reed MK, Kelly EL, Wagner B, Hajjar E, Garber G, Worster B. A Failure to Guide: Patient Experiences within a State-Run Cannabis Program in Pennsylvania, United States. Subst Use Misuse 2022; 57:516-521. [PMID: 34958295 DOI: 10.1080/10826084.2021.2019780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
INTRODUCTION Medical cannabis has been available for purchase in dispensaries in Pennsylvania, United States since April 2018. Patients wanting to access medical cannabis must receive certification from physicians for a limited number of physical and psychological conditions. Despite increasing numbers of patients using cannabis in the United States, little is known about the patient experience during certification and entry into state-regulated cannabis programs and how and if they are guided by health care professionals and dispensary staff. Through focus group discussions, we sought to capture patient perspectives of certification, cannabis acquisition and cannabis use. METHODS Twenty-seven Pennsylvania participants took part in 7 virtual focus groups from June to July 2020. Participants were recruited statewide from the community, medical settings, and dispensaries. RESULTS Focus group results indicate that while the medical cannabis program is functional, policymakers and the medical community have failed to meaningfully integrate cannabis into the health care system. Participants expressed frustration around two central themes: there was no overarching education about medical use of cannabis and there was little consistency and availability for people once they found a suitable product, resulting in inadequate symptom relief and exorbitant out of pocket costs to pursue cannabis use as an adjuvant therapeutic. Participants noted a siloed experience between the certification process, accessing dispensaries, and receiving ongoing medical care. The lack of integrated care required high levels of self-reliance and experimentation with medical cannabis for participants. CONCLUSION We recommend that cannabis be better integrated into medical care for patients with qualifying conditions.
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Affiliation(s)
- Megan K Reed
- Department of Emergency Medicine, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Erin L Kelly
- Department of Family and Community Medicine, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Beth Wagner
- Department of Family and Community Medicine, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Emily Hajjar
- College of Pharmacy, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Greg Garber
- Sidney Kimmel Cancer Center at Jefferson Health, Philadelphia, Pennsylvania, USA
| | - Brooke Worster
- Department of Family and Community Medicine, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
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Filetti M, Trapani D, Cortellini A, Cofini V, Necozione S, Pinato DJ, Porzio G, Marchetti P, Giusti R. Knowledge and attitudes of Italian medical oncologists and palliative care physicians toward medical use of cannabis in cancer care: a national survey. Support Care Cancer 2021; 29:7845-7854. [PMID: 34176017 DOI: 10.1007/s00520-021-06383-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Accepted: 06/21/2021] [Indexed: 01/14/2023]
Abstract
PURPOSE Despite advances in supportive care, cancer-related symptoms tend to be persistent regardless of cancer type, stage of disease, or treatment received. There is an increasing prescription for complementary and alternative medicines, such as medical cannabis (MC). Knowledge and attitudes of Italian medical oncologists and palliative care physicians toward medical cannabis in cancer care remain unknown. METHODS We conducted a cross-sectional study to investigate the knowledge and attitude toward MC prescription among cancer care professionals in Italy. All invited participants received an email with the electronic questionnaire accessible through a direct link. RESULTS Among the 2616 members who received the invitation, 475 replied to the questionnaire and were considered for the survey analysis. The most prescribed formulations among those available in Italy were cannabis FM2. The most frequent clinical indications for the use of MC were pain, gastrointestinal, and mood disorders. Only 9 responders reported MC-related side effects like anxiety insomnia and muscle spasms. The question regarding the normative references for MC prescription and use in Italy had conflicting results: only 14% indicated the exact legislative reference. CONCLUSION Our study highlights a significant discrepancy between personal attitudes, prescription levels, and actual knowledge on MC. This represent a critical issue that should be systemically faced, building educational programs and national guidelines that sublimate personal physicians' beliefs and predispositions, resulting in a robust science-based MC practice. Only through coordinated interventions on science and health policy of MC, there will be success of safety and efficacy, ensuring the best knowledge for the best outcomes.
