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Dobson O, Barber M, Graham M, Carter A, Savic M. 'The wild west of medicine': A qualitative investigation of the factors influencing Australian health-care practitioners' delivery of medicinal cannabis. Drug Alcohol Rev 2024; 43:1280-1293. [PMID: 38630896 DOI: 10.1111/dar.13847] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Revised: 03/13/2024] [Accepted: 03/19/2024] [Indexed: 04/19/2024]
Abstract
INTRODUCTION Strong patient interest in the use of medicinal cannabis to treat various clinical indications has sparked global legislative changes. Practitioners are vital in implementing regulatory changes and facilitating patient access to medicinal cannabis, however, little is currently known about the factors influencing practitioners' uptake. Recent rapid increases in practitioner applications to prescribe medicinal cannabis in Australia provides a unique backdrop to examine the current factors influencing prescribing behaviours. This qualitative study examined Australian practitioners' perspectives on prescribing medicinal cannabis to provide a comprehensive exploration of the potential factors influencing uptake in clinical practice. METHODS Seventeen semi-structured interviews were conducted with Australian health-care practitioners. Transcripts were analysed using the Framework approach to thematic analysis and cross-mapped to appropriate domains of the Theoretical Domains Framework. RESULTS We identified four themes related to the barriers and facilitators to prescribing medicinal cannabis: (i) clinical capabilities needed to prescribe; (ii) prescribing an unapproved therapeutic good; (iii) negative attitudes towards prescribers in the medical community; and (iv) divergent beliefs about clinical utility. DISCUSSION AND CONCLUSIONS Practitioners face multiple pervasive barriers to prescribing medicinal cannabis. Beliefs about clinical utility appear to be highly influential in shaping prescribing behaviours. Moreover, our findings suggest that a medicinal cannabis 'specialisation' has emerged within the Australian medical community. Findings demonstrate that a range of complex and multifaceted factors influence practitioners' medicinal cannabis prescribing behaviours. We highlight several considerations for policy and practice to support safe and appropriate patient access to medicinal cannabis in this emerging area of clinical practice.
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Affiliation(s)
- Olivia Dobson
- School of Psychological Sciences and the Turner Institute for Brain and Mental Health, Monash University, Melbourne, Australia
| | - Michaela Barber
- School of Psychological Sciences and the Turner Institute for Brain and Mental Health, Monash University, Melbourne, Australia
| | - Myfanwy Graham
- Monash Addiction Research Centre, Eastern Health Clinical School, Monash University and Turning Point, Melbourne, Australia
| | - Adrian Carter
- School of Psychological Sciences and the Turner Institute for Brain and Mental Health, Monash University, Melbourne, Australia
- Monash Bioethics Centre, School of Philosophy, History and International Studies, Monash University, Melbourne, Australia
| | - Michael Savic
- Monash Addiction Research Centre, Eastern Health Clinical School, Monash University and Turning Point, Melbourne, Australia
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Morris JN, Loyer J, Blunt J. Stigma, risks, and benefits of medicinal cannabis use among Australians with cancer. Support Care Cancer 2024; 32:252. [PMID: 38532234 DOI: 10.1007/s00520-024-08439-w] [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: 10/01/2023] [Accepted: 03/15/2024] [Indexed: 03/28/2024]
Abstract
PURPOSE People with cancer who use medicinal cannabis do so despite risks associated with limited clinical evidence, legalities, and stigma. This study investigated how Australians with cancer rationalise their medicinal cannabis use despite its risks. METHODS Ten adults (5 males and 5 females; mean age of 53.3) who used cannabis medicinally for their cancer were interviewed in 2021-2022 about how they used and accessed the substance, attitudes and beliefs underpinning their use, and conversations with others about medicinal cannabis. RESULTS Participants had cancer of the bowel, skin, oesophagus, stomach, thyroid, breast, and Hodgkin lymphoma for which they were receiving treatment (n = 5) or under surveillance (n = 5), with most (n = 6) encountering metastatic disease. Cannabis was used to treat a variety of cancer-related symptoms such as pain, poor sleep, and low mood. Cannabis was perceived as natural and thus less risky than pharmaceuticals. Participants legitimised their medicinal cannabis use by emphasising its natural qualities and distancing themselves from problematic users or riskier substances. Cost barriers and a lack of healthcare professional communication impeded prescription access. Similarly, participants navigated medicinal cannabis use independently due to a lack of guidance from healthcare professionals. CONCLUSION Findings highlight the need for robust data regarding the harms and efficacy of medicinal cannabis and dissemination of such information among healthcare professionals and to patients who choose to use the substance. Ensuring healthcare professionals are equipped to provide non-judgmental and evidence-based guidance may mitigate potential safety and legal risks.
