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Stasiłowicz-Krzemień A, Nogalska W, Maszewska Z, Maleszka M, Dobroń M, Szary A, Kępa A, Żarowski M, Hojan K, Lukowicz M, Cielecka-Piontek J. The Use of Compounds Derived from Cannabis sativa in the Treatment of Epilepsy, Painful Conditions, and Neuropsychiatric and Neurodegenerative Disorders. Int J Mol Sci 2024; 25:5749. [PMID: 38891938 PMCID: PMC11171823 DOI: 10.3390/ijms25115749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2024] [Revised: 05/20/2024] [Accepted: 05/23/2024] [Indexed: 06/21/2024] Open
Abstract
Neurological disorders present a wide range of symptoms and challenges in diagnosis and treatment. Cannabis sativa, with its diverse chemical composition, offers potential therapeutic benefits due to its anticonvulsive, analgesic, anti-inflammatory, and neuroprotective properties. Beyond cannabinoids, cannabis contains terpenes and polyphenols, which synergistically enhance its pharmacological effects. Various administration routes, including vaporization, oral ingestion, sublingual, and rectal, provide flexibility in treatment delivery. This review shows the therapeutic efficacy of cannabis in managing neurological disorders such as epilepsy, neurodegenerative diseases, neurodevelopmental disorders, psychiatric disorders, and painful pathologies. Drawing from surveys, patient studies, and clinical trials, it highlights the potential of cannabis in alleviating symptoms, slowing disease progression, and improving overall quality of life for patients. Understanding the diverse therapeutic mechanisms of cannabis can open up possibilities for using this plant for individual patient needs.
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Affiliation(s)
- Anna Stasiłowicz-Krzemień
- Department of Pharmacognosy and Biomaterials, Faculty of Pharmacy, Poznan University of Medical Sciences, Rokietnicka 3, 60-806 Poznan, Poland; (A.S.-K.)
| | - Wiktoria Nogalska
- Department of Pharmacognosy and Biomaterials, Faculty of Pharmacy, Poznan University of Medical Sciences, Rokietnicka 3, 60-806 Poznan, Poland; (A.S.-K.)
| | - Zofia Maszewska
- Department of Pharmacognosy and Biomaterials, Faculty of Pharmacy, Poznan University of Medical Sciences, Rokietnicka 3, 60-806 Poznan, Poland; (A.S.-K.)
| | - Mateusz Maleszka
- Department of Pharmacognosy and Biomaterials, Faculty of Pharmacy, Poznan University of Medical Sciences, Rokietnicka 3, 60-806 Poznan, Poland; (A.S.-K.)
| | - Maria Dobroń
- Department of Pharmacognosy and Biomaterials, Faculty of Pharmacy, Poznan University of Medical Sciences, Rokietnicka 3, 60-806 Poznan, Poland; (A.S.-K.)
| | - Agnieszka Szary
- Department of Pharmacognosy and Biomaterials, Faculty of Pharmacy, Poznan University of Medical Sciences, Rokietnicka 3, 60-806 Poznan, Poland; (A.S.-K.)
| | - Aleksandra Kępa
- Department of Pharmacognosy and Biomaterials, Faculty of Pharmacy, Poznan University of Medical Sciences, Rokietnicka 3, 60-806 Poznan, Poland; (A.S.-K.)
| | - Marcin Żarowski
- Department of Developmental Neurology, Poznan University of Medical Sciences, Przybyszewski 49, 60-355 Poznan, Poland;
| | - Katarzyna Hojan
- Department of Occupational Therapy, Poznan University of Medical Sciences, Swięcickiego 6, 61-847 Poznan, Poland;
- Department of Rehabilitation, Greater Poland Cancer Centre, Garbary 15, 61-866 Poznan, Poland
| | - Malgorzata Lukowicz
- Department of Rehabilitation, Centre of Postgraduate Medical Education, Konarskiego 13, 05-400 Otwock, Poland;
| | - Judyta Cielecka-Piontek
- Department of Pharmacognosy and Biomaterials, Faculty of Pharmacy, Poznan University of Medical Sciences, Rokietnicka 3, 60-806 Poznan, Poland; (A.S.-K.)
- Department of Pharmacology and Phytochemistry, Institute of Natural Fibres and Medicinal Plants, Wojska Polskiego 71b, 60-630 Poznan, Poland
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Kitsantas P, Pursell SR. Are Health Care Providers Caring for Pregnant and Postpartum Women Ready to Confront the Perinatal Cannabis Use Challenge? Am J Perinatol 2024; 41:e3249-e3254. [PMID: 38092020 DOI: 10.1055/s-0043-1777669] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/06/2024]
Abstract
OBJECTIVE The purpose of this study was to assess health care providers' knowledge and practices related to cannabis use among pregnant and postpartum women. STUDY DESIGN A survey of health care providers (n = 75 responders) was conducted across four main regions in the state of Virginia to assess knowledge of adverse health effects associated with perinatal cannabis use, screening tools, follow-up for positive screening, barriers to having discussions about cannabis use, and treatment among pregnant and postpartum women. RESULTS An astonishing 34.7% of the providers surveyed responded as not being aware of the impacts of cannabis use on the health of the mother and infant, and 66.7% of them reported that they would like some training on feeling comfortable with their knowledge about the impact of perinatal cannabis use on the population they are serving. When asked about providing resources and/or patient education related to cannabis use during pregnancy and/or breastfeeding, 62.7% reported they did not but they would be interested in providing both resources and education. Over one-third of the providers did not have a follow-up process for positive screening. In addition, numerous barriers to asking/screening and/or discussing cannabis use and potential harm reduction methods for the pregnant and postpartum populations emerged such as inadequate or lack of resources for positive screening, lack of knowledge on the topic, unsure about the policies of reporting a positive screening, etc. CONCLUSION: The findings of this study indicate that health care providers caring for pregnant and postpartum women are not equipped to make appropriate recommendations to patients and guide them through decision-making. Health care providers caring for pregnant and postpartum women need to be knowledgeable on how to best support patients with cannabis use for effective counseling and guidance due to health risks. State policies and resources are needed to ensure training for clinicians on perinatal cannabis. KEY POINTS · Providers are not knowledgeable about perinatal cannabis.. · Providers lack resources and do not have a follow-up process.. · Providers would like to receive training on the impact of perinatal cannabis on health outcomes..
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Affiliation(s)
- Panagiota Kitsantas
- Department of Population Health and Social Medicine, Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, Florida
| | - Shannon R Pursell
- Department of Pediatrics, Virginia Neonatal Perinatal Collaborative, Children's Hospital of Richmond, Richmond, Virginia
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Thomson ACS, McCarrel TM, Zakharov A, Gomez B, Lyubimov A, Schwark WS, Mallicote MF, Portela DA, Bisiau AL, Wakshlag JJ. Pharmacokinetics and tolerability of single-dose enteral cannabidiol and cannabidiolic acid rich hemp in horses ( Equus caballus). Front Vet Sci 2024; 11:1356463. [PMID: 38681854 PMCID: PMC11047043 DOI: 10.3389/fvets.2024.1356463] [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: 12/15/2023] [Accepted: 03/26/2024] [Indexed: 05/01/2024] Open
Abstract
The pharmacokinetics and tolerability of cannabinoids and their metabolites were determined in eight horses after enteral administration of a commercial CBD/CBDA-rich hemp oil product. Each horse was administered 2 mg/kg or 8 mg/kg CBD/CBDA or no treatment in a randomized cross-over design. Serial serum samples collected over 48 h were analyzed by high performance liquid chromatography with tandem mass spectrometry. Plasma chemistry analysis was performed at 0 h and 24 h. Vital parameters, pedometry, and blinded mentation and gait evaluations were recorded at intervals up to 24 h. Manure production and gastrointestinal transit time were tracked for 48 h after oil administration. The median maximal concentration of CBD and CBDA were 5.2 and 36.95 ng/mL in the 2 mg/kg group, respectively; and 40.35 and 353.56 ng/mL in the 8 mg/kg group. The median half-life of elimination was not calculated for the 2 mg/kg CBD treatment due to lack of time points above the lower quantifiable limit beyond the Cmax while it was 7.75 h in the 8 mg/kg group. CBDA absorption was biphasic. Pharmacokinetic parameters for tetrahydrocannabinol, tetrahydrocannabinolic acid, cannabigerolic acid, and 7-carboxy cannabidiol are also reported. No significant differences in any of the measured tolerability parameters were demonstrated between treatment groups. Single-dose enteral administration of CBD/CBDA-rich hemp extract up to 8 mg/kg does not appear to produce neurologic, behavioral, or gastrointestinal effects in horses.
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Affiliation(s)
- Alexander C. S. Thomson
- Department of Comparative, Population, and Diagnostic Medicine, College of Veterinary Medicine, University of Florida, Gainesville, FL, United States
| | - Taralyn M. McCarrel
- Department of Large Animal Clinical Sciences, College of Veterinary Medicine, University of Florida, Gainesville, FL, United States
| | - Alexander Zakharov
- Department of Pharmacology, College of Medicine, University of Illinois, Chicago, IL, United States
| | - Beatriz Gomez
- Department of Pharmacology, College of Medicine, University of Illinois, Chicago, IL, United States
| | - Alex Lyubimov
- Department of Pharmacology, College of Medicine, University of Illinois, Chicago, IL, United States
| | - Wayne S. Schwark
- Department of Molecular Medicine, College of Veterinary Medicine, Cornell University, Ithaca, NY, United States
| | - Martha F. Mallicote
- Department of Large Animal Clinical Sciences, College of Veterinary Medicine, University of Florida, Gainesville, FL, United States
| | - Diego A. Portela
- Department of Comparative, Population, and Diagnostic Medicine, College of Veterinary Medicine, University of Florida, Gainesville, FL, United States
| | - Amber L. Bisiau
- Department of Large Animal Clinical Sciences, College of Veterinary Medicine, University of Florida, Gainesville, FL, United States
| | - Joseph J. Wakshlag
- Department of Clinical Sciences, College of Veterinary Medicine, Cornell University, Ithaca, NY, United States
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Singla A, Anstine CV, Huang L, Rosedahl JK, Mohabbat AB, Philpot LM. A Cross-Sectional Survey Study of Cannabis Use for Fibromyalgia Symptom Management. Mayo Clin Proc 2024; 99:542-550. [PMID: 38569809 DOI: 10.1016/j.mayocp.2023.12.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Revised: 11/29/2023] [Accepted: 12/26/2023] [Indexed: 04/05/2024]
Abstract
OBJECTIVE To assess the use of cannabis as a symptom management strategy for patients with fibromyalgia. PATIENTS AND METHODS An electronic, cross-sectional survey was conducted among patients diagnosed with fibromyalgia and treated in Integrative Medicine & Health at Mayo Clinic, Rochester, Minnesota. The survey was constructed with the Symptom Management Theory tool and was sent anonymously via web-based software to patients with a diagnosis of fibromyalgia. RESULTS Of 5234 patients with fibromyalgia sent the online survey, 1336 (25.5%) responded and met the inclusion criteria. Survey respondents had a median age of 48 (Q1-Q3: 37.5-58.0) years, and most identified as female. Nearly half of respondents (49.5%, n=661) reported cannabis use since their fibromyalgia diagnosis. The most common symptoms for which respondents reported using cannabis were pain (98.9%, n=654); fatigue (96.2%; n=636); stress, anxiety, or depression (93.9%; n=621); and insomnia (93.6%; n=619). Improvement in pain symptoms with cannabis use was reported by 82.0% (n=536). Most cannabis-using respondents reported that cannabis also improved symptoms of stress, anxiety, and depression and of insomnia. CONCLUSION Considering that cannabis is a popular choice among patients for managing fibromyalgia symptoms, clinicians should have adequate knowledge of cannabis when discussing therapeutic options for fibromyalgia with their patients.
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Affiliation(s)
- Abhinav Singla
- Division of General Internal Medicine, Mayo Clinic, Rochester, MN, USA.
| | | | - Linda Huang
- Pharmacy Services, Mayo Clinic, Rochester, MN, USA
| | - Jordan K Rosedahl
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, USA
| | - Arya B Mohabbat
- Division of General Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - Lindsey M Philpot
- Division of General Internal Medicine, Mayo Clinic, Rochester, MN, USA; Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, USA
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Pav M, Haesaert G, De Steur H. Public Knowledge, Perceptions, and Behavioral Intention Regarding Medical Cannabis in Belgium. J Psychoactive Drugs 2024; 56:187-198. [PMID: 37155939 DOI: 10.1080/02791072.2023.2209893] [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: 09/08/2022] [Accepted: 03/02/2023] [Indexed: 05/10/2023]
Abstract
Growing evidence on medical cannabis has moved its legislation forward in various countries, which has increased research on stakeholder reactions. While various studies looked at experts and users, research on public perceptions is scarce. This study aims to (1) examine the relationships between knowledge, perceptions, and behavioral intention toward medical cannabis, and (2) identify and profile key segments within the general public. An online survey was conducted among 656 respondents in Belgium. Findings showed that both subjective and objective knowledge are relatively poor, while risk/benefit perceptions and behavioral intention are much more positive. Subjective and objective knowledge as well as social trust have a positive influence on benefit perceptions and a negative influence on risk perceptions. In turn, risk and benefit perceptions are key determinants of behavioral intention, but in opposite directions. Furthermore, cluster analysis identified a cautious (23% of the sample), positive (50%), and enthusiastic cluster (27%). In terms of socio-demographic profile, older and highly educated people were significantly more represented in the latter two clusters. While our study demonstrated that cannabis is well accepted for medical purposes, research is needed to further validate the relationships between knowledge, perceptions, and (intended) behavior in different settings and policy contexts.