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Affiliation(s)
- Marco Filetti
- Medical Oncology Unit, Sapienza University of Rome, Via di Grottarossa, 1035-1039, Rome, Italy
| | - Dario Trapani
- Division of Early Drug Development for Innovative Therapies, European Institute of Oncology IRCCS, Milan, Italy
| | - Alessio Cortellini
- Department of Biotechnology and Applied Clinical Science, University of L'Aquila, L'Aquila, Italy.,Department of Surgery and Cancer, Imperial College London, London, UK
| | - Vincenza Cofini
- Department of Clinical Medicine Life Health and Environmental Sciences, University of L'Aquila, L'Aquila, Italy
| | - Stefano Necozione
- Department of Clinical Medicine Life Health and Environmental Sciences, University of L'Aquila, L'Aquila, Italy
| | - David James Pinato
- Department of Surgery and Cancer, Imperial College London, London, UK.,Division of Oncology, Department of Translational Medicine, University of Piemonte Orientale, Novara, Italy
| | - Giampiero Porzio
- Department of Biotechnology and Applied Clinical Science, University of L'Aquila, L'Aquila, Italy
| | - Paolo Marchetti
- Medical Oncology Unit, Sapienza University of Rome, Via di Grottarossa, 1035-1039, Rome, Italy.,Department of Clinical and Molecular Medicine, Sapienza University of Rome, Roma, Lazio, Italy
| | - Raffaele Giusti
- Medical Oncology Unit, Azienda Ospedaliero Universitaria Sant'Andrea, Via di Grottarossa, 1035-39 00189, Rome, Italy.
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Clinical Evidence of Magistral Preparations Based on Medicinal Cannabis. Pharmaceuticals (Basel) 2021; 14:ph14020078. [PMID: 33494156 PMCID: PMC7909828 DOI: 10.3390/ph14020078] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Revised: 01/12/2021] [Accepted: 01/18/2021] [Indexed: 12/15/2022] Open
Abstract
Cannabis has been widely used as a medicinal plant for millennia; however, studies related to its main components were first conducted in 1960. Subsequently, laboratories have produced new components and structures related to its active biological properties. Countries that have approved the medicinal use of cannabis impose regulations that govern its clinical and scientific use. One means of administering medicinal cannabis is via a magistral preparation that must have a medical prescription and be prepared in an establishment that meets quality standards to ensure the quantities of its main components, such as tetrahydrocannabinol (THC) and cannabidiol (CBD). Furthermore, suppliers must have a clear indication of its use in the patient before prescription. This review shows the published evidence regarding the clinical use of medicinal cannabis magistral preparations in the management of post-chemotherapy nausea and vomiting, neuropathic pain in multiple sclerosis, and anorexia and cachexia in patients with HIV.
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Luque JS, Okere AN, Reyes-Ortiz CA, Williams PM. Mixed methods study of the potential therapeutic benefits from medical cannabis for patients in Florida. Complement Ther Med 2021; 57:102669. [PMID: 33460744 DOI: 10.1016/j.ctim.2021.102669] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Revised: 12/28/2020] [Accepted: 01/04/2021] [Indexed: 10/22/2022] Open
Abstract
OBJECTIVES To evaluate medical marijuana patients' perceptions of therapeutic benefits for self-reported medical conditions. DESIGN The study was a concurrent mixed methods study with adult medical marijuana patients. Survey data were collected using a web-based survey, and interviews were conducted in person or over the phone. SETTING The study recruited 196 medical marijuana patients to complete surveys and 13 patients to participate in qualitative interviews in Florida. MEASURES A validated patient survey was distributed via Florida medical marijuana social media groups to examine the therapeutic benefits of the cannabis plant for medical conditions and overall well-being. Concurrently, qualitative interviews were conducted to understand barriers and facilitators to accessing medical cannabis and explore preferences for different forms and strains, as well as any unexpected side effects. RESULTS Patients used medical cannabis for relief of chronic pain or depression, followed by arthritis and nausea. Survey results indicated 89 % of patients reported "great relief" for their medical condition. Over 76 % of patients reported a score of 8 or higher on a 10-point scale that their medical condition had improved, and over 68 % reported a score of 8 or higher that medical cannabis had reduced their pain. Interviews indicated medical cannabis was effective for pain relief and reducing the use of prescription medicines, but the drug was perceived as too expensive. CONCLUSIONS Medical marijuana patients were positive about the health benefits they received and the fact they were able to reduce or eliminate many prescription medications; however, there were concerns about the costs.