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Affiliation(s)
- Julia N Morris
- Cancer Council SA, 202 Greenhill Road, Eastwood, SA, 5063, Australia.
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Hachem Y, Moride Y, Castilloux AM, Castillon G, Kalaba M, Néron A, Gamaoun R, Martel MO, Beaulieu P, Ware M, Vigano A. A Descriptive Analysis of Adverse Event Reports from the Quebec Cannabis Registry. Drug Saf 2024; 47:161-171. [PMID: 37996777 DOI: 10.1007/s40264-023-01379-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/30/2023] [Indexed: 11/25/2023]
Abstract
INTRODUCTION Published data on the safety of natural medical cannabis (MC) when used in the real-world clinical practice setting are lacking. This study aimed to describe adverse events (AEs) reported across three years following MC initiation. METHODS The Quebec Cannabis Registry (QCR) was a prospective registry of adults enrolled through participating physicians when they initiated MC between May 2015 and October 2018. Follow-up ended at MC discontinuation, loss to follow-up, three years, or end of data collection (May 2019). Data were collected at baseline and at follow-up visits every three months for the first two years, then once in the third year. Physicians filled adverse event (AE) reports, which were coded using MedDRA® preferred terms (PTs), and descriptive analyses were conducted. RESULTS A total of 2991 patients were enrolled (mean age 50.9 years, 50.2% females). During follow-up, 108 patients (3.6%) experienced moderate or severe AEs, yielding 111 AE reports (three patients had two reports) and 214 AEs (average 1.9 AEs per report). Mild AEs were recorded as a reason for MC discontinuation for nine patients, but no AE reports were available. The most common PTs for ingested MC (62 reports) were dizziness (12.9%), nausea (11.3%), somnolence (9.7%), and vomiting (8.1%), and for inhaled MC (23 reports), headache (13.0%) was the most common. The most frequent PTs associated with tetrahydrocannabinol (THC)-dominant MC (25 reports) were dizziness and somnolence (12.0% each); for cannabidiol (CBD)-dominant MC (20 reports), vomiting (20.0%) was most common; and dizziness (17.2%), nausea (13.8%), somnolence (10.3%), and headache (8.6%) were the most frequent for balanced MC (58 reports). CONCLUSION No new safety concerns were identified relative to the published literature, although notable differences in AE profile between modes of administration and cannabinoid content ratios should be considered by health professionals. Further work identifying and managing risk factors for AEs is warranted to maintain a favorable benefit-risk balance for MC.
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Affiliation(s)
- Yasmina Hachem
- Medical Cannabis Program in Oncology, McGill University Health Center, Montréal, QC, Canada
- Department of Medicine, Mount Auburn Hospital, Harvard Medical School, Cambridge, MA, USA
| | - Yola Moride
- Center for PharmacoEpidemiology and Treatment Science, Rutgers, The State University of New Jersey, New Brunswick, NJ, USA.
- YolaRX Consultants, Montréal, QC, Canada.
| | | | | | - Maja Kalaba
- Canopy Growth Corporation, Smiths Falls, ON, Canada
| | - Andrée Néron
- Bureau d'évaluation médicale (Consultant on request in medical cannabis-related pharmacological assessments and needs for injured workers), Québec City, QC, Canada
| | - Rihab Gamaoun
- Research Institute of the McGill University Health Centre, Montréal, QC, Canada
| | - Marc O Martel
- Department of Anesthesiology, Faculty of Dental Medicine and Oral Health Sciences, McGill University, Montréal, QC, Canada
| | - Pierre Beaulieu
- Département de pharmacologie et physiologie/Département d'anesthésiologie et de médecine de la douleur, Faculté de médecine de l'Université de Montréal, Montréal, QC, Canada
| | - Mark Ware
- Alan Edwards Pain Management Unit, McGill University Health Center, Montréal, QC, Canada
| | - Antonio Vigano
- Medical Cannabis Program in Oncology, McGill University Health Center, Montréal, QC, Canada
- Division of Palliative and Supportive Care, McGill University Health Center, Montréal, QC, Canada
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Graham M, Chiu V, Stjepanović D, Hall W. A provisional evaluation of Australia's medical cannabis program. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2023; 122:104210. [PMID: 37813082 DOI: 10.1016/j.drugpo.2023.104210] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Revised: 09/03/2023] [Accepted: 09/18/2023] [Indexed: 10/11/2023]
Abstract
In 2016, the Australian Government legislated to allow cannabis to be prescribed to patients as an unapproved medicine under the special access provisions of the Therapeutic Goods Act. This paper compares the Australian regulatory approach with other national approaches, outlines the main provisions of the Special Access Scheme for medical cannabis, describes how the program has evolved since 2017, includes an analysis of adverse events reported to the Therapeutic Goods Administration, and discusses the barriers that remain for patients who wish to access medical cannabis. It assesses how well the Australian program has addressed the challenges of providing patients with easier access to medical cannabis while ensuring that high-quality products are used safely and effectively under medical guidance.