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Affiliation(s)
- Matthias Pav
- Division of Agri-Food Marketing and Chain Management, Faculty of Bioscience Engineering, Ghent University, Ghent, Belgium
- Department of Plants and Crops, Faculty of Bioscience Engineering, Ghent University, Ghent, Belgium
| | - Geert Haesaert
- Department of Plants and Crops, Faculty of Bioscience Engineering, Ghent University, Ghent, Belgium
| | - Hans De Steur
- Division of Agri-Food Marketing and Chain Management, Faculty of Bioscience Engineering, Ghent University, Ghent, Belgium
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Selamoglu M, Erbas B, Wilson H, Barton C. 'Why do we have to be the gatekeepers?' Australian general practitioners' knowledge, attitudes and prescribing intentions on e-cigarettes as a smoking cessation aid. BMC PRIMARY CARE 2024; 25:53. [PMID: 38326738 PMCID: PMC10848430 DOI: 10.1186/s12875-024-02292-w] [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: 03/16/2023] [Accepted: 02/02/2024] [Indexed: 02/09/2024]
Abstract
BACKGROUND A significant policy change impacting the availability of nicotine for use in electronic cigarettes (e-cigarettes) in Australia took effect from October 1, 2021. This change meant that nicotine containing liquids for use with e-cigarettes would only be available by prescription from a medical practitioner as part of a smoking cessation plan. This study aimed to explore general practitioners (GPs) perceptions about the role of e-cigarettes, and understand factors informing their intentions to prescribe e-cigarettes as part of a smoking cessation plan. METHODS In-depth semi-structured interviews were conducted with thirteen GPs. Purposeful sampling was used to recruit participants. Interviews were audio recorded and transcribed verbatim. Thematic analysis was used to classify, describe and report themes in the data. QSR NVivo was used to aid coding, thematic analysis and retrieval of quotes. RESULTS Participants had diverse views on recommending and prescribing e-cigarettes as smoking cessation aids to patients. Some participants were willing to prescribe e-cigarettes to patients if other methods of smoking cessation had not worked but there were concerns, and uncertainty, about the safety and efficacy of e-cigarettes for smoking cessation. There was poor understanding of the current policy and legislation about e-cigarettes in Australia. Mostly the participants in this sample did not feel confident or comfortable to prescribe, or have discussions about e-cigarettes with patients. CONCLUSION The participants of this study held diverse attitudes on recommending and prescribing e-cigarettes for smoking cessation. Clarity in guidelines and consumer product information are required to enable GPs to provide consistent and accurate advice to patients that wish to use e-cigarettes as a smoking cessation aid.
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Affiliation(s)
- Melis Selamoglu
- Department of General Practice, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia.
| | - Bircan Erbas
- Department of Public Health, School of Psychology and Public Health, La Trobe University, Melbourne, Australia
| | - Hester Wilson
- Population and Community Health, South Eastern Sydney Local Health District, Sydney, Australia
- School of Population Health, University of New South Wales, Sydney, Australia
- Centre for Primary Health Care and Equity, University of New South Wales, Sydney, Australia
| | - Chris Barton
- Department of General Practice, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
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Batinic A, Curkovic A, Bukic J, Žuntar I, Kuret S, Mimica B, Kalajzic N, Dujic G, Glavaš-Obrovac L, Soldo A, Včeva A, Dujic Z, Sutlovic D. Knowledge and Attitudes of Cannabidiol in Croatia among Students, Physicians, and Pharmacists. PHARMACY 2023; 12:2. [PMID: 38251396 PMCID: PMC10801513 DOI: 10.3390/pharmacy12010002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Revised: 12/12/2023] [Accepted: 12/21/2023] [Indexed: 01/23/2024] Open
Abstract
Due to cannabidiol's health benefits and absence of serious side effects, its use is constantly growing. This is a survey-based cross-sectional study that was conducted to determine Croatian pharmacists', physicians', and students' knowledge and attitudes about cannabidiol (CBD). Two questionnaires were created, one for students and the other for physicians and pharmacists. Our participants (in total 874: 473 students and 401 physicians and pharmacists) generally had positive attitudes towards CBD therapy as approximately 60% of them believe that CBD treatment is generally efficacious. Participants had positive attitudes toward the therapeutic value of CBD, especially pharmacists and pharmacy students (63.8% and 72.2%, respectively). Pharmacists were significantly more convinced that CBD could reduce the use of opioids prescribed for chronic pain (p < 0.05). Only 17.5% of students had read scientific papers about CBD, compared to a significantly higher percentage of physicians and pharmacists (43.0% and 47.8%, respectively) (p < 0.05). This study revealed a gap in knowledge regarding CBD, since 89.3% of pharmacists and physicians, as well as 84.8% of students, believe they need more education about CBD. We conclude that it is important to improve the educational curricula so that medical professionals can recommend CBD use to their patients when needed.
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Affiliation(s)
- Ana Batinic
- Pharmacy of Split-Dalmatia County, 21000 Split, Croatia
| | - Ana Curkovic
- Department of Health Studies, University of Split, 21000 Split, Croatia; (A.C.); (S.K.); (N.K.); (D.S.)
| | - Josipa Bukic
- Department of Pharmacy, University of Split School of Medicine, 21000 Split, Croatia;
| | - Irena Žuntar
- Faculty of Pharmacy and Biochemistry, University of Zagreb, 10000 Zagreb, Croatia;
| | - Sendi Kuret
- Department of Health Studies, University of Split, 21000 Split, Croatia; (A.C.); (S.K.); (N.K.); (D.S.)
| | - Bianka Mimica
- School of Medicine, University of Split School of Medicine, 21000 Split, Croatia
| | - Nina Kalajzic
- Department of Health Studies, University of Split, 21000 Split, Croatia; (A.C.); (S.K.); (N.K.); (D.S.)
| | - Goran Dujic
- Clinical Department of Diagnostic and Interventional Radiology, University Hospital of Split, 21000 Split, Croatia;
| | - Ljubica Glavaš-Obrovac
- Department of Medicinal Chemistry, Biochemistry and Clinical Chemistry, Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, 31000 Osijek, Croatia;
| | - Ana Soldo
- Croatian Chamber for Pharmacists, 10000 Zagreb, Croatia;
| | - Andrijana Včeva
- Department of Otorhinolaryngology and Maxillofacial Surgery, Medical Faculty, University of Osijek, J. Huttlera 4, 31000 Osijek, Croatia;
- Department of Otorhinolaryngology and Head and Neck Surgery, Clinical Hospital Centre Osijek, J. Huttlera 4, 31000 Osijek, Croatia
| | - Zeljko Dujic
- Department of Integrative Physiology, School of Medicine, University of Split, 21000 Split, Croatia;
| | - Davorka Sutlovic
- Department of Health Studies, University of Split, 21000 Split, Croatia; (A.C.); (S.K.); (N.K.); (D.S.)
- Department of Toxicology and Pharmacogenetics, School of Medicine, University of Split, 21000 Split, Croatia
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Canals PC, Aguilar AG, Carter GT, Shields CM, Westerkamp A, D'Elia M, Aldrich J, Moore RN, Moore AT, Piper BJ. Patient Reported Outcomes Using Medical Cannabis for Managing Pain in Charcot-Marie-Tooth Disease. Am J Hosp Palliat Care 2023; 40:1163-1167. [PMID: 36793224 DOI: 10.1177/10499091231158388] [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] [Indexed: 02/17/2023] Open
Abstract
Objective: Chronic pain is a major problem for patients with Charcot-Marie-Tooth (CMT) disease. This exploratory study examined patient reported efficacy of medical cannabis for pain management in this population. Methods: Participants (N = 56; 71.4% female; Age = 48.9, SD = 14.6; 48.5% CMT1) were recruited though the Hereditary Neuropathy Foundation. The online survey contained 52 multiple choice questions about demographics, medical cannabis use, symptomology, efficacy, and adverse effects. Results: Nearly all (90.9%) of respondents reported experiencing pain, including all (100%) females and 72.7% of males (chi-square P < .05) with 91.7% of respondents indicating cannabis provided at least 50% pain relief. The most frequent response was an 80% reduction in pain. Moreover, 80.0% of respondents reported using less opiates, 69% noted using less sleep medication, and 50.0% reported using less anxiety/antidepressant medications. Negative side effects were noted by 23.5% of respondents. However, almost all (91.7%) of that subgroup did not have plans to stop consuming cannabis. One-third (33.9%) possessed a medical cannabis certificate. Patient perceptions of their physicians' attitudes regarding patient medical cannabis use greatly impacted whether respondents informed their providers of their usage. Conclusion: The vast majority of patients with CMT reported that cannabis was effective to manage pain symptoms. These data support the need for prospective, randomized, controlled trials using standardized dosing protocols to further delineate and optimize the potential use of cannabis to treat pain related to CMT.
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Affiliation(s)
- Priscilla C Canals
- Department of Medical Education, Geisinger Commonwealth School of Medicine, Scranton, PA, USA
| | - Alexia G Aguilar
- Department of Medical Education, Geisinger Commonwealth School of Medicine, Scranton, PA, USA
| | - Gregory T Carter
- Providence St Luke's Rehabilitation Medical Center, Hereditary Neuropathy Foundation Center of Excellence, Spokane, WA, USA
| | | | | | | | - Joy Aldrich
- Hereditary Neuropathy Foundation, New York, NY, USA
| | | | | | - Brian J Piper
- Department of Medical Education, Geisinger Commonwealth School of Medicine, Scranton, PA, USA
- Center for Pharmacy Innovation and Outcomes, Precision Health Center, Forty Fort, PA, USA
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Bosley HG, Peña JM, Penn AD, Sorensen JL, Tierney M, Flentje A. A Pragmatic, Person-Centered View of Cannabis in the United States: Pursuing Care That Transcends Beliefs. Subst Abus 2023; 44:337-347. [PMID: 37902034 DOI: 10.1177/08897077231202836] [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] [Indexed: 10/31/2023]
Abstract
BACKGROUND Rates of cannabis use are increasing in the United States, likely as a result of changes in societal attitudes and expanding legalization. Although many patients report wanting to discuss the risks and benefits of cannabis use with their clinical providers, many providers hold conflicting beliefs regarding cannabis use and often do not engage patients in discussion about cannabis. This dilemma is underscored by the limitations imposed on cannabis related research, and lack of empirically based best-practice guidelines for clinicians when addressing cannabis use with patients. OBJECTIVES We aimed to briefly summarize clinician and patient attitudes toward cannabis use and review current clinical guidelines and provide suggestions to assist health care providers and clinicians in increasing their comfort and skill in discussing cannabis use with patients. METHODS A narrative review on attitudes toward cannabis use and clinical guidelines was performed to summarize the literature and provide evidence-based recommendations. RESULTS Attitudes toward cannabis use have been shaped by personal and political factors and contribute to clinician hesitance in speaking with patients about the topic. Administrative barriers have hindered the development of clearer public health guidelines that might enable the dissemination of evidence-based information on the health effects of cannabis use and might ultimately lead to better health outcomes. CONCLUSION Not discussing cannabis use with patients may be a crucial missed opportunity for harm reduction. In the absence of empirically supported best-practice guidelines, a person-centered approach can facilitate conversations on the harms and benefits of cannabis use.
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Affiliation(s)
- Hannah G Bosley
- University of California, San Francisco, CA, USA
- Berkeley Therapy Institute, Berkeley, CA, USA
| | - Juan M Peña
- University of California, San Francisco, CA, USA
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Cohen T, Ezra MB, Yanai S, Oren-Azulay T, Wein S, Hamama-Raz Y. Use of Medical Cannabis by Patients With Cancer: Attitudes, Knowledge, and Practice. J Pain Symptom Manage 2023; 66:203-211.e1. [PMID: 37244526 DOI: 10.1016/j.jpainsymman.2023.05.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Revised: 05/18/2023] [Accepted: 05/22/2023] [Indexed: 05/29/2023]
Abstract
CONTEXT Demand for medical cannabis (MC) is growing among Israeli patients with cancer. OBJECTIVES The study sought to assess factors contributing to the demand for MC among patients with cancer. METHODS Patients applying for a permit to receive MC at a pain and palliative clinic of a university-affiliated cancer center in Israel in 2020-2021 were asked to complete self-report questionnaires assessing attitudes, knowledge, and expectations regarding MC use. Findings were compared between first-time and repeat applicants. Repeat applicants were asked to report their indications for requesting MC, patterns of use, and treatment effect. RESULTS The cohort included 146 patients: 63 first-time applicants and 83 repeat applicants. First-time applicants were more likely to consult sources other than their oncologist for MC-related information (P < 0.01) and expressed more concern about addiction (P < 0.001) and side effects (P < 0.05). They often erroneously assumed the treatment was subsidized (P < 0.001). Repeat applicants were younger (P < 0.05) and included more smokers (P < 0.05) and recreational cannabis users (P < 0.05); 56.6% were cancer survivors and 78% used high-potency MC. Most patients believed to some degree that MC is more effective than conventional medications for symptom control, and over half thought that MC helps to cure cancer. CONCLUSION Misconceptions regarding the effectiveness of MC for symptom management and treatment may explain the motivation of patients with cancer to apply for a permit. There seems to be an association of young age, cigarette smoking, and recreational cannabis use with ongoing use of MC among cancer survivors.
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Affiliation(s)
- Tzeela Cohen
- Palliative Care Service (T.C., S.Y., T.O.A., S.W.), Davidoff Cancer Center, Rabin Medical Center, Beilinson Hospital, Petach Tikva, Israel.
| | | | - Shirly Yanai
- Palliative Care Service (T.C., S.Y., T.O.A., S.W.), Davidoff Cancer Center, Rabin Medical Center, Beilinson Hospital, Petach Tikva, Israel
| | - Tal Oren-Azulay
- Palliative Care Service (T.C., S.Y., T.O.A., S.W.), Davidoff Cancer Center, Rabin Medical Center, Beilinson Hospital, Petach Tikva, Israel
| | - Simon Wein
- Palliative Care Service (T.C., S.Y., T.O.A., S.W.), Davidoff Cancer Center, Rabin Medical Center, Beilinson Hospital, Petach Tikva, Israel
| | - Yaira Hamama-Raz
- School of Social Work (M.B.E., Y.H.R.), Ariel University, Ariel, Israel
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Gewandter JS, Edwards RR, Hill KP, Wasan AD, Hooker JE, Lape EC, Besharat S, Cowan P, Foll BL, Ditre JW, Freeman R. Cannabinoid Therapy: Attitudes and Experiences of People With Chronic Pain. Clin J Pain 2023; 39:249-258. [PMID: 36971412 PMCID: PMC10563515 DOI: 10.1097/ajp.0000000000001109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Accepted: 03/06/2023] [Indexed: 03/29/2023]
Abstract
OBJECTIVE Clinical trials of cannabinoids for chronic pain have mixed and often inconclusive results. In contrast, many prospective observational studies show the analgesic effects of cannabinoids. This survey study aimed to examine the experiences/attitudes of individuals with chronic pain who are currently taking, have previously taken, or never taken cannabinoids for chronic pain to inform future research. METHODS This study is based on a cross-sectional, web-based survey of individuals with self-reported chronic pain. Participants were invited to participate through an email that was distributed to the listservs of patient advocacy groups and foundations that engage individuals with chronic pain. RESULTS Of the 969 respondents, 444 (46%) respondents reported currently taking, 213 (22%) previously taken, and 312 (32%) never taken cannabinoids for pain. Participants reported using cannabinoids to treat a wide variety of chronic pain conditions. Those currently taking cannabinoids (vs previously) more frequently reported: (1) large improvements from cannabinoids in all pain types, including particularly difficult-to-treat chronic overlapping pain conditions (eg, pelvic pain), (2) improvements in comorbid symptoms (eg, sleep), and (3) lower interference from side effects. Those currently taking cannabinoids reported more frequent and satisfactory communication with clinicians regarding cannabinoid use. Those never taken cannabinoids reported a lack of suggestion/approval of a clinician (40%), illegality (25%), and lack of FDA regulation (19%) as reasons for never trying cannabinoids. CONCLUSION These findings underscore the importance of conducting high-quality clinical trials that include diverse pain populations and clinically relevant outcomes that if successful, could support FDA approval of cannabinoid products. Clinicians could then prescribe and monitor these treatments similarly to other chronic pain medications.