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Affiliation(s)
- John S Luque
- College of Pharmacy & Pharmaceutical Sciences, Institute of Public Health, Florida A&M University, United States.
| | - Arinze Nkemdirim Okere
- College of Pharmacy & Pharmaceutical Sciences, Institute of Public Health, Florida A&M University, United States
| | - Carlos A Reyes-Ortiz
- College of Pharmacy & Pharmaceutical Sciences, Institute of Public Health, Florida A&M University, United States
| | - Paula M Williams
- College of Pharmacy & Pharmaceutical Sciences, Institute of Public Health, Florida A&M University, United States
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Comparison of Male and Female Patients in Louisiana Medical Marijuana Dispensaries. J Clin Med 2020; 9:jcm9061865. [PMID: 32549257 PMCID: PMC7355764 DOI: 10.3390/jcm9061865] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Revised: 06/01/2020] [Accepted: 06/11/2020] [Indexed: 12/28/2022] Open
Abstract
Relatively little is known in terms of patient demographics, indications, previous cannabis use, or the forms and dosages of medical marijuana (MM) dispensed for patients at MM dispensaries. Even less is known in terms of how male and female patients may differ in each of these aspects. The goal of the current study was to examine each of these variables using a retrospective analysis of deidentified patient data from MM dispensaries in Louisiana. Deidentified data were analyzed from web-based pharmacist-patient consultations at MM dispensaries throughout Louisiana. Data were collected during the first 6 months following the initiation of the MM dispensing program in Louisiana. A total of 1195 MM patients (598 male/597 female) were included in the analyses. The average age of the sample was 51.9 years (±14.8) and it was composed primarily of white patients (86.7%). Males and females were nearly identical in terms of average age, race, previous cannabis use, indication profile, and MM recommendations. Differences between males and females were observed in terms of opioid use, history of psychosis, presence of more than one indication, and the duration of previous cannabis use. Our data indicate that, in MM dispensaries of the Deep South state, there are numerous similarities-and some potentially important differences-between male and female MM patients. The importance of these differences, and the importance of continued data collection/analysis, for improving MM dispensing are discussed.
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Howell K, Washington A, Williams PM, Mathis AL, Luque JS. Medical Marijuana Policy Reform Reaches Florida: A Scoping Review. FLORIDA PUBLIC HEALTH REVIEW 2019; 16:128-136. [PMID: 31891164 PMCID: PMC6936729] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
BACKGROUND Florida became the first state in the U.S. South to legalize the use of medical marijuana to treat a variety of health conditions including chronic pain, epilepsy, and spasticity symptoms from multiple sclerosis. While there are over 200,000 medical marijuana patients in Florida, there remain financial, psychological, and insurance coverage barriers which reduce access for many patients. PURPOSE This scoping review, with a focus on state health policy, first describes some clinical studies examining the therapeutic benefits of medical marijuana. Next, there is a discussion of the Florida regulatory environment and major legislation. Also, the review describes how the current Florida policy landscape presents challenges for physicians and patients. METHODS A scoping review of the literature was conducted in PubMed and Google Scholar using the search terms, "medical marijuana" and "medical cannabis" to identify research articles, newspaper reports, and government documents. The purpose of the review was to identify research investigating the therapeutic efficacy of medical marijuana and state policies affecting physician practice. RESULTS The review concluded there was general scientific consensus of therapeutic benefits for patients, especially for chronic pain, from the use of medical marijuana. The review also identified several barriers for physicians and patients around cost, stigma, and lack of insurance coverage which constrains use and access. DISCUSSION The review discusses several directions for future medical marijuana policy and research with the aim to improve therapeutic benefits for Florida patients.
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Affiliation(s)
- Khadesia Howell
- Florida A&M University, College of Pharmacy & Pharmaceutical Sciences, Institute of Public Health. Tallahassee, FL
| | - Alexandria Washington
- Florida A&M University, College of Pharmacy & Pharmaceutical Sciences, Institute of Public Health. Tallahassee, FL
| | - Paula M Williams
- Florida A&M University, College of Pharmacy & Pharmaceutical Sciences, Institute of Public Health. Tallahassee, FL
| | - Arlesia L Mathis
- Florida A&M University, College of Pharmacy & Pharmaceutical Sciences, Institute of Public Health. Tallahassee, FL
| | - John S Luque
- Florida A&M University, College of Pharmacy & Pharmaceutical Sciences, Institute of Public Health. Tallahassee, FL
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Reed T, Shuffett ML. Barriers to Achieving Optimal Success with Medical Cannabis: Opportunities for Quality Improvement. J Altern Complement Med 2018; 25:121-122. [PMID: 30543464 DOI: 10.1089/acm.2018.0438] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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