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Affiliation(s)
- Myfanwy Graham
- Centre for Drug Repurposing & Medicines Research, School of Medicine and Public Health, The University of Newcastle, Australia; Schaeffer Center for Health Policy & Economics, The University of Southern California, United States.
| | - Vivian Chiu
- National Centre for Youth Substance Use Research, The University of Queensland, Australia
| | - Daniel Stjepanović
- National Centre for Youth Substance Use Research, The University of Queensland, Australia
| | - Wayne Hall
- National Centre for Youth Substance Use Research, The University of Queensland, Australia
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D'Mello K, Chan GCK, Hall W, Rychert M, Wilkins C, Hammond D. Use of flavored cannabis vaping products in the US, Canada, Australia, and New Zealand: findings from the international cannabis policy study wave 4 (2021). THE AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE 2023; 49:640-651. [PMID: 37624645 DOI: 10.1080/00952990.2023.2238116] [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: 10/06/2022] [Revised: 07/12/2023] [Accepted: 07/14/2023] [Indexed: 08/27/2023]
Abstract
Background: Vaping is an increasingly popular mode of cannabis use. Few studies have characterized the role of flavors in cannabis e-liquids.Objectives: To explore the prevalence of flavored vaping liquids, including differences between countries and correlates of use.Methods: Data were from Wave 4 (2021) of the International Cannabis Policy Study with national samples aged 16-65 in Canada, the United States (US), Australia, and New Zealand. The sample comprised 52,938 respondents, including 6,265 who vaped cannabis e-liquids in the past 12-months (2,858 females, 3,407 males). Logistic regression models examined differences in the use of flavored e-liquids between countries and sociodemographic characteristics.Results: The prevalence of vaping cannabis e-liquids was highest in the US (15.3%) and Canada (10.7%) compared to Australia (4.0%) and New Zealand (3.7%). Among past 12-month cannabis consumers, 57.5% reported using flavored vaping liquids, 34.2% used unflavored vaping products and 8.3% did not know. People who vape in Australia were most likely to report using flavored liquids compared to New Zealand (OR = 2.29), Canada (OR = 3.14), and the US (OR = 3.14) (p < .05 for all). Fruit was the most reported vaping flavor (40.8%), followed by candy/dessert (20.4%) and vanilla (15.2%). Use of flavored vapes was greater among younger, ethnic minorities, female, higher education and income adequacy, and more frequent consumers (p < .05).Conclusion: Many cannabis consumers reported using flavored e-liquids, with highest levels among young people aged 16-35. Given the high prevalence of vaping in legal markets, regulators should consider the role of flavored vaping products in promoting cannabis use among this group.