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Affiliation(s)
- Jennifer S. Gewandter
- Department of Anesthesiology and Perioperative Medicine, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA
| | - Robert R. Edwards
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham & Women’s Hospital, Boston, Massachusetts, USA
| | - Kevin P. Hill
- Department of Psychiatry, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts, USA
| | - Ajay D. Wasan
- Department of Anesthesiology and Perioperative Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Julia E. Hooker
- Department of Psychology, Syracuse University, Syracuse, New York, USA
| | - Emma C. Lape
- Department of Psychology, Syracuse University, Syracuse, New York, USA
| | - Soroush Besharat
- Department of Anesthesiology and Perioperative Medicine, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA
| | | | - Bernard Le Foll
- Department of Family and Community Medicine, University of Toronto, CA
- Addictions Division, Centre for Addiction and Mental Health, Toronto, CA
| | - Joseph W. Ditre
- Department of Psychology, Syracuse University, Syracuse, New York, USA
| | - Roy Freeman
- Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
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12
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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: 3] [Impact Index Per Article: 3.0] [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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13
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Butler JI, Dahlke S, Devkota R, Shrestha S, Hunter KF, Toubiana M, Kalogirou MR, Law J, Scheuerman M. The Information-Seeking Behavior and Unmet Knowledge Needs of Older Medicinal Cannabis Consumers in Canada: A Qualitative Descriptive Study. Drugs Aging 2023; 40:427-438. [PMID: 37147415 PMCID: PMC10162651 DOI: 10.1007/s40266-023-01030-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/05/2023] [Indexed: 05/07/2023]
Abstract
INTRODUCTION Older Canadians (age 60+) are increasingly using cannabis to treat their health problems, but little is known regarding how they learn about medicinal cannabis. This study explored the perspectives of older cannabis consumers, prospective consumers, healthcare professionals, and cannabis retailers on older adults' information-seeking behavior and unmet knowledge needs. METHODS A qualitative descriptive design was used. Semi-structured telephone interviews were conducted with a purposeful sample of 36 older cannabis consumers and prospective consumers, as well as 4 healthcare professionals and 5 cannabis retailers from across Canada, for a total sample of 45 participants. Data were thematically analyzed. RESULTS Three main themes characterizing older cannabis consumers' information-seeking were identified: (1) knowledge sources, (2) types of information sought, and (3) unmet knowledge needs. Participants accessed a variety of knowledge sources to inform themselves about medicinal cannabis. Cannabis retailers were identified as providing medical information to many older adults, despite regulations to the contrary. Cannabis-specialized healthcare professionals were also viewed as key knowledge sources, while primary care providers were perceived as both knowledge sources and gatekeepers limiting access to information. The types of information participants sought included the effects and potential benefits of medicinal cannabis, the side effects and risks involved, and guidance regarding suitable cannabis products. Participants' most salient unmet knowledge needs focused on dosing and use of cannabis to treat specific health conditions. DISCUSSION Findings suggest that barriers to learning about medical cannabis among older consumers identified in prior research remain pervasive and cut across jurisdictions. To address these barriers, there is a need for better knowledge products tailored to older cannabis consumers and their information needs, and further education for primary healthcare providers on medicinal cannabis and its therapeutic applications with older patients.
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Affiliation(s)
- Jeffrey I Butler
- Faculty of Nursing, University of Alberta, Edmonton Clinic Health Academy, 11405-87 Ave NW, Edmonton, AB, T6G 1C9, Canada.
| | - Sherry Dahlke
- Faculty of Nursing, University of Alberta, Edmonton Clinic Health Academy, 11405-87 Ave NW, Edmonton, AB, T6G 1C9, Canada.
| | - Rashmi Devkota
- Faculty of Nursing, University of Alberta, Edmonton Clinic Health Academy, 11405-87 Ave NW, Edmonton, AB, T6G 1C9, Canada
| | - Shovana Shrestha
- Faculty of Nursing, University of Alberta, Edmonton Clinic Health Academy, 11405-87 Ave NW, Edmonton, AB, T6G 1C9, Canada
| | - Kathleen F Hunter
- Faculty of Nursing, University of Alberta, Edmonton Clinic Health Academy, 11405-87 Ave NW, Edmonton, AB, T6G 1C9, Canada
| | - Madeline Toubiana
- Telfer School of Management, University of Ottawa, 55 Laurier Avenue East, Ottawa, ON, K1N 6N5, Canada
| | - Maya R Kalogirou
- Faculty of Nursing, MacEwan University, 11405-87th Avenue, Edmonton, AB, T6G 1C9, Canada
| | - Joanna Law
- Faculty of Nursing, University of Alberta, Edmonton Clinic Health Academy, 11405-87 Ave NW, Edmonton, AB, T6G 1C9, Canada
| | - Melissa Scheuerman
- Faculty of Nursing, University of Alberta, Edmonton Clinic Health Academy, 11405-87 Ave NW, Edmonton, AB, T6G 1C9, Canada
- Medical Cannabis Manager, Avant Brands Inc., 335-1632 Dickson Avenue, Kelowna, BC, V1Y 7T2, Canada
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14
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Galvin SL, Coulson CC. Addressing cannabis consumption among patients with hyperemesis gravidarum. AJOG GLOBAL REPORTS 2023; 3:100180. [PMID: 36911236 PMCID: PMC9992753 DOI: 10.1016/j.xagr.2023.100180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2023] Open
Abstract
Severe nausea and vomiting of pregnancy and hyperemesis gravidarum affect up to 3% of all pregnant people, causing substantial maternal and neonatal morbidity, suffering, and financial cost. Evidence supports the association of cannabis consumption with symptoms of severe nausea and vomiting of pregnancy or hyperemesis gravidarum as the general public has come to believe that cannabis is a natural, safe antiemetic. Cannabis consumption in pregnancy is discouraged strongly by the Surgeon General of the United States and the American College of Obstetricians and Gynecologists because of evidence of potential harms. Symptoms of intractable, severe nausea and vomiting of pregnancy or hyperemesis gravidarum associated with cannabis consumption may be unrecognized cannabinoid hyperemesis syndrome, and this syndrome may be more common than previously thought. Cannabis consumption is especially detrimental when causing or exacerbating debilitating symptoms such as the intense, persistent, recurrent, or cyclic vomiting and associated dehydration and other sequelae of cannabinoid hyperemesis syndrome. Open discussion of cannabis consumption during pregnancy is very challenging for patients and maternity care providers in our current environment of variable legal status across states and variable degrees of personal and societal acceptance. Evidence-based medical knowledge, guidance, tools, and skills are needed to differentially diagnose and treat cannabinoid hyperemesis syndrome in pregnancy. Researchers, clinicians, and medical specialty organizations must work together to strengthen the evidence base and develop or refine the necessary guidelines and tools for maternity care provider skill development, and to increase public and patient awareness of cannabinoid hyperemesis syndrome, specifically during pregnancy.
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Affiliation(s)
- Shelley L Galvin
- Department of Obstetrics and Gynecology, Mountain Area Health Education Center, Asheville, NC.,Department of Obstetrics and Gynecology, The University of North Carolina School of Medicine at Chapel Hill, Chapel Hill, NC
| | - Carol C Coulson
- Department of Obstetrics and Gynecology, Mountain Area Health Education Center, Asheville, NC.,Department of Obstetrics and Gynecology, The University of North Carolina School of Medicine at Chapel Hill, Chapel Hill, NC
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15
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Alharbi FF, Alqahtani TM, Alzamil AM, Alharbi NH, Masud N. Knowledge, perception, and beliefs of Saudi physicians at King Abdulaziz Medical City, Riyadh related to medical cannabis: Literature review and a cross-sectional survey. J Family Med Prim Care 2023; 12:536-544. [PMID: 37122648 PMCID: PMC10131962 DOI: 10.4103/jfmpc.jfmpc_1856_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2022] [Revised: 11/03/2022] [Accepted: 12/12/2022] [Indexed: 05/02/2023] Open
Abstract
Cannabis is an herbaceous flowering plant, originally an indigenous plant in Eastern Asia, which later spread globally due to widespread agricultural practices. Cannabis was used medicinally until the early twentieth century, but subsequently prohibited due to the psychoactive effects. Aims To explore the medical cannabis-related level of knowledge of physicians at King Abdulaziz Medical City, including patient needs, perceptions of therapeutic effects, potential harm, and the willingness to prescribe if legalized in future. Methodology The study was a cross-sectional questionnaire-based survey. It was conducted at King Abdulaziz Medical City in Riyadh from February 2020 to February 2021. All physicians from the different specialties, who consented to participate, were included in this study. Statistical Analysis Descriptive statistics are presented as mean and standard deviation and proportions. An ANOVA test was applied to measure the association of the beliefs regarding the right to prescribe with overall knowledge. All tests were considered significant at P < 0.05. Results A total of 249 physicians participated with the majority (70%) male. The sample was similar regardless of the physician's position in the medical hierarchy, with a mean work experience of 8 years. Almost half of the participants indicated that they do not have good knowledge regarding the effects of MC products and more than half that they are unaware of the different MC products and formulations currently available. Conclusion The majority of the sample lacked knowledge about the medicinal use of cannabis for specific indications and felt uncomfortable to discuss the medicinal use of cannabis with their patients.
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Affiliation(s)
- Fares F Alharbi
- Department of Mental Health, King Abdulaziz Medical City, Ministry of National Guard-Health Affairs, College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
- Research Center, King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Taif M Alqahtani
- Department of Family Medicine, Second Health Cluster, Ministry of Health, Riyadh, Saudi Arabia
- Bachelor of Medicine and Bachelor of Surgery, College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
- Research Center, King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
- Address for correspondence: Dr. Taif M Alqahtani, Department of Family Medicine, Second Health Cluster, Ministry of Health, Riyadh, Saudi Arabia. E-mail:
| | - Alaa M Alzamil
- Bachelor of Medicine and Bachelor of Surgery, College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
- Research Center, King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Nouf H Alharbi
- Bachelor of Medicine and Bachelor of Surgery, College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
- Research Center, King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Nazish Masud
- Member of Research Unit, College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
- Research Center, King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
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16
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Lee AHX, Tse EK, Nightingale TE, Sachdeva R, Walter M, Krassioukov AV. Cannabis health survey on usage in women with spinal cord injury and knowledge among physicians: A cross-sectional study. J Spinal Cord Med 2023; 46:291-297. [PMID: 35349394 PMCID: PMC9987743 DOI: 10.1080/10790268.2022.2038049] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
OBJECTIVE Individuals with spinal cord injury (SCI) report using cannabis to self-manage chronic pain and spasticity. However, its safety and efficacy are not well understood. As more women with SCI are pursuing motherhood, clinicians must consider the possibility of maternal cannabis use and its impact on fetal development. Moreover, due to the lack of current evidence for cannabis, it is important to characterize the perceptions and knowledge of physicians towards both recreational and synthetic cannabinoids. DESIGN Two anonymous surveys (10-items each) were conducted. SETTING AND PARTICIPANTS Women with SCI (n = 20) completed an anonymous, online survey regarding cannabis use. Physicians at a Canadian SCI rehabilitation center (n = 15) completed a survey on their knowledge of recreational and synthetic cannabinoids among individuals with SCI. OUTCOME MEASURES Survey 1 evaluated cannabis use patterns and perceptions before/after SCI in women, including during pregnancy and breastfeeding. The aim of Survey 2 was to understand the perception and current knowledge of physicians regarding recreational cannabis and synthetic cannabinoid use by patients with SCI. RESULTS At the time of survey, 7 women with SCI reported use of cannabis, only 4 of them used prior to injury. Managing tone/spasticity (n = 5) was the major reported benefit of cannabis use. Women used cannabis during pregnancy and/or breastfeeding as a sleep aid or relief for morning sickness (n = 1 pregnancy, n = 1 breastfeeding, n = 1 both). The most-reported challenge with cannabis use was difficulty obtaining consistent, desirable effects (n = 5). Almost all physicians (n = 13) described their knowledge on recreational cannabis products as "none, very little or poor", with greater overall comfort and knowledge of synthetic cannabinoids. CONCLUSION Due to the reported use of cannabis during pregnancy/breastfeeding and current impoverishment of physicians' knowledge (particularly regarding recreational cannabis products), it is imperative to further investigate the safety and efficacy of cannabis use in women with SCI.