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Affiliation(s)
- Kimberly D'Mello
- School of Public Health Sciences, Faculty of Health, University of Waterloo, Waterloo, Ontario, Canada
| | - Gary C K Chan
- National Centre for Youth Substance Use Research, The University of Queensland, Brisbane, Australia
| | - Wayne Hall
- National Centre for Youth Substance Use Research, The University of Queensland, Brisbane, Australia
| | - Marta Rychert
- SHORE & Whariki Research Centre, College of Health, Massey University, Auckland, New Zealand
| | - Chris Wilkins
- SHORE & Whariki Research Centre, College of Health, Massey University, Auckland, New Zealand
| | - David Hammond
- School of Public Health Sciences, Faculty of Health, University of Waterloo, Waterloo, Ontario, Canada
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Gliksberg O, Kushnir T, Sznitman SR, Lev-Ran S, Brill S, Amit BH, Feingold D. Negative experiences of patients using medicinal cannabis: A systematic review of qualitative studies. J Clin Nurs 2023; 32:5607-5618. [PMID: 36807590 DOI: 10.1111/jocn.16653] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Revised: 01/25/2023] [Accepted: 01/30/2023] [Indexed: 02/22/2023]
Abstract
AIMS AND OBJECTIVES In this study, we systematically reviewed qualitative studies concerning patients' experience with medicinal cannabis (MC) use, to gain insight into the negative effects of MC. BACKGROUND Over the past decades, the use of MC for therapeutic purposes has increased. However, there is conflicting and insufficient data on possible negative physiological and psychological effects of MC treatment. DESIGN A systematic review was conducted and the PRISMA guidelines were adopted. Literature searches were conducted using PubMed, PsycINFO and EMBASE. Critical Appraisal Skills Programme (CASP) qualitative checklist used to assess risk of bias in the included studies. METHODS We included studies focusing on conventional medical treatment using cannabis-based products, approved by a physician for a particular health issue. RESULTS Of the 1230 articles identified in the initial search, eight articles were included in the review. Following the compilation of themes in the eligible studies, six themes were identified: (1) MC approval; (2) administrative barriers; (3) social perception; (4) MC misuse/widespread effect; (5) adverse effects; and (6) dependence or addiction. These were grouped into two meta-themes: (1) administrative and social aspects of MC use; and (2) experiences of the effects of medicinal cannabis. CONCLUSIONS Our findings call for specific attention to unique consequences associated with MC use. Further research is needed in order to assess the degree to which negative experiences associated with MC use may affect various aspects of patients' medical condition. RELEVANCE TO CLINICAL PRACTICE Describing the complex experience of MC treatment and its spectrum of consequences for patients may enable physicians, therapists and researchers to provide more attentive and accurate MC treatment to their patients. PATIENT OR PUBLIC CONTRIBUTION In this review, patients' narratives were explored, yet the research methods did not directly involve patients or the public.
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Affiliation(s)
- Or Gliksberg
- Doctoral Program, Department of Psychology, Ariel University, Ariel, Israel
| | - Talma Kushnir
- Adelson School of Medicine, Ariel University, Ariel, Israel
- Department of Psychology, Ariel University, Ariel, Israel
| | | | - Shaul Lev-Ran
- Israel Center on Addiction, Netanya, Israel
- Lev Hasharon Medical Center, Netanya, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Silviu Brill
- Institute of Pain Medicine, Tel Aviv Medical Center, Tel Aviv, Israel
| | - Ben H Amit
- Cannabis Clinic, Reuth Rehabilitation Center, Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Graham M, Renaud E, Lucas CJ, Schneider J, Martin JH. Medicinal Cannabis Guidance and Resources for Health Professionals to Inform Clinical Decision Making. Clin Ther 2023; 45:527-534. [PMID: 37414503 DOI: 10.1016/j.clinthera.2023.03.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Revised: 02/17/2023] [Accepted: 03/09/2023] [Indexed: 07/08/2023]
Abstract
PURPOSE Interest in the use of cannabis as a medicine has markedly increased during the last decade, with an unprecedented number of patients now seeking advice or prescriptions for medicinal cannabis. Unlike other medicines prescribed by physicians, many medicinal cannabis products have not undergone standard clinical trial development required by regulatory authorities. Different formulations with varying strengths and ratios of tetrahydrocannabinol and cannabidiol are available, and this diversity of medicinal cannabis products available for a myriad of therapeutic indications adds to the complexity. Physicians face challenges and barriers in their clinical decision making with medicinal cannabis because of current evidence limitations. Research efforts to address evidence limitations are ongoing; in the interim, educational resources and clinical guidance are being developed to address the gap in clinical information and support the needs of health professionals. METHODS This article provides an overview of various resources that health professionals may use when seeking information about medicinal cannabis in the absence of high-quality evidence and clinical guidelines. It also identifies examples of international evidence-based resources that support clinical decision making with medicinal cannabis. FINDINGS Similarities and differences between international examples of guidance and guideline documents are identified and summarized. IMPLICATIONS Guidance can help guide physicians in the individualized choice and dose of medicinal cannabis. Before quality clinical trials and regulator-approved products with risk management programs, safety data require clinical and academic collaborative pharmacovigilance.
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Affiliation(s)
- Myfanwy Graham
- Australian Centre for Cannabinoid Clinical and Research Excellence, University of Newcastle, New South Wales, Australia; Centre for Drug Repurposing and Medicines Research, University of Newcastle, New South Wales, Australia; Hunter Medical Research Institute, New South Wales, Australia.
| | - Elianne Renaud
- Australian Centre for Cannabinoid Clinical and Research Excellence, University of Newcastle, New South Wales, Australia; Centre for Drug Repurposing and Medicines Research, University of Newcastle, New South Wales, Australia; Hunter Medical Research Institute, New South Wales, Australia
| | - Catherine J Lucas
- Australian Centre for Cannabinoid Clinical and Research Excellence, University of Newcastle, New South Wales, Australia; Centre for Drug Repurposing and Medicines Research, University of Newcastle, New South Wales, Australia; Hunter Medical Research Institute, New South Wales, Australia
| | - Jennifer Schneider
- Australian Centre for Cannabinoid Clinical and Research Excellence, University of Newcastle, New South Wales, Australia; Centre for Drug Repurposing and Medicines Research, University of Newcastle, New South Wales, Australia; Hunter Medical Research Institute, New South Wales, Australia
| | - Jennifer H Martin
- Australian Centre for Cannabinoid Clinical and Research Excellence, University of Newcastle, New South Wales, Australia; Centre for Drug Repurposing and Medicines Research, University of Newcastle, New South Wales, Australia; Hunter Medical Research Institute, New South Wales, Australia
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Khademi S, Hallinan CM, Conway M, Bonomo Y. Using Social Media Data to Investigate Public Perceptions of Cannabis as a Medicine: Narrative Review. J Med Internet Res 2023; 25:e36667. [PMID: 36848191 PMCID: PMC10012004 DOI: 10.2196/36667] [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: 01/20/2022] [Revised: 08/31/2022] [Accepted: 12/16/2022] [Indexed: 03/01/2023] Open
Abstract
BACKGROUND The use and acceptance of medicinal cannabis is on the rise across the globe. To support the interests of public health, evidence relating to its use, effects, and safety is required to match this community demand. Web-based user-generated data are often used by researchers and public health organizations for the investigation of consumer perceptions, market forces, population behaviors, and for pharmacoepidemiology. OBJECTIVE In this review, we aimed to summarize the findings of studies that have used user-generated text as a data source to study medicinal cannabis or the use of cannabis as medicine. Our objectives were to categorize the insights provided by social media research on cannabis as medicine and describe the role of social media for consumers using medicinal cannabis. METHODS The inclusion criteria for this review were primary research studies and reviews that reported on the analysis of web-based user-generated content on cannabis as medicine. The MEDLINE, Scopus, Web of Science, and Embase databases were searched from January 1974 to April 2022. RESULTS We examined 42 studies published in English and found that consumers value their ability to exchange experiences on the web and tend to rely on web-based information sources. Cannabis discussions have portrayed the substance as a safe and natural medicine to help with many health conditions including cancer, sleep disorders, chronic pain, opioid use disorders, headaches, asthma, bowel disease, anxiety, depression, and posttraumatic stress disorder. These discussions provide a rich resource for researchers to investigate medicinal cannabis-related consumer sentiment and experiences, including the opportunity to monitor cannabis effects and adverse events, given the anecdotal and often biased nature of the information is properly accounted for. CONCLUSIONS The extensive web-based presence of the cannabis industry coupled with the conversational nature of social media discourse results in rich but potentially biased information that is often not well-supported by scientific evidence. This review summarizes what social media is saying about the medicinal use of cannabis and discusses the challenges faced by health governance agencies and professionals to make use of web-based resources to both learn from medicinal cannabis users and provide factual, timely, and reliable evidence-based health information to consumers.