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Affiliation(s)
- Amanda H X Lee
- International Collaboration on Repair Discoveries (ICORD), Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Emmanuel K Tse
- MD Undergraduate Program, Faculty of Medicine, The University of British Columbia, Vancouver, Canada
| | - Thomas E Nightingale
- International Collaboration on Repair Discoveries (ICORD), Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.,School of Sport, Exercise & Rehabilitation Sciences, University of Birmingham, Birmingham, UK.,Centre for Trauma Sciences Research, University of Birmingham, Edgbaston, Birmingham, UK
| | - Rahul Sachdeva
- International Collaboration on Repair Discoveries (ICORD), Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Matthias Walter
- International Collaboration on Repair Discoveries (ICORD), Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.,Department of Urology, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Andrei V Krassioukov
- International Collaboration on Repair Discoveries (ICORD), Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.,Division of Physical Medicine and Rehabilitation, Department of Medicine, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.,G.F. Strong Rehabilitation Centre, Vancouver, British Columbia, Canada
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17
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Gette JA, Regan T, Schumacher JA. Screening, brief intervention, and referral to treatment (SBIRT) for cannabis: A scoping review. JOURNAL OF SUBSTANCE USE AND ADDICTION TREATMENT 2023; 146:208957. [PMID: 36880902 DOI: 10.1016/j.josat.2023.208957] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Revised: 10/04/2022] [Accepted: 01/09/2023] [Indexed: 01/26/2023]
Abstract
INTRODUCTION Screening, brief intervention, and referral to treatment (SBIRT) has been used to change substance use behavior. Despite cannabis being the most prevalent federally illicit substance, we have limited understanding of use of SBIRT for managing cannabis use. This review aimed to summarize the literature on SBIRT for cannabis use across age groups and contexts over the last two decades. METHODS This scoping review followed the a priori guide outlined by the PRISMA (Preferred Reporting Items for Scoping Reviews and Meta-Analyses) statement. We gathered articles from PsycINFO, PubMed, Sage Journals Online, ScienceDirect, and SpringerLink. RESULTS The final analysis includes forty-four articles. Results indicate inconsistent implementation of universal screens and suggest screens assessing cannabis-specific consequences and utilizing normative data may increase patient engagement. Broadly, SBIRT for cannabis demonstrates high acceptability. However, the impact of SBIRT on behavior change across various modifications to intervention content and modality has been inconsistent. In adults, patients with primary cannabis use are not engaging in recommended treatment at similar rates to other substances. Results also suggest a lack of research addressing referral to treatment in adolescents and emerging adults. DISCUSSION Based on this review, we offer several to improve each component of SBRIT that may increase implementation of screens, effectiveness of brief interventions, and engagement in follow-up treatment.
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Affiliation(s)
- J A Gette
- Center for Alcohol and Substance Use Studies, Rutgers, the State University of New Jersey, Piscataway, NJ, United States of America.
| | - T Regan
- Department of Psychiatry, the University of Mississippi Medical Center, Jackson, MS, United States of America
| | - J A Schumacher
- Department of Psychiatry, the University of Mississippi Medical Center, Jackson, MS, United States of America
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18
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Towobola A, Towobola B, Nair B, Makwana A. The ethics and management of cannabis use in pregnancy following decriminalisation and licensing for medical use: narrative review. BJPsych Bull 2023; 47:28-37. [PMID: 34749839 PMCID: PMC10028554 DOI: 10.1192/bjb.2021.102] [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: 02/04/2023] Open
Abstract
AIMS AND METHOD As drug policies pertaining to cannabis use become more liberalised, the prevalence of cannabis use in pregnancy could increase. However, there is limited guidance available for clinicians. This paper presents a narrative review of literature published in the past 16 years (2006-2021) to (a) address the impact of legalisation and decriminalisation on the risks, ethics and support of women who use cannabis during pregnancy and (b) develop guidance for clinicians. RESULTS Both national and international trends suggest increased use of cannabis over the past decade, while the risks of cannabis use for recreational or medicinal purposes in pregnancy remain unmitigated. CLINICAL IMPLICATIONS This review confirmed that the recommendation of cannabinoid-based products for pregnant and breast-feeding women is currently premature. More research is needed to address safety concerns. We discussed navigating ethical concerns and suggest targeted management strategies for clinicians treating pregnant women who choose to use cannabis.
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Affiliation(s)
| | | | - Bosky Nair
- Kent and Medway NHS and Social Care Partnership Trust, Maidstone, Kent, UK
| | - Arti Makwana
- Kent and Medway NHS and Social Care Partnership Trust, Maidstone, Kent, UK
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19
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Withanarachchie V, Rychert M, Wilkins C. The role of cannabis clinics in the health system: a qualitative study of physicians' views in New Zealand. BMC Health Serv Res 2023; 23:10. [PMID: 36600251 DOI: 10.1186/s12913-022-09021-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Accepted: 12/30/2022] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Privately-owned cannabis clinics have sprung up in many jurisdictions where medicinal cannabis has been legalised and provide an alternative pathway for patients who are unable or unwilling to access a prescription for cannabis-based medicinal products from their usual healthcare providers. AIMS This study aimed to explore physicians' views on cannabis clinics, including their perceptions of the role cannabis clinics play in the wider health system. METHODS A qualitative study using in-depth, semi-structured interviews with thirty-one physicians affiliated with private and community clinics in New Zealand (including cannabis clinicians, GPs, and specialist doctors). The interviews were conducted from July to December 2021. Data were transcribed and analysed using inductive thematic analysis. RESULTS Cannabis clinicians positioned themselves as (1) "service providers", facilitating consumer access to cannabis prescriptions and products, and (2) "educators", providing advice to patients and the wider physician community. While general practitioners and specialists recognised the benefits of specialised cannabis clinics (i.e., knowledge of products and a non-judgmental environment), they questioned the limited evidence of clinical efficacy for cannabis, potential financial conflicts of interests of cannabis clinicians that may blur their clinical judgement, and the risk of compartmentalising patients' healthcare. CONCLUSIONS Our paper raises a number of challenges with attempting to integrate cannabis clinics into the wider health system.
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Affiliation(s)
- Vinuli Withanarachchie
- Shore & Whāriki Research Centre, College of Health, Massey University, Auckland, New Zealand.
| | - Marta Rychert
- Shore & Whāriki Research Centre, College of Health, Massey University, Auckland, New Zealand
| | - Chris Wilkins
- Shore & Whāriki Research Centre, College of Health, Massey University, Auckland, New Zealand
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20
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Younis J, Jiang H, Fan Y, Wang L, Li Z, Jebril M, Ma M, Ma L, Ma M, Hui Z. Prevalence of overweight, obesity, and associated factors among healthcare workers in the Gaza Strip, Palestine: A cross-sectional study. Front Public Health 2023; 11:1129797. [PMID: 36908479 PMCID: PMC9998069 DOI: 10.3389/fpubh.2023.1129797] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Accepted: 02/01/2023] [Indexed: 02/25/2023] Open
Abstract
Background Overweight and obesity are multifactorial conditions that are prevalent in developing and developed countries. They are emerging as a significant public health concern among healthcare workers (HCWs). We aimed to estimate the prevalence of overweight and obesity and their associated factors among HCWs in the Gaza Strip. Methods A cross-sectional study was conducted to recruit 1,850 HCWs aged 22 years and older. Interviews were carried out to collect sociodemographic information, nutritional information, and physical activity. Anthropometric measurements [height, weight, and waist circumference] were conducted with the HCWs. The body mass index was computed to determine the prevalence of overweight and obesity. Chi-square, t-test, and one-way ANOVA were used to compare the variables, and logistic regression was used to examine the associated factors of overweight and obesity. Results The combined prevalence of overweight and obesity among HCWs was 65%. The result of logistic regression showed the risk of being overweight and obesity increased within the age group of 40-49 years (OR = 3.20; 95% CI: 2.37-4.32; P < 0.001). Male participants had more risk of obesity than female participants (OR = 1.77; 95% CI: 1.45-2.15). Married participants had a significantly higher risk of being overweight and obese (OR = 2.52; 95% CI: 2.05-3.28; P = 0.001). Increased monthly income was significantly associated with the risk of being overweight and obese (OR = 2.16; 95% CI: 1.22-3.83; P = 0.008). In addition, hypertension (OR = 2.49; 95% CI: 1.65-3.78; P < 0.001) and type 2 diabetes (OR = 2.42; 95% CI: 1.21-4.85; P= 0.012) were associated with overweight and obesity. Finally, a family history of NCDs was associated with overweight and obesity (OR = 1.69; 95% CI: 1.38-2.07; P < 0.001). Conclusion This study showed a high prevalence of overweight and obesity among HCWs. Age, monthly income, marital status, known hypertension, type 2 diabetes, and eating habits were associated with the prevalence of overweight and obesity compared to other variables that were not associated with overweight and obesity such as profession, vegetables, fruit consumption, and physical activity. Urgent action is needed to tackle overweight and obesity among HCWs.
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Affiliation(s)
- Joma Younis
- School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an, China.,Al-Rantisi Pediatric Specialized Hospital, Ministry of Health, Gaza, Palestine
| | - Hong Jiang
- School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an, China
| | - Yahui Fan
- School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an, China
| | - Lina Wang
- School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an, China
| | - Zhaofang Li
- School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an, China
| | - Majed Jebril
- Al-Rantisi Pediatric Specialized Hospital, Ministry of Health, Gaza, Palestine
| | - Mei Ma
- School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an, China
| | - Le Ma
- School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an, China
| | - Mao Ma
- The First Affiliated Hospital, Xi'an Jiaotong University Health Science Center, Xi'an, China
| | - Zhaozhao Hui
- School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an, China
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21
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Tsampoula I, Zartaloudi A, Dousis E, Koutelekos I, Pavlatou N, Toulia G, Kalogianni A, Polikandrioti M. Quality of Life in Patients Receiving Medical Cannabis. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2023; 1425:401-415. [PMID: 37581814 DOI: 10.1007/978-3-031-31986-0_39] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/16/2023]
Abstract
INTRODUCTION Medical cannabis has been used to relieve the symptoms of people with various chronic diseases. Despite of this, it has been stigmatized, even after its legalization in many countries. AIM The purpose of this study was to investigate the quality of life of patients receiving medical cannabis. MATERIAL AND METHOD One hundred patients receiving medical cannabis were given (a) a socio-demographic and clinical questionnaire, and (b) the SF-36 Health Survey scale for assessing quality of life. RESULTS The majority of our patients who received medical cannabis to treat their neurological disorders (58%) reported decrease in their symptoms (96%), better energy and vitality (68%), ability to perform their professional duties (88%), and an improvement in sleeping and appetite (79% and 71%, respectively) after receiving medical cannabis. Our participants exhibited very few restrictions in activities due to emotional difficulties, a moderate general health status as well as moderate vitality and energy. Participants, who reported a longer period of receiving medical cannabis, reported statistically significant more energy and vitality (p = 0.000), but also better mental (p = 0.000) and general health status (p = 0.001). Furthermore, the majority of patients have disclosed medical cannabis use to their family members (85%) and enjoyed their support (93%), but they haven't revealed their medication treatment to their social environment (81%). CONCLUSIONS Appropriate knowledge could significantly help health professionals in the field of planning and implementation of personalized nursing care in order to achieve optimal therapeutic outcomes.
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Affiliation(s)
- Iliana Tsampoula
- Department of Nursing, University of West Attica, Athens, Greece
| | | | - Evangelos Dousis
- Department of Nursing, University of West Attica, Athens, Greece
| | | | - Niki Pavlatou
- Department of Nursing, University of West Attica, Athens, Greece
| | - Georgia Toulia
- Department of Nursing, University of West Attica, Athens, Greece
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22
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Ng JY, Quach H, Phillips MR, Busse JW. Surveying Canadian Pain Physicians' Attitudes and Beliefs Regarding Medical Cannabis for Chronic Noncancer Pain: A Qualitative Study. J Pain Res 2022; 15:3899-3910. [PMID: 36540576 PMCID: PMC9760033 DOI: 10.2147/jpr.s382589] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2022] [Accepted: 12/06/2022] [Indexed: 10/22/2023] Open
Abstract
BACKGROUND Medical cannabis is commonly and increasingly used by Canadians to manage chronic pain. As of March 2021, Health Canada reported that approximately 300,000 Canadians who were authorized to access medical cannabis, which is more than a 1000% increase from the 24,000 registered in 2015. Physicians, however, receive limited information on therapeutic cannabis during their training, and their perceptions regarding this therapeutic option are uncertain. This study focused on exploring attitudes and beliefs of pain physicians regarding medical cannabis for the management of chronic noncancer pain. METHODS This study utilized a focused ethnography approach. Pain management clinicians within the Greater Toronto and Hamilton Area were recruited through snowball sampling methods, and individually interviewed. We applied thematic analysis to interview transcripts and identified representative quotes. The Hamilton Integrated Research Ethics Board reviewed and approved this project. RESULTS Thirteen physicians who focused their clinical practice on pain management agreed to be interviewed, and three themes regarding medical cannabis emerged: 1) evidence regarding medical cannabis, 2) medical cannabis as first-line therapy for chronic pain, and 3) barriers to accessing medical cannabis. Subthemes of the last theme included out-of-pocket costs, stigma by society and healthcare providers, and lack of knowledge among physicians. CONCLUSION Despite increasing use of medical cannabis for chronic pain among Canadians, pain physicians in our study expressed concerns regarding the evidence to support this therapy and acknowledged important barriers to access.
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Affiliation(s)
- Jeremy Y Ng
- Department of Health Research Methods, Evidence, and Impact, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Halton Quach
- Department of Health Research Methods, Evidence, and Impact, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Mark R Phillips
- Department of Health Research Methods, Evidence, and Impact, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Jason W Busse
- Department of Health Research Methods, Evidence, and Impact, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
- The Michael G. DeGroote Centre for Medicinal Cannabis Research, McMaster University, Hamilton, Ontario, Canada
- Department of Anesthesia, McMaster University, Hamilton, Ontario, Canada
- The Chronic Pain Centre of Excellence for Canadian Veterans, Hamilton, Ontario, Canada
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Pottieger M, Rowland L, DiSantis KI. Assessing Increases in Cannabis-Related Diagnoses in US Hospitals by Regional Policy Status. Popul Health Manag 2022; 25:738-743. [PMID: 36219744 DOI: 10.1089/pop.2022.0122] [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: 12/31/2022] Open
Abstract
Cannabis policy is rapidly changing and more individuals are using cannabis nationally. Despite increased use and known adverse outcomes to cannabis use, there is a lack of understanding of health care utilization for cannabis-related conditions. The objectives of this study were: (1) To understand the change in the incidence of cannabis-related diagnoses from 2012 to 2015 nationally and (2) to describe the relationship between regional cannabis policies and changes in the incidence of cannabis-related diagnoses from 2012 to 2015. National Inpatient Sample (NIS) data from the Healthcare Cost and Utilization Project for 2012 and 2015 were analyzed using SPSS software for incidence of cannabis diagnoses. Previously defined NIS regions were assigned a policy status related to medical and recreational cannabis laws. Comparisons were made at the national and regional levels to better understand change in incidence of diagnoses. From 2012 to 2015, there was a 26.7% increase in cannabis-related diagnoses in the inpatient setting nationally. All 9 regions showed increases in the incidence of cannabis-related diagnoses ranging from 15.5% to 41.9% regardless of cannabis policy. As cannabis policy increased legal access, cannabis-related diagnoses increased nationally and regionally across the United States from 2012 to 2015 regardless of cannabis policy. Continued tracking of cannabis-related diagnoses is needed to identify where interventions are necessary to reduce negative impacts of increased cannabis use.