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Affiliation(s)
- Sedigh Khademi
- Department of General Practice, Faculty of Medicine, Dentistry & Health Sciences, University of Melbourne, Victoria, Australia.,Centre for Health Analytics, Murdoch Children's Research Institute, Melbourne, Australia
| | - Christine Mary Hallinan
- Department of General Practice, Faculty of Medicine, Dentistry & Health Sciences, University of Melbourne, Victoria, Australia.,Health & Biomedical Research Information Technology Unit, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Australia
| | - Mike Conway
- School of Computing and Information Systems, University of Melbourne, Melbourne, Australia
| | - Yvonne Bonomo
- Department of General Practice, Faculty of Medicine, Dentistry & Health Sciences, University of Melbourne, Victoria, Australia.,Department of Addiction Medicine, St Vincent's Health, Melbourne, Australia
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Hallinan CM, Khademi Habibabadi S, Conway M, Bonomo YA. Social media discourse and internet search queries on cannabis as a medicine: A systematic scoping review. PLoS One 2023; 18:e0269143. [PMID: 36662832 PMCID: PMC9858862 DOI: 10.1371/journal.pone.0269143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Accepted: 12/15/2022] [Indexed: 01/21/2023] Open
Abstract
The use of cannabis for medicinal purposes has increased globally over the past decade since patient access to medicinal cannabis has been legislated across jurisdictions in Europe, the United Kingdom, the United States, Canada, and Australia. Yet, evidence relating to the effect of medical cannabis on the management of symptoms for a suite of conditions is only just emerging. Although there is considerable engagement from many stakeholders to add to the evidence base through randomized controlled trials, many gaps in the literature remain. Data from real-world and patient reported sources can provide opportunities to address this evidence deficit. This real-world data can be captured from a variety of sources such as found in routinely collected health care and health services records that include but are not limited to patient generated data from medical, administrative and claims data, patient reported data from surveys, wearable trackers, patient registries, and social media. In this systematic scoping review, we seek to understand the utility of online user generated text into the use of cannabis as a medicine. In this scoping review, we aimed to systematically search published literature to examine the extent, range, and nature of research that utilises user-generated content to examine to cannabis as a medicine. The objective of this methodological review is to synthesise primary research that uses social media discourse and internet search engine queries to answer the following questions: (i) In what way, is online user-generated text used as a data source in the investigation of cannabis as a medicine? (ii) What are the aims, data sources, methods, and research themes of studies using online user-generated text to discuss the medicinal use of cannabis. We conducted a manual search of primary research studies which used online user-generated text as a data source using the MEDLINE, Embase, Web of Science, and Scopus databases in October 2022. Editorials, letters, commentaries, surveys, protocols, and book chapters were excluded from the review. Forty-two studies were included in this review, twenty-two studies used manually labelled data, four studies used existing meta-data (Google trends/geo-location data), two studies used data that was manually coded using crowdsourcing services, and two used automated coding supplied by a social media analytics company, fifteen used computational methods for annotating data. Our review reflects a growing interest in the use of user-generated content for public health surveillance. It also demonstrates the need for the development of a systematic approach for evaluating the quality of social media studies and highlights the utility of automatic processing and computational methods (machine learning technologies) for large social media datasets. This systematic scoping review has shown that user-generated content as a data source for studying cannabis as a medicine provides another means to understand how cannabis is perceived and used in the community. As such, it provides another potential 'tool' with which to engage in pharmacovigilance of, not only cannabis as a medicine, but also other novel therapeutics as they enter the market.
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Affiliation(s)
- Christine Mary Hallinan
- Faculty of Medicine, Department of General Practice, Dentistry & Health Sciences, The University of Melbourne, Melbourne, Victoria, Australia
- Faculty of Medicine, Department of General Practice, Health & Biomedical Research Information Technology Unit (HaBIC R2), Melbourne Medical School, Dentistry & Health Sciences, The University of Melbourne, Melbourne, Victoria, Australia
| | - Sedigheh Khademi Habibabadi
- Faculty of Medicine, Department of General Practice, Dentistry & Health Sciences, The University of Melbourne, Melbourne, Victoria, Australia
| | - Mike Conway
- Centre for Digital Transformation of Health, Victorian Comprehensive Cancer Centre, The University of Melbourne, Melbourne, Victoria, Australia
| | - Yvonne Ann Bonomo
- St Vincent’s Health—Department of Addiction Medicine, Melbourne, Victoria, Australia
- Faculty of Medicine, St Vincent’s Clinical School, Melbourne Medical School, Dentistry & Health Sciences, The University of Melbourne, Melbourne, Victoria, Australia
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Hallinan CM, Gunn JM, Bonomo YA. Use of electronic medical records to monitor the safe and effective prescribing of medicinal cannabis: is it feasible? Aust J Prim Health 2022; 28:564-572. [PMID: 35927928 DOI: 10.1071/py22054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Accepted: 06/17/2022] [Indexed: 12/13/2022]
Abstract
BACKGROUND General practitioners are well positioned to contribute to the pharmacovigilance of medical cannabis via the general practice electronic medical record (EMR). The aim of this research is to interrogate de-identified patient data from the Patron primary care data repository for reports of medicinal cannabis to ascertain the feasibility of using EMRs to monitor medicinal cannabis prescribing in Australia. METHODS EMR rule-based digital phenotyping of 1 164 846 active patients from 109 practices was undertaken to investigate reports of medicinal cannabis use from September 2017 to September 2020. RESULTS Eighty patients with 170 prescriptions of medicinal cannabis were identified in the Patron repository. Reasons for prescription included anxiety, multiple sclerosis, cancer, nausea, and Crohn's disease. Nine patients showed symptoms of a possible adverse event, including depression, motor vehicle accident, gastrointestinal symptoms, and anxiety. CONCLUSIONS The recording of medicinal cannabis effects in the patient EMR provides potential for medicinal cannabis monitoring in the community. This is especially feasible if monitoring were to be embedded into general practitioner workflow.
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Affiliation(s)
- Christine M Hallinan
- Department of General Practice, Melbourne Medical School, Faculty of Medicine, Dentistry and Health Sciences of the University of Melbourne, Level 2, 780 Elizabeth Street, Melbourne, Vic. 3004, Australia; and Faculty of Medicine, Dentistry and Health Sciences of the University of Melbourne, Level 2, Alan Gilbert Building, Grattan Street, Parkville, Vic. 3010, Australia; and Health and Biomedical Research Information Technology Unit (HaBIC R2), Faculty of Medicine, Dentistry and Health Sciences of the University of Melbourne, Level 2, 780 Elizabeth Street, Melbourne, Vic. 3004, Australia
| | - Jane M Gunn
- Faculty of Medicine, Dentistry and Health Sciences of the University of Melbourne, Level 2, Alan Gilbert Building, Grattan Street, Parkville, Vic. 3010, Australia
| | - Yvonne A Bonomo
- Faculty of Medicine, Dentistry and Health Sciences of the University of Melbourne, Level 2, Alan Gilbert Building, Grattan Street, Parkville, Vic. 3010, Australia; and Department of Addiction Medicine, St Vincent's Hospital, Fitzroy, Vic. 3065, Australia
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Hallinan CM, Bonomo YA. The Rise and Rise of Medicinal Cannabis, What Now? Medicinal Cannabis Prescribing in Australia 2017-2022. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19169853. [PMID: 36011488 PMCID: PMC9408026 DOI: 10.3390/ijerph19169853] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Revised: 08/01/2022] [Accepted: 08/03/2022] [Indexed: 05/10/2023]
Abstract
Medicinal cannabis was legalised in Australia in November 2016. By August 2022, there were 5284 specialist physician and general practitioner (GP) prescribers who submitted Special Access Scheme (SAS) applications to the Therapeutic Goods Administration (TGA) for the provision of medicinal cannabis prescriptions their patients. In this article we examine the impact of the delivery of publicly available clinical guidance documents, provision of education to prescribers, establishment of the TGA online portal, and launching of cannabis clinics on the number of applications approved by the TGA over time. We considered these findings in the context of the need to align the interventions facilitating the prescribing of medicinal cannabis with the establishment of processes to enable the systematic monitoring of patient outcomes. The cumulative number of medicinal cannabis Special Access Scheme-B (SAS-B) prescription approvals from January 2017 to June 2022 was 258,926. SAS-B approvals increased at an average rate of 208.55% p < 0.000, (95% CI 187.25−229.85) per month. Conclusion: There has been a rapid growth in prescribing since the legalisation of medicinal cannabis in Australia and this expansion has not been accompanied by parallel processes for the monitoring of medicinal cannabis. The capture of more highly granulated data, as found in the electronic medical record (EMR), patient smartphone applications, and social media provide an opportunity to monitor medicinal cannabis effectiveness and safety across multiple prescribing indications.