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Affiliation(s)
- Michael Pottieger
- Department of Public Health and College of Health Sciences, Arcadia University, Philadelphia, Pennsylvania, USA.,Department of Medical Science, College of Health Sciences, Arcadia University, Philadelphia, Pennsylvania, USA
| | - Leslie Rowland
- College of Population Health, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Katherine I DiSantis
- College of Population Health, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
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Kurtzman ET, Greene J, Begley R, Drenkard KN. "We want what's best for patients." nurse leaders' attitudes about medical cannabis: A qualitative study. INTERNATIONAL JOURNAL OF NURSING STUDIES ADVANCES 2022; 4:100065. [PMID: 38745605 PMCID: PMC11080284 DOI: 10.1016/j.ijnsa.2022.100065] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Revised: 01/07/2022] [Accepted: 01/29/2022] [Indexed: 10/19/2022] Open
Abstract
Background The majority of states have legalized medical cannabis. Nurse leaders must be prepared for an increase in patients' use of the drug across all care settings. Objectives To explore nurse leaders' attitudes towards, knowledge of, and experiences with medical cannabis. Design : Descriptive qualitative study design. Participants 28 nurse leaders-19 in four focus groups of 3-7 participants and another 9 in interviews. Methods Semi-structured, one-on-one interviews and focus groups of nurse leaders about their attitudes towards and experiences with patients' use of medical cannabis. Thematic analysis was used to identify themes and subthemes. Results Four major themes were identified: overwhelming support for legalized medical cannabis; importance of overcoming the stereotype of a gateway drug; problematic mismatch between federal and state cannabis policies; and nursing needs to be move involved. Conclusions There was strong support for legalized medical cannabis to meet patients' needs; yet, respondents reported little discussion about or education regarding medical cannabis among nurses. Inconsistent federal and state cannabis policies were viewed as especially problematic and in need of alignment.
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Affiliation(s)
- Ellen T. Kurtzman
- Associate Professor, School of Nursing, The George Washington University, 1919 Pennsylvania Ave., NW, Ste. 500, Washington, DC 20006, U.S
| | - Jessica Greene
- Professor and Luciano Chair of Health Care Policy, Marxe School of Public and International Affairs, Baruch College, City University of New York, 135 East 22nd Street, New York, NY
| | - Robyn Begley
- Chief Executive Officer, American Organization for Nursing Leadership, 155 N. Wacker Dr., Suite 400, Chicago, IL 60606
| | - Karen Neil Drenkard
- Associate Dean, Clinical Practice and Community Engagement, School of Nursing, The George Washington University, 1919 Pennsylvania Ave., NW, Ste. 500, Washington, DC 20006
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Mina A, Rahme C, Hallit S, Soufia M. Development of scales to measure Lebanese university students’ perceived knowledge about and attitudes about cannabis use: initial psychometric properties. J Cannabis Res 2022; 4:34. [PMID: 35778764 PMCID: PMC9250259 DOI: 10.1186/s42238-022-00144-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Accepted: 06/24/2022] [Indexed: 11/22/2022] Open
Abstract
Background For a long period, cannabis in Lebanon was categorized as an illegal psychoactive substance criminalized by law, despite being the 3rd largest producer of cannabis resin after Morocco and Afghanistan. The current available literature on the topic in Lebanon is scarce, as perceived knowledge towards cannabis use in the general population is not well established, and public health policies are absent. In the context of future legalization of cannabis for both medical and recreational purposes, what is the public’s perception of cannabis perceived knowledge about and attitude against cannabis use? The objectives of this study were to create two scales to assess perceived knowledge towards cannabis use and attitude against cannabis use and check their psychometric properties in a sample of Lebanese university students. Methods The study was designed as a cross-sectional study involving 415 Lebanese university students aged between 18 and 30 years. Students were only recruited from one university and were sent an email with a brief description of the study and a link to the questionnaire. The questionnaire items covered perceived knowledge and attitude about cannabis use, recovered and adapted from available literature. Results Perceived knowledge items converged over a solution of four factors that had an Eigenvalue over 1, explaining a total of 64% of the variance (factor 1 = perceived knowledge about cannabis quality of life improvement; factor 2 = perceived knowledge about cannabis psychiatric use; factor 3 = perceived knowledge about cannabis risks; factor 4 = perceived knowledge about cannabis neurological use). Attitude items converged over a solution of two factors that had an Eigenvalue over 1, explaining a total of 58.2% of the variance (factor 1 = negative attitude about cannabis use; factor 2 = positive attitude about cannabis use). Good Cronbach’s alpha values were found for the perceived knowledge and attitude scales (α = 0.78 and α = 0.73 respectively). Greater perceived knowledge was found in male participants and in those who have tried cannabis for recreational purposes. Greater perceived knowledge was also associated with stronger attitude about cannabis use and older age. Furthermore, greater mean attitude about cannabis use scores were significantly found in male participants and in those who have tried cannabis for recreational or medicinal purposes. Conclusion Primary results showed acceptable psychometric properties for the perceived knowledge towards and attitudes about cannabis use scale. Further studies are needed in order to validate them among the general population and assess more psychometric properties of these scales.
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Sharma P, Holland A, Sheikh T, Novy B, Oesterle T, Platt R, Hammond CJ. Primary care provider attitudes, experiences and practices about cannabidiol (CBD) and barriers to patient-provider communication about CBD use: A qualitative study. PEC INNOVATION 2022; 1:100044. [PMID: 37213726 PMCID: PMC10194378 DOI: 10.1016/j.pecinn.2022.100044] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/01/2022] [Revised: 04/21/2022] [Accepted: 04/23/2022] [Indexed: 05/23/2023]
Abstract
Objectives Federal hemp legalization and ongoing shifts in US marijuana laws have led to increased population-wide use of cannabidiol (CBD) supplements, often without the knowledge of primary healthcare providers (PCPs). Given the potential risks related to CBD use, especially in vulnerable subgroups, improved communication is warranted. This study aimed to examine PCP attitudes, experiences, and practice behaviors related to CBD and provider-reported barriers to communication with patients about CBD use. Methods Fourteen PCPs were recruited and participated in semi-structured interviews. Transcripts were digitally analyzed using inductive thematic analysis. Results Analyses identified that most PCPs had neutral views about CBD use by their patients. The study found that discussions about CBD use were initiated by patients. Most PCPs cited lack of time, discomfort, low-quality evidence, and low prioritization as reasons for not discussing CBD with patients. Conclusion PCPs rarely screen for or discuss CBD use with their patients and most of them had neutral views about CBD use by their patients. A number of barriers exist to open dialogue about CBD. Innovation Our study is the first in-depth report on PCP attitudes, experiences, and practice behaviors related to CBD. The findings of our study have the potential to significantly impact future PCP practice behaviors. These results can inform healthcare system policies around screening for CBD use and PCP communication training. In doing so, these efforts may mitigate risk and optimize benefits related to the expanding CBD market.
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Affiliation(s)
- Pravesh Sharma
- Mayo Clinic Health System, 1221 Whipple St., Eau Claire, WI 54703, USA
| | - Ashley Holland
- Mayo Clinic Health System, 1221 Whipple St., Eau Claire, WI 54703, USA
| | - Taharat Sheikh
- Johns Hopkins School of Medicine, 733 N Broadway, Baltimore, MD 21205, USA
| | - Blake Novy
- Mayo Clinic, 200 First St. SW Rochester, MN 55905, USA
| | | | - Rheanna Platt
- Johns Hopkins School of Medicine, 733 N Broadway, Baltimore, MD 21205, USA
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Krüger M, van Eeden T, Beswa D. Cannabis sativa Cannabinoids as Functional Ingredients in Snack Foods-Historical and Developmental Aspects. PLANTS (BASEL, SWITZERLAND) 2022; 11:plants11233330. [PMID: 36501366 PMCID: PMC9739163 DOI: 10.3390/plants11233330] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Revised: 11/04/2022] [Accepted: 11/08/2022] [Indexed: 05/10/2023]
Abstract
The published health benefits of Cannabis sativa has caught the attention of health-conscious consumers and the food industry. Historically, seeds have long been utilized as a food source and currently there is an increasing number of edibles on the market that contain cannabis. Cannabinoids include the psychoactive constituent, delta-9-tetrahydrocannabinol (THC), and the non-psychoactive cannabidiol (CBD) that are both compounds of interest in Cannabis sativa. This paper looks at the distribution of nutrients and phytocannabinoids in low-THC Cannabis sativa, the historical uses of hemp, cannabis edibles, and the possible side-effects and concerns related to cannabis edibles. Several authors have pointed out that even though the use of cannabis edibles is considered safe, it is important to mention their possible side-effects and any concerns related to its consumption that negatively influence consumer acceptance of cannabis edibles. Such risks include unintentional overdose by adults and accidental ingestion by children and adolescents resulting in serious adverse effects. Therefore, cannabis edibles should be specifically packaged and labelled to differentiate them from known similar non-cannabis edibles so that, together with tamperproof packaging, these measures reduce the appeal of these products to children.
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Affiliation(s)
- Marlize Krüger
- Department of Life and Consumer Sciences, School of Agriculture and Life Sciences, University of South Africa, 28 Pioneer Ave, Florida Park, Roodepoort 1709, South Africa
| | - Tertia van Eeden
- Department of Life and Consumer Sciences, School of Agriculture and Life Sciences, University of South Africa, 28 Pioneer Ave, Florida Park, Roodepoort 1709, South Africa
| | - Daniso Beswa
- Department of Life and Consumer Sciences, School of Agriculture and Life Sciences, University of South Africa, 28 Pioneer Ave, Florida Park, Roodepoort 1709, South Africa
- Department of Biotechnology and Food Technology, Faculty of Science, University of Johannesburg, 25 Louisa St, Doornfontein, Johannesburg 2028, South Africa
- Correspondence: ; Tel.: +27-11559-6000
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28
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Townsend CB, Liss F, Langman C, Mazur D, Stache SA, Sharma S, Stolzenberg DS, Srinivasan M, Pedowitz D, Namdari S, Wang ML, Greis AC, Ilyas AM. Perspectives of Orthopedic Patients on Medical Cannabis: A Survey of More Than 2500 Patients. Orthopedics 2022; 45:e309-e314. [PMID: 36098574 DOI: 10.3928/01477447-20220907-05] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Nationwide perspectives on cannabis have changed dramatically over recent decades. Although cannabis remains illegal at the federal level, medical cannabis (MC) is now legal in most states, and research has continued to show its effectiveness in a variety of medical conditions. However, both perception and acceptance of MC by the general public are evolving and remain poorly understood. Treating patients effectively with these novel therapeutics requires an understanding of the complex interplay of social and legal factors that could affect patient use. This cross-sectional survey study of more than 2500 patients sought to assess current patient perspectives on MC and to investigate factors related to its use that may represent barriers to broader patient use. Most respondents would consider using MC for chronic pain or other medical conditions. Most respondents were aware of the legal status of MC in their state, and 9 of 10 respondents believed that MC should be legal throughout the United States. General public knowledge of the utility of MC is an area needing improvement because older patients were significantly less likely to believe that MC is safe to use or that MC is safer than prescription opioids. As has been reported in previous literature, social stigma and cost appear to remain barriers for patient use of MC. Our findings provide further insight into current patient perspectives on MC, aiding both medical providers and researchers as we continue to provide access to and research MC. [Orthopedics. 2022;45(6):e309-e314.].
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Use of X-ray irradiation for inactivation of Aspergillus in cannabis flower. PLoS One 2022; 17:e0277649. [PMID: 36378669 PMCID: PMC9665375 DOI: 10.1371/journal.pone.0277649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Accepted: 11/01/2022] [Indexed: 11/17/2022] Open
Abstract
California cannabis regulations require testing for four pathogenic species of Aspergillus-A. niger, A. flavus, A. fumigatus and A. terreus in cannabis flower and cannabis inhalable products. These four pathogenic species of Aspergillus are important human pathogens and their presence in cannabis flower and cannabis products may pose a threat to human health. In this study, we examined the potential of X-ray irradiation for inactivation of cannabis flower contaminated with any of the four pathogenic species of Aspergillus. We determined that X-ray irradiation at a dose of 2.5 kGy is capable of rendering Aspergillus cells non-viable at low (102 spores/g dried flower), medium (103 spores/g dried flower) and high (104 spores/g dried flower) levels of inoculation. We also showed that X-ray treatment of cannabis flower did not significantly alter the cannabinoid or the terpene profiles of the flower samples. Therefore, X-ray irradiation may be a feasible method for Aspergillus decontamination of cannabis flower. More work is required to determine the consumer safety of irradiated cannabis flower and cannabis products.
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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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Mekrungrongwong S, Kitreerawutiwong N, Keeratisiroj O, Jariya W. Self-perceived knowledge, attitudes, and training needs regarding medical cannabis among health care providers and health volunteers in district health systems, Phitsanulok Province. BMC PRIMARY CARE 2022; 23:266. [PMID: 36271334 PMCID: PMC9585781 DOI: 10.1186/s12875-022-01877-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Revised: 09/05/2022] [Accepted: 10/06/2022] [Indexed: 11/10/2022]
Abstract
BACKGROUND Health care providers and health volunteers play an important role in the collaborative provision of patient access and care regarding medical cannabis in district health systems (DHSs) according to their roles and responsibilities. However, there is limited evidence on the self-perceived knowledge, attitudes, and training needs regarding medical cannabis use by health care providers and health volunteers in DHSs. The aim of this study was to compare self-perceived knowledge, attitudes, and training needs regarding medical cannabis among health care providers and health volunteers in Phitsanulok Province, Thailand. METHODS A cross-sectional study was conducted in Phitsanulok Province. A total of 836 participants consisting of 166 health care providers and 670 health volunteers were recruited by stratified cluster random sampling. Descriptive and inferential statistics, including independent sample t tests and chi-square tests, were employed for data analyses. RESULTS The results revealed that self-perceived knowledge of medical cannabis was not significantly different between the health care providers and health volunteers (p = 0.875), whereas attitudes about medical cannabis were significantly different between the two groups (p < 0.001). The mean scores of attitudes were 29.10 for the health care providers and 31.84 for the health volunteers. Regarding training needs, the health care providers proposed training topics, including adverse effects of medical cannabis (27.5%), information on prescribing cannabis drugs (20.5%) and information on prescribing drugs that contain cannabis substances (14.7%). On the other hand, health volunteers preferred to obtain training on cannabis legislation (23.5%), information on caring for patients who used drugs containing cannabis substances (21.4%), and a history of medical cannabis use (17.6%). CONCLUSION In summary, to ensure effective care in the DHSs, health care providers and health volunteers should be trained to be confident in their knowledge and attitudes towards the use of medical cannabis. Training topics should be designed with consideration for the role and responsibility of each group to prepare professionals and nonprofessional to achieve patients quality and safety with respect to medical cannabis use.
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Affiliation(s)
- Sunsanee Mekrungrongwong
- grid.412029.c0000 0000 9211 2704Faculty of Public Health, Naresuan University, 65000 Phitsanulok, Thailand
| | - Nithra Kitreerawutiwong
- grid.412029.c0000 0000 9211 2704Faculty of Public Health, Naresuan University, 65000 Phitsanulok, Thailand
| | - Orawan Keeratisiroj
- grid.412029.c0000 0000 9211 2704Faculty of Public Health, Naresuan University, 65000 Phitsanulok, Thailand
| | - Wutthichai Jariya
- grid.412029.c0000 0000 9211 2704Faculty of Public Health, Naresuan University, 65000 Phitsanulok, Thailand
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Singer J, Daum C, Shen MJ, Zecha G, Kaplan L, Plakovic K, Blazey M, Arnold M, Silko B, Baker K, Loggers ET. Assessment of Oncology Advanced Practice Professional Willingness to Participate in Medical Aid in Dying. JAMA Netw Open 2022; 5:e2239068. [PMID: 36287559 PMCID: PMC9606841 DOI: 10.1001/jamanetworkopen.2022.39068] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
IMPORTANCE In 2021, New Mexico passed legislation allowing nurse practitioners and physician assistants (referred to herein as advanced practice professionals [APPs]) to prescribe medications for medical aid in dying (MAID). Other US states with existing MAID laws (eg, Washington) are also considering expanding MAID prescribing authority to APPs. There is a lack of research exploring APP knowledge of, willingness to, and comfort with acting as a prescribing or consulting clinician for MAID. OBJECTIVE To assess perspectives of oncology APPs regarding MAID, including their willingness to prescribe and/or consult for MAID and factors associated with willingness. DESIGN, SETTING, AND PARTICIPANTS This cross-sectional, self-report survey study used data collected from APPs working at a comprehensive cancer center in Washington State in fall 2021. MAIN OUTCOMES AND MEASURES The primary survey question was whether APPs would be willing to participate in death with dignity, the term used for MAID in Washington. Survey questions evaluated how influential specific factors were on APP views on MAID as well as respondents' knowledge of and comfort with aspects of the MAID process. RESULTS Of 167 eligible APPs, 77 (46.1%) responded to the survey. Most respondents (68 [88.3%]) reported their race and ethnicity as White; 72 (93.5%) identified as a woman. Medical oncology (28 [36.4%]) was the most common field of practice, and 21 respondents (27.3%) reported having practiced as an APP for 6 to 10 years. Of all respondents, 61 (79.2%) reported having at least 1 patient who inquired about MAID; depending on the question, less than a third of respondents (5.0%-27.0%) endorsed feeling knowledgeable or very knowledgeable about any aspect of the MAID process. In this study, 39 APPs (50.6%) endorsed being willing to participate in MAID either as a consulting or prescribing clinician, whereas 31 (40.3%) were uncertain of whether they would participate. Willingness to participate was associated with having had more patients pursue MAID (33 of the 39 willing participants [84.6%] vs 15 of the 31 unsure participants [48.4%] reported having 1 or more patients pursue MAID). Higher knowledge and comfort scores were both significantly associated with increased odds of being willing to participate (odds ratio, 1.14 per 1-point score increase [95% CI, 1.03-1.27]; P = .01) vs unsure (1.18 [95% CI, 1.07-1.30; P = .001). CONCLUSIONS AND RELEVANCE The results of this survey study suggest that oncology APPs may require preparation for the addition of MAID to their scope of practice. This study also raises questions for future research regarding support for APPs who may be considering participation in MAID but question their role or want physician involvement.
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Affiliation(s)
- Jonathan Singer
- Department of Psychological Sciences, Texas Tech University, Lubbock
| | - Courtney Daum
- Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, Washington
| | - Megan J. Shen
- Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, Washington
| | | | - Louise Kaplan
- College of Nursing, Washington State University, Vancouver
| | | | | | - Molly Arnold
- Fred Hutchinson Cancer Center, Seattle, Washington
| | | | - Kelsey Baker
- Clinical Research Division, Department of Clinical Biostatistics, Fred Hutchinson Cancer Center, Seattle, Washington
| | - Elizabeth T. Loggers
- Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, Washington
- Division of Oncology, University of Washington, Seattle
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Hachem Y, Abdallah SJ, Rueda S, Wiese JL, Mehra K, Rup J, Cowan J, Vigano A, Costiniuk CT. Healthcare practitioner perceptions on barriers impacting cannabis prescribing practices. BMC Complement Med Ther 2022; 22:237. [PMID: 36076191 PMCID: PMC9453734 DOI: 10.1186/s12906-022-03716-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Accepted: 09/02/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Canadians seeking medical cannabis (MC) may encounter difficulties in finding a healthcare provider (HCP) who authorizes their access to it. Barriers that HCPs face in authorizing MC are unclear. The objectives of this study were to evaluate HCP opinions, knowledge, comfort, and practice in MC prescribing and counseling on recreational cannabis use, and whether the COVID-19 pandemic affected MC prescribing practices.
Methods
Eligible participants included HCPs (e.g., attending physicians, nurses, pharmacists) in Canada. A questionnaire evaluating their knowledge, comfort, and practice in medical and recreational cannabis was designed based on instruments developed in previous studies. Between April 13th-December 13th 2021, ninety-one healthcare associations were asked to distribute the survey to their members, and an advertisement was placed in the online Canadian Medical Association Journal. Descriptive statistics were used to analyze the results.
Results
Twenty-four organizations agreed to disseminate the survey and 70 individuals completed it. Of respondents, 71% were attending physicians or medical residents, while the remainder were nurses, pharmacists or other HCPs. Almost none (6%) received training in MC in professional school but 60% did receive other training (e.g., workshops, conferences). Over half (57%) received more questions regarding MC since recreational cannabis was legalized, and 82% reported having patients who use MC. However, 56% felt uncomfortable or ambivalent regarding their knowledge of MC, and 27% were unfamiliar with the requirements for obtaining MC in Canada. The most common symptoms for recommending MC were pain and nausea, whereas the most common conditions for recommending it were cancer and intractable pain. The strongest barrier to authorizing MC was uncertainty in safe and effective dosage and routes of administration. The strongest barrier to recommending or authorizing MC was the lack of research evidence demonstrating its safety and efficacy. During the pandemic, many respondents reported that a greater number of their patients used cannabis to relieve anxiety and depression.
Conclusions
Our results suggest that HCPs across Canada who responded to our survey are unfamiliar with topics related to MC. The strongest barriers appear to be lack of clinical research, and uncertainty in safe and effective MC administration. Increasing research, training, and knowledge may help HCPs feel more equipped to make informed treatment/prescribing decisions, which may help to improve access to MC.
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Raghunathan NJ, Brens J, Vemuri S, Li QS, Mao JJ, Korenstein D. In the weeds: a retrospective study of patient interest in and experience with cannabis at a cancer center. Support Care Cancer 2022; 30:7491-7497. [PMID: 35665859 PMCID: PMC9165925 DOI: 10.1007/s00520-022-07170-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Accepted: 05/19/2022] [Indexed: 12/03/2022]
Abstract
BACKGROUND Cannabis products, including the cannabinoids CBD and THC, are rising in popularity and increasingly used for medical purposes. While there is some evidence that cannabinoids improve cancer-associated symptoms, understanding regarding appropriate use remains incomplete. PURPOSE To describe patient experiences with medical cannabis with focus on use contexts and patients' reported benefits and harms. METHODS A standardized intake form was implemented in a dedicated medical cannabis clinic at an NCI-designated cancer center; data from this form was abstracted for all initial visits from October 2019 to October 2020. We report descriptive statistics, chi-square analysis, and multivariate logistic regression. RESULTS Among 163 unique new patients, cannabis therapy was commonly sought for sleep, pain, anxiety, and appetite. Twenty-nine percent expressed interest for cancer treatment; 40% and 46% reported past use of CBD and THC, respectively, for medical purposes. Among past CBD users, the most commonly reported benefits were less pain (21%) or anxiety (17%) and improvement in sleep (15%); 92% reported no side effects. Among those with past THC use, reported benefits included improvement in appetite (40%), sleep (32%), nausea (28%), and pain (17%); side effects included feeling "high." Seeking cannabis for anti-neoplastic effects was associated with receipt of active cancer treatment in both univariate and multivariate analysis. CONCLUSION Cancer patients seek medical cannabis to address a wide variety of concerns despite insufficient evidence of benefits and harms. As more states move to legalize medical and recreational cannabis, cancer care providers must remain aware of emerging data and develop knowledge and skills to counsel their patients about its use.
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Affiliation(s)
- Nirupa J Raghunathan
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
- Department of Pediatrics, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
| | - Jessica Brens
- Department of Nursing, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Swetha Vemuri
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Qing S Li
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Jun J Mao
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Deborah Korenstein
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
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Abstract
Introduction: Medical cannabis (marijuana) use is legal in 33 U.S. states and the District of Columbia. Clinicians can play an important role in helping patients access and weigh potential benefits and risks of medicinal cannabis. Accordingly, this study aimed to assess clinician beliefs and practices related to cannabis. Methods: Data are from 1506 family practice doctors, internists, nurse practitioners, and oncologists who responded to the 2018 DocStyles, a web-based panel survey of clinicians. Questions assessed medicinal uses for and practices related to cannabis and assessed clinicians' knowledge of cannabis legality in their state. Logistic regression was used to assess multivariable correlates of asking about, assessing, and recommending cannabis. Results: Over two-thirds (68.9%) of clinicians surveyed believe that cannabis has medicinal uses and just over a quarter (26.6%) had ever recommended cannabis to a patient. Clinicians who believed cannabis had medicinal uses had 5.9 times the adjusted odds (95% confidence interval 3.9-8.9) of recommending cannabis to patients. Beliefs about conditions for medical cannabis use did not necessarily align with the current scientific evidence. Nearly two-thirds (60.0%) of clinicians surveyed incorrectly reported the legal status of cannabis in their state. Discussion: Findings suggest that while clinicians believe that cannabis has medicinal uses, they may not have a full understanding of the scientific evidence and may not accurately understand their state-based policies for cannabis legalization and use. Given that clinicians are responsible for recommending medicinal cannabis in most states that have legalized it, ongoing education about the health effects of cannabis is warranted.
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Affiliation(s)
- Gillian L. Schauer
- Division of Overdose Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
- Addictions, Drug & Alcohol Institute, University of Washington, Seattle, Washington, USA
| | - Rashid Njai
- U.S. Public Health Service Commissioned Corps, Atlanta, Georgia, USA
- Office of Minority Health and Health Equity, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Althea M. Grant
- U.S. Public Health Service Commissioned Corps, Atlanta, Georgia, USA
- Commissioned Corps Activity Specialty Services Team, Human Resources Office, Office of the Chief Operating Officer, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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Self-Reported Medical and Nonmedical Cannabis Use: Results from the 2018 Behavioral Risk Factor Surveillance System in 14 States. J Community Health 2022; 47:641-649. [PMID: 35460471 PMCID: PMC9884044 DOI: 10.1007/s10900-021-01049-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/08/2021] [Indexed: 01/31/2023]
Abstract
As policies legalizing adult cannabis use increase in the United States, understanding and characterizing the proportion of individuals consuming cannabis for medical and nonmedical purposes is important to inform targeted health education efforts. Data came from 7672 adults (> = 18 years) with past month cannabis use who responded to questions about reason for cannabis use on the 2018 Behavioral Risk Factor Surveillance System survey in 14 states. State and aggregated data were analyzed using weighted frequencies for descriptive analyses, and prevalence ratios were computed to identify demographic and substance use characteristics associated with medical only use or use for both medical and nonmedical reasons (vs. nonmedical use). Overall, 28.6% (95% CI: 26.7, 30.4) of adults who use cannabis reported using cannabis medically, 34.2% (95% CI: 32.3, 36.2) nonmedically, and 37.2% (95% CI: 35.2, 39.2) both medically and nonmedically. Characteristics associated with medical only use (compared with nonmedical only use) included being female; aged > 45 years; out of work, a homemaker, or unable to work; having daily or near daily cannabis use; having past month cigarette use; having no past month alcohol use; self-reporting poor health; and ever having been diagnosed with certain chronic diseases. Medical only use of cannabis is the least prevalent reason for use; use for both medical and nonmedical reasons is the most prevalent. Monitoring reasons for cannabis use can aid states in understanding differences between medical and nonmedical cannabis users, providing context to use patterns, and targeting health education messages to appropriate audiences.
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Kruger DJ, Mokbel MA, Clauw DJ, Boehnke KF. Assessing Health Care Providers' Knowledge of Medical Cannabis. Cannabis Cannabinoid Res 2022; 7:501-507. [PMID: 34463161 PMCID: PMC9418358 DOI: 10.1089/can.2021.0032] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Introduction: Many health care providers would benefit from greater knowledge and awareness of medical cannabis, even if they choose not to integrate it into their medical practice. Unfortunately, health care providers generally report low knowledge of medical cannabis and cite this lack of knowledge as a barrier to making patient recommendations. It is important to understand health care providers' medical cannabis knowledge and its correlates. However, few studies have rigorously assessed clinically relevant cannabis-related knowledge, instead typically focusing on attitudes toward cannabis and perceived knowledge. Methods: Physicians in a university-affiliated health system completed an anonymous online survey. The survey assessed participants' basic demographics and medical experience, experiences with cannabis education, beliefs about their knowledge of and competency regarding medical cannabis, and knowledge of medical cannabis in relation to the current scientific evidence. Results: The average level of medical cannabis knowledge was 58% correct, with scores ranging from 39% to 78% correct. Perceived cannabis knowledge predicted actual knowledge, and those who pursued self-initiated study or attended a lecture on medical cannabis had higher knowledge levels. Conclusion: Levels of factual knowledge about medical cannabis among physicians were moderate. Our results highlight the mismatch between physician knowledge and cannabis policy. We offer our brief, 10-min assessment as a baseline for characterizing cannabis knowledge, acknowledging that the content and interpretation may change as knowledge advances.
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Affiliation(s)
- Daniel J. Kruger
- Population Studies Center, University of Michigan, Ann Arbor, Michigan, USA
| | - Majd A. Mokbel
- Medical School, University of Michigan, Ann Arbor, Michigan, USA
| | - Daniel J. Clauw
- Medical School, University of Michigan, Ann Arbor, Michigan, USA
| | - Kevin F. Boehnke
- Medical School, University of Michigan, Ann Arbor, Michigan, USA
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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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Vaillancourt R, Dhalla R, Merks P, Lougheed T, Goldfield G, Mansell H, Cameron J. Concerns, beliefs and attitudes of pharmacists and pharmacy students on cannabis use in Canada. Can Pharm J (Ott) 2022; 155:219-229. [PMID: 35813525 PMCID: PMC9266375 DOI: 10.1177/17151635221102143] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2023]
Abstract
BACKGROUND Since cannabis has been legalized in Canada for medical and recreational use, there has been an increased demand on pharmacists for cannabis counselling. The objective of this study was to determine the concerns, beliefs and attitudes of Canadian pharmacists and pharmacy students towards using cannabis. METHODS An online survey was synthesized under 3 broad themes: concerns, beliefs and attitudes about cannabis, consisting of 27 questions capturing demographics and Likert scale responding to survey questions. We examined whether there were differences in responses by geographic location (i.e., Ontario, Quebec, Canada), sex or practice setting (i.e., community, hospital). RESULTS Across Canada, there were 654 survey respondents, with 399 in Ontario and 95 in Quebec. Approximately 24% indicated they had used cannabis since legalization, 69% indicated they believed cannabis should be available for medical and recreational use and 34% indicated their perceptions towards cannabis had become more positive since legalization. Relative to Quebec or the rest of Canada, respondents from Ontario were significantly more likely to be comfortable providing counselling to and answering questions of patients on the safety and efficacy of medical cannabis use. Examining sex differences across Canada, male respondents were more comfortable than female counselling patients on the safety and efficacy of medical cannabis. CONCLUSION The current results reinforce the perceived need by pharmacists and pharmacy students for targeted education, and future research in cannabis education should consider potential gender differences in attitudes and beliefs surrounding cannabis therapy.
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Affiliation(s)
- Régis Vaillancourt
- Department of Pharmacy, Children’s Hospital of Eastern Ontario, Ottawa
- Department of Family Medicine, University of Ottawa Faculty of Medicine, Ottawa
| | | | - Piotr Merks
- Cardinal Stefan Wyszyński University, Faculty of Medicine, Warsaw and the Department of Pharmaceutical Technology, Faculty of Pharmacy, Collegium, Medicum, Bydgoszcz, Poland
| | - Taylor Lougheed
- Section of Emergency Medicine, Northern Ontario School of Medicine, Sudbury
| | - Gary Goldfield
- Healthy Active Living and Obesity (HALO) Research Group, Children’s Hospital of Eastern Ontario, Ottawa
| | - Holly Mansell
- College of Pharmacy and Nutrition, University of Saskatchewan, Saskatoon, Saskatchewan
| | - Jameason Cameron
- Department of Pharmacy, Children’s Hospital of Eastern Ontario, Ottawa
- Department of Family Medicine, University of Ottawa Faculty of Medicine, Ottawa
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Jacobs RJ, Kane MN. Exploratory Factor Analysis of Medical Students’ Perceptions of Medical Cannabis Scale. Cureus 2022; 14:e25749. [PMID: 35812569 PMCID: PMC9270071 DOI: 10.7759/cureus.25749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Accepted: 06/08/2022] [Indexed: 11/05/2022] Open
Abstract
Background There are few published research articles investigating medical students’ perceptions of medical cannabis (MC), including their attitudes toward its efficacy and appropriateness in medicine, concerns for potential adverse effects, and their willingness to prescribe it to patients (in future practice). This research investigated the factor structure of a tool to assess medical students’ perceptions of MC for the purpose of curriculum enhancement. Methods Using a voluntary electronic survey, quantitative data were collected between January and March 2022 from 526 medical students enrolled in a large medical school in Florida, United States. A 32-item questionnaire developed by the researchers was used to investigate medical students’ perceptions of MC. The survey was anonymous and took about 10 minutes to complete. Bivariate correlation analyses were conducted prior to performing a principal component analysis with varimax rotation. Results Using principal component analysis with varimax rotation, three factors were identified with eigenvalues greater than 1.0 and a cumulative variance of 59.694%. These factors are perceived knowledge of MC, concern for possible adverse effects of MC (e.g., the potential for misuse/dependence), and attitudes toward MC (e.g., cannabis having an acceptable role in medicine, willingness (as a future physician) to help patients access MC, obtaining training about MC in school and residency training, the physician’s role as a prescriber, and efficacy and benefits of MC for certain health conditions). Conclusions The development of this kind of brief measure may be valuable for defining the future educational needs of medical students and other health professionals as well as a tool for future research.
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Sokratous S, Kaikoush K, Mpouzika MD, Alexandrou G, Karanikola NM. Attitudes, beliefs and knowledge about medical cannabis among nurses and midwives in Cyprus: a cross-sectional descriptive correlational study. BMC Nurs 2022; 21:120. [PMID: 35585574 PMCID: PMC9118681 DOI: 10.1186/s12912-022-00887-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2022] [Accepted: 04/29/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND There is a lack of evidence on healthcare professionals' attitudes, knowledge, and beliefs about medical cannabis in Cyprus and across the world. Therefore, the present study aimed to explore the attitudes, beliefs, and knowledge about MC use among nurses and midwives in Cyprus. Special focus was given to differences across gender, age, religion, marital status, and years of work experience. METHODS A descriptive, cross-sectional correlational study with internal comparisons was conducted during the 26th Nurses and Midwives Congress in Cyprus. All active nurses and midwives (convenience sampling), from the private and national healthcare services (n = 526) were eligible to participate. To analyze the data, the Pearson Chi-square test for group differences was employed, and descriptive and inferential statistics were assessed. RESULTS The final sample population consisted of 232 nurses and midwives (response rate of 46.4%). In total, 67(28.9%) participants were male, and 165(71.1%) were female. Cypriot nurses and midwives reported lack of knowledge regarding the risks and benefits about MC use to patients. However, specific number of participants believed MC use was considered acceptable for the patients with persistent muscle spasms, insomnia/sleeping disorders, mental health conditions, and terminal illnesses. The vast majority of the participants believed that formal training on MC should be integrated into academic programs, and expressed the necessity of urgent training under the current curriculum, as well as, educational training programs about MC use should be integrated into the practice/clinical practice. Concerning the socio-demographic characteristics of the participants, gender had a statistically significant positive effect on participants' attitudes and beliefs about MC (p < 0.01, 26.8% vs. 13.4%). Male and unmarried participants reported higher frequency about cannabis use for recreational purposes, compared with female group (p < 0.01, 22.8%Vs 11.4%). Unmarried participants agreed that using cannabis might develop serious mental health risks compared with married participants group (p < 0.05, 77.9% vs. 66.8%). CONCLUSIONS The conclusions seem to be rather recommending in favor of MC use. Participants proposed enriching nursing curricula with theoretical and clinical/laboratory courses about MC during studies and clinical practice. Additional tailoring interventions should be established to decrease recreational cannabis use among Cypriot nurses and midwives.
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Affiliation(s)
- S Sokratous
- Assistant Professor, Department of Nursing, School of Health Sciences, Cyprus University of Technology, Vragadinou Street, Limassol, Cyprus.
| | - K Kaikoush
- PhD, Mental health Nurse, Cyprus Mental Health Services, Larnaca, Cyprus
| | - M D Mpouzika
- Assistant Professor, Critical Care Nursing, Advanced Emergency and Intensive Nursing Care, Department of Nursing, School of Health Sciences, Cyprus University of Technology, Vragadinou Street, Limassol, Cyprus
| | - G Alexandrou
- PhD(c), Mental health Nurse, Cyprus Mental Health Services, Nicosia, Cyprus
| | - N M Karanikola
- Associate Professor, Department of Nursing, School of Health Sciences, Faculty of Health Sciences, Mental Health Studies & Research Cyprus University of Technology Chair Cyprus University of Technology Vragadinou Street, Limassol, Cyprus
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Lapham GT, Matson TE, Carrell DS, Bobb JF, Luce C, Oliver MM, Ghitza UE, Hsu C, Browne KC, Binswanger IA, Campbell CI, Saxon AJ, Vandrey R, Schauer GL, Pacula RL, Horberg MA, Bailey SR, McClure EA, Bradley KA. Comparison of Medical Cannabis Use Reported on a Confidential Survey vs Documented in the Electronic Health Record Among Primary Care Patients. JAMA Netw Open 2022; 5:e2211677. [PMID: 35604691 PMCID: PMC9127557 DOI: 10.1001/jamanetworkopen.2022.11677] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Accepted: 03/23/2022] [Indexed: 12/18/2022] Open
Abstract
Importance Patients who use cannabis for medical reasons may benefit from discussions with clinicians about health risks of cannabis and evidence-based treatment alternatives. However, little is known about the prevalence of medical cannabis use in primary care and how often it is documented in patient electronic health records (EHR). Objective To estimate the primary care prevalence of medical cannabis use according to confidential patient survey and to compare the prevalence of medical cannabis use documented in the EHR with patient report. Design, Setting, and Participants This study is a cross-sectional survey performed in a large health system that conducts routine cannabis screening in Washington state where medical and nonmedical cannabis use are legal. Among 108 950 patients who completed routine cannabis screening (between March 28, 2019, and September 12, 2019), 5000 were randomly selected for a confidential survey about cannabis use, using stratified random sampling for frequency of past-year use and patient race and ethnicity. Data were analyzed from November 2020 to December 2021. Exposures Survey measures of patient-reported past-year cannabis use, medical cannabis use (ie, explicit medical use), and any health reason(s) for use (ie, implicit medical use). Main Outcomes and Measures Survey data were linked to EHR data in the year before screening. EHR measures included documentation of explicit and/or implicit medical cannabis use. Analyses estimated the primary care prevalence of cannabis use and compared EHR-documented with patient-reported medical cannabis use, accounting for stratified sampling and nonresponse. Results Overall, 1688 patients responded to the survey (34% response rate; mean [SD] age, 50.7 [17.5] years; 861 female [56%], 1184 White [74%], 1514 non-Hispanic [97%], and 1059 commercially insured [65%]). The primary care prevalence of any past-year patient-reported cannabis use on the survey was 38.8% (95% CI, 31.9%-46.1%), whereas the prevalence of explicit and implicit medical use were 26.5% (95% CI, 21.6%-31.3%) and 35.1% (95% CI, 29.3%-40.8%), respectively. The prevalence of EHR-documented medical cannabis use was 4.8% (95% CI, 3.45%-6.2%). Compared with patient-reported explicit medical use, the sensitivity and specificity of EHR-documented medical cannabis use were 10.0% (95% CI, 4.4%-15.6%) and 97.1% (95% CI, 94.4%-99.8%), respectively. Conclusions and Relevance These findings suggest that medical cannabis use is common among primary care patients in a state with legal use, and most use is not documented in the EHR. Patient report of health reasons for cannabis use identifies more medical use compared with explicit questions about medical use.
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Affiliation(s)
- Gwen T. Lapham
- Kaiser Permanente Washington Health Research Institute, Seattle
- Department of Health Systems and Population Health, University of Washington, Seattle
| | - Theresa E. Matson
- Kaiser Permanente Washington Health Research Institute, Seattle
- Department of Health Systems and Population Health, University of Washington, Seattle
| | | | | | - Casey Luce
- Kaiser Permanente Washington Health Research Institute, Seattle
| | - Malia M. Oliver
- Kaiser Permanente Washington Health Research Institute, Seattle
| | - Udi E. Ghitza
- Center for the Clinical Trials Network, National Institute on Drug Abuse, National Institutes of Health, Bethesda, Maryland
| | - Clarissa Hsu
- Kaiser Permanente Washington Health Research Institute, Seattle
| | - Kendall C. Browne
- Center of Excellence in Substance Addiction Treatment and Education, Veteran Affairs Puget Sound Health Care System, Seattle, Washington
| | - Ingrid A. Binswanger
- Kaiser Permanente Colorado Institute for Health Research, Denver
- Colorado Permanente Medical Group, Denver
| | | | - Andrew J. Saxon
- Center of Excellence in Substance Addiction Treatment and Education, Veteran Affairs Puget Sound Health Care System, Seattle, Washington
| | - Ryan Vandrey
- Johns Hopkins University School of Medicine, Baltimore, Maryland
| | | | - Rosalie Liccardo Pacula
- Price School of Public Policy, University of Southern California, Los Angeles
- Leonard D Schaeffer Center for Health Policy & Economics, University of Southern California, Los Angeles
| | - Michael A. Horberg
- Kaiser Permanente Mid-Atlantic Permanente Research Institute, North Bethesda, Maryland
| | - Steffani R. Bailey
- Department of Family Medicine, Oregon Health & Science University, Portland
| | - Erin A. McClure
- Medical University of South Carolina College of Medicine, Charleston
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Barbosa-Leiker C, Brooks O, Smith CL, Burduli E, Gartstein MA. Healthcare professionals' and budtenders' perceptions of perinatal cannabis use. THE AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE 2022; 48:186-194. [PMID: 34779673 PMCID: PMC9107527 DOI: 10.1080/00952990.2021.1988091] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Background: While national guidelines state that cannabis should not be consumed during pregnancy, cannabis use during pregnancy continues to increase. Pregnant individuals have reported using healthcare professionals and budtenders (i.e., cannabis store retailers) as resources for information on cannabis use during pregnancy and postpartum.Objectives: To determine healthcare professionals' and budtenders' perceptions of risks and benefits of perinatal cannabis use.Method: A qualitative study, using semi-structured, open-ended questions, was conducted with ten healthcare professionals (predominantly nurses; 100% women) and ten budtenders (70% women) in a state where cannabis use is legal for adults 21 years of age and older. Data were interpreted using a qualitative description methodology to identify themes. Themes were generated from participant responses (implicit and explicit). We analyzed data separately and sequentially and present linked themes across samples. Data saturation, rigor, and trustworthiness were discussed and agreed upon by the analytic team.Results: Six themes arose from the healthcare professional and budtender data: 1) Perinatal customers and patients perceive cannabis to be medicinal, 2) Supporting perinatal people who use cannabis, 3) Spectrum of perceived impacts of perinatal cannabis use, 4) Comparison to use of other substances during pregnancy, 5) Perceived limited knowledge and training about cannabis regulation and product safety, and 6) Current trends of purchase and use.Conclusion: Participants reported that perinatal patients/customers perceived cannabis to be medicinal, and highlighted non-judgmental/harm reduction strategies for engaging patients/customers. Training is needed for healthcare professionals and budtenders to assist with patient/customer discussions about perinatal cannabis use.
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Affiliation(s)
- Celestina Barbosa-Leiker
- College of Nursing, Washington State University, Spokane, WA, USA.,Program of Excellence in Addictions Research, Washington State University, Spokane, WA, USA
| | - Olivia Brooks
- College of Nursing, Washington State University, Spokane, WA, USA.,Program of Excellence in Addictions Research, Washington State University, Spokane, WA, USA
| | - Crystal Lederhos Smith
- Program of Excellence in Addictions Research, Washington State University, Spokane, WA, USA.,Elson S. Floyd College of Medicine, Washington State University, Spokane, WA, USA
| | - Ekaterina Burduli
- College of Nursing, Washington State University, Spokane, WA, USA.,Program of Excellence in Addictions Research, Washington State University, Spokane, WA, USA
| | - Maria A Gartstein
- Program of Excellence in Addictions Research, Washington State University, Spokane, WA, USA.,Department of Psychology, Washington State University, Pullman, WA, USA
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Makki I, Zheng-Lin B, Kohli M. Medical marijuana knowledge and attitudes amongst internal medicine residents. BMC PRIMARY CARE 2022; 23:38. [PMID: 35240989 PMCID: PMC8895539 DOI: 10.1186/s12875-022-01651-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/26/2021] [Accepted: 02/24/2022] [Indexed: 11/10/2022]
Abstract
BACKGROUND Mounting evidence suggests the safety and efficacy of medical marijuana (MM) in treating chronic ailments, including chronic pain, epilepsy, and anorexia. Despite incremental use of medical and recreational cannabinoids, current limited evidence shows generalized unpreparedness of medical providers to discuss or recommend these substances to their patients. Herein, the present study aims to examine internal medicine residents' knowledge of marijuana and their attitude towards its medical use. METHODS This is a descriptive cross-sectional study. A survey with 12 standardized queries was created and distributed among the internal medicine residents from Mount Sinai Morningside-West (MSMW) program from July 2020 to December 2020. Participants included preliminary and categorical residents from post-graduate years one to three. The survey consisted of self-assessment of residents' knowledge on the indication, contraindication, adverse effects of MM. RESULTS Eighty-six (59%) out of 145 residents completed the questionnaire. Despite most trainees (70%) having considered certifying the use of MM for their patients, over 90% reported none to little knowledge on its use. Approximately 80% of the surveyed residents expressed willingness to receive an appropriate educational curriculum. CONCLUSION To the best of our knowledge, this is the first study that indicated a critical lack of medical marijuana-related knowledge in surveyed internal medicine residents. In a population with growing cannabis consumption, physician training on the indication, toxicity, and drug interaction of cannabinoids is warranted.
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Affiliation(s)
- Iman Makki
- Department of Medicine, Mount Sinai Morningside and Mount Sinai West, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Binbin Zheng-Lin
- Department of Medicine, Mount Sinai Morningside and Mount Sinai West, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Maanit Kohli
- Department of Medicine, Mount Sinai Morningside and Mount Sinai West, Icahn School of Medicine at Mount Sinai, New York, NY, USA. .,Division of Hospital Medicine, Department of Medicine, Mount Sinai Morningside and Mount Sinai West, Icahn School of Medicine at Mount Sinai, 1000 10th Ave, New York, NY, 10019, USA.
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Javanbakht M, Takada S, Akabike W, Shoptaw S, Gelberg L. Cannabis use, comorbidities, and prescription medication use among older adults in a large healthcare system in Los Angeles, CA 2019-2020. J Am Geriatr Soc 2022; 70:1673-1684. [PMID: 35234291 DOI: 10.1111/jgs.17719] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Revised: 01/18/2022] [Accepted: 01/26/2022] [Indexed: 12/31/2022]
Abstract
OBJECTIVE To describe the reported prevalence of cannabis use and co-use with prescription medications among older adult patients attending primary care (PC) clinics in Los Angeles, CA. METHODS We used electronic health record (EHR) data from sixty PC clinics part of a university-based, urban healthcare system. Patients' ≥50 years of age with an annual physical examination between July 2019 and May 2020 were eligible for inclusion (n = 42,555). Cannabis use was assessed by clinic staff at the time of the visit and recorded in the EHR. We also used EHR data on clinical characteristics including current prescriptions and comorbidities. RESULTS The median age was 63 years (range: 50-101) and 56% were female. Recent cannabis use was reported by 7.6%, which was higher than tobacco use (4.0%; p < 0.01). Prevalence of cannabis use was higher among patients prescribed psychotropic medications. For instance, 10.9% of patients prescribed benzodiazepines reported cannabis use as compared with 7.3% among patients without a prescription for benzodiazepines (p < 0.01). Patients with neurologic/musculoskeletal medications such as antiepileptics also had a higher prevalence of cannabis use when compared with those without these prescriptions (13.6% vs. 7.6% respectively; p < 0.01) as did those who were prescribed muscle relaxants (10.3% vs. 7.5% respectively; p < 0.01). After adjusting for age, sex, race/ethnicity, and comorbidities those prescribed medications for psychiatric (adjusted OR = 1.5; 95% CI 1.4-1.7), respiratory (adjusted OR = 1.2; 95% CI 1.1-1.3), or neurologic conditions (adjusted OR = 1.4; 95% CI 1.2-1.5) had increased odds of cannabis use compared with those not prescribed these medications. DISCUSSION The prevalence of cannabis use among older adults attending PC clinics in a university-based healthcare system was higher among those prescribed medications, which may interact with cannabis. These findings suggest that key groups of older patients who may benefit from routine PC screening for cannabis use and brief advice.
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Affiliation(s)
- Marjan Javanbakht
- Department of Epidemiology, UCLA Fielding School of Public Health, Los Angeles, California, USA
| | - Sae Takada
- Department of Internal Medicine, UCLA David Geffen School of Medicine, Los Angeles, California, USA
| | - Whitney Akabike
- Department of Family Medicine, UCLA David Geffen School of Medicine, Los Angeles, California, USA
| | - Steve Shoptaw
- Department of Family Medicine, UCLA David Geffen School of Medicine, Los Angeles, California, USA
| | - Lillian Gelberg
- Department of Epidemiology, UCLA Fielding School of Public Health, Los Angeles, California, USA.,Department of Health Policy and Management, UCLA Fielding School of Public Health, Los Angeles, California, USA
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Price RL, Charlot KV, Frieler S, Dettori JR, Oskouian R, Chapman JR. The Efficacy of Cannabis in Reducing Back Pain: A Systematic Review. Global Spine J 2022; 12:343-352. [PMID: 35128969 PMCID: PMC8907633 DOI: 10.1177/21925682211065411] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE To critically analyze the evidence and efficacy of cannabis to treat surgical and nonsurgical back pain via a Systematic Review. METHODS We conducted a systematic review to investigate the efficacy of cannabis to treat non-surgical and surgical back pain. A literature search was performed with MEDLINE and Embase databases. Only RCTs and prospective cohort studies with concurrent control were included in this study. Risk of bias and quality grading was assessed for each included study. RESULTS Database searches returned 1738 non-duplicated results. An initial screening excluded 1716 results. Twenty-two full text articles were assessed for eligibility. Four articles ultimately met pre-determined eligibility and were included in the study. Two studies addressed post-SCI pain while other two studies addressed low back pain. No studies specifically examined the use of cannabis for surgical back pain. The type of cannabis varied between study and included THC, dronabinol, and Nabilone. A total of 110 patients were included in the four studies reviewed. In each study, there was a quantifiable advantage of cannabis therapy for alleviating back pain. There were no serious adverse effects reported. CONCLUSIONS In all articles, cannabis was shown to be effective to treat back pain with an acceptable side effect profile. However, long-term follow up is lacking. As medicinal cannabis is being used more commonly for analgesic effect and patients are "self-prescribing" cannabis for back pain, additional studies are needed for healthcare providers to confidently recommend cannabis therapy for back pain. STUDY DESIGN Systematic review.
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Affiliation(s)
- Richard L. Price
- Swedish Neuroscience
Institute, Seattle, WA, USA,Department of Neurosurgery, Washington University in St.
Louis, St. Louis, MO, USA,Richard L. Price, Swedish Neuroscience
Institute 500 17th Avenue, Suite 500, Seattle, WA 98122, USA.
| | | | - Sven Frieler
- Swedish Neuroscience
Institute, Seattle, WA, USA
| | | | - Rod Oskouian
- Swedish Neuroscience
Institute, Seattle, WA, USA
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Tomsič K, Rakinić K, Seliškar A. Slovenian Pet Owners' Experience, Attitudes, and Predictors Regarding Cannabinoid Use in Dogs and Cats. Front Vet Sci 2022; 8:796673. [PMID: 35071387 PMCID: PMC8767012 DOI: 10.3389/fvets.2021.796673] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2021] [Accepted: 12/09/2021] [Indexed: 12/03/2022] Open
Abstract
The aim of this study was to assess the personal experience and attitudes of Slovenian pet owners regarding cannabinoid (CBD) use and to identify the predictors of the first use and reuse of CBDs in dogs and cats. We hypothesized that positive attitudes toward CBDs, postmodern health values, and personal experience would be significant predictors of CBD use in animals. An open online survey targeted randomly selected Slovenian dog and cat owners, regardless of their experience with cannabis products. The questionnaire consisted of six sections related to demographic data and personal experience with CBD use, information about the participant's animal, experience with CBD use in the participant's animal, reasons for not using CBDs in their animal, attitudes toward CBD use in dogs and cats, and postmodern health values. Descriptive statistics were performed to analyze demographics, personal experience with CBD use, and experience with CBD use in dogs and cats. Hierarchical multiple regression using the enter method was performed to analyze the important predictors of CBD use. A total of 408 completed questionnaires were included in the statistical analysis. A substantial proportion (38.5%) of owners had already used CBDs to treat their animal. Positive attitudes and previous personal experience were significant (p < 0.05) predictors of first use and reuse of CBDs in pets, while postmodern health values were not. In conclusion, the decision to use CBDs for medicinal purposes is based on acquired information and personal experience. Veterinarians should be informed and familiar with CBDs as a treatment option. However, further research is essential to establish the use of CBDs in veterinary medicine. Improved laws and regulations are also needed to ensure that only high-quality medications are prescribed to dogs and cats.
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Affiliation(s)
- Katerina Tomsič
- Veterinary Faculty, University of Ljubljana, Ljubljana, Slovenia
| | - Kristina Rakinić
- Faculty of Social Sciences, University of Ljubljana, Ljubljana, Slovenia
| | - Alenka Seliškar
- Veterinary Faculty, University of Ljubljana, Ljubljana, Slovenia
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Adler L, Zacay G, Schonmann Y, Azuri J, Yehoshua I, Vinker S, Shani M, Heymann AD, Hoffman R. Primary care physicians' attitudes and knowledge regarding medical cannabis and willingness to prescribe it: the Israeli experience. Fam Pract 2022; 39:59-64. [PMID: 34476478 DOI: 10.1093/fampra/cmab108] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Use of medical cannabis (MC) in Israel has increased since its regulatory approval in 2016. Currently, more than 1% of Israeli adults are treated with MC; this requires primary care physicians (PCPs) to be familiar with this treatment option. OBJECTIVES We assessed the attitudes and knowledge of Israeli PCPs toward MC and evaluated their willingness to prescribe it for different medical conditions. METHODS A cross-sectional survey which was distributed to PCPs in Israel. Physicians were asked about their opinions, knowledge, and willingness to prescribe MC. RESULTS Two hundred and one PCPs answered the questionnaire. Their average age was 47 years (±11.2), 71% were specialists. 51% of the respondents thought that MC is an effective treatment. 63% replied that they had little knowledge and 75% indicated that they would like to deepen it. 61% of the respondents were willing to initiate an MC treatment for a dying patient, while less than 50% were willing to initiate MC treatment for various other conditions. Most respondents indicated that they were willing to renew a prescription for any approved medical condition. Willingness to prescribe MC increased for physicians who agreed that MC was effective (odds ratio [OR] 21.9, 95% confidence interval [CI] 2.40-200.85), for physicians who strongly agreed with the statement that they had sufficient knowledge (OR 5.0, 95% CI 1.58-15.83) and for residents compared with