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Affiliation(s)
- Christine Mary Hallinan
- Department of General Practice, Faculty of Medicine, Dentistry and Health Sciences, Melbourne Medical School, University of Melbourne, Parkville, VIC 3010, Australia
- Health and Biomedical Research Information Technology Unit (HaBIC R2), Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Level 2, 780 Elizabeth Street, Melbourne, VIC 3010, Australia
- Correspondence: ; Tel.: +61-438-811-595
| | - Yvonne Ann Bonomo
- Department of Medicine, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Parkville, VIC 3010, Australia
- Department of Addiction Medicine, St. Vincent’s Hospital, Fitzroy, VIC 3065, Australia
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MacPhail SL, Bedoya-Pérez MA, Cohen R, Kotsirilos V, McGregor IS, Cairns EA. Medicinal Cannabis Prescribing in Australia: An Analysis of Trends Over the First Five Years. Front Pharmacol 2022; 13:885655. [PMID: 35620292 PMCID: PMC9127064 DOI: 10.3389/fphar.2022.885655] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Accepted: 03/31/2022] [Indexed: 11/13/2022] Open
Abstract
A regulatory framework allowing legal access to medicinal cannabis (MC) products has operated in Australia since November 2016. MC prescribing by healthcare practitioners (HCPs) is primarily conducted through the Special Access Scheme - Category B (SAS-B) pathway, through which prescribers apply to the Therapeutic Goods Administration (TGA–the federal regulator) for approval to prescribe a category of product to an individual patient suffering from a specific indication. The dataset collected by the TGA provides a unique opportunity to examine MC prescribing trends over time in the Australian population. Here we analysed this TGA SAS-B dataset since inception with respect to age, gender, product type (e.g., oil, flower, etc.), CBD content, indication treated, and prescriber location. Results are presented descriptively as well as being analysed using non-linear regression models. Relationship between variables were explored via correspondence analyses. Indications were classified with reference to the International Statistical Classification of Diseases and Related Health Problems (10th Revision). As of 31 August 2021, a total of 159,665 SAS-B approvals had been issued for MC products, 82.4% of were since January 2020. Leading indications for approvals were for pain, anxiety, and sleep disorders. Oil products were the most popular product type, while CBD-dominant products (≥98% CBD) accounted for 25.1% of total approvals. Approvals for flower products increased markedly during 2020–2021, as did approvals involving younger age groups (18–31 years old), male patients, and non-CBD dominant products. A disproportionate number of SAS-B MC applications (around 50%) came from HCPs in the state of Queensland. Associations between patient gender and age and/or indication with product type were found. For example, approvals for oil products were commonly associated with approvals for pain. While, overall prescribing increased dramatically over the last 2 years of analysis, stabilization of approval numbers is evident for some indications, such as pain. Current prescribing practices do not always reflect provided TGA guidance documents for MC prescribing. While acknowledging some limitations around the SAS-B dataset, it provides a unique and valuable resource with which to better understand current prescribing practices and utilisation of MC products within Australia.
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Affiliation(s)
- Sara L MacPhail
- The Lambert Initiative for Cannabinoid Therapeutics, The University of Sydney, Sydney, NSW, Australia.,School of Psychology, The University of Sydney, Sydney, NSW, Australia
| | - Miguel A Bedoya-Pérez
- The Lambert Initiative for Cannabinoid Therapeutics, The University of Sydney, Sydney, NSW, Australia.,School of Psychology, The University of Sydney, Sydney, NSW, Australia
| | - Rhys Cohen
- School of Social Sciences, Department of Sociology, Macquarie University, Sydney, NSW, Australia.,Cannabis Consulting Australia, Sydney, NSW, Australia
| | - Vicki Kotsirilos
- NICM Health Research Institute, Western Sydney University, Sydney, NSW, Australia
| | - Iain S McGregor
- The Lambert Initiative for Cannabinoid Therapeutics, The University of Sydney, Sydney, NSW, Australia.,School of Psychology, The University of Sydney, Sydney, NSW, Australia
| | - Elizabeth A Cairns
- The Lambert Initiative for Cannabinoid Therapeutics, The University of Sydney, Sydney, NSW, Australia.,School of Psychology, The University of Sydney, Sydney, NSW, Australia
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Khademi Habibabadi S, Hallinan C, Bonomo Y, Conway M. Consumer-generated discourse on cannabis as a medicine: Review of techniques (Preprint). J Med Internet Res 2021; 24:e35974. [DOI: 10.2196/35974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2021] [Revised: 06/16/2022] [Accepted: 07/27/2022] [Indexed: 11/13/2022] Open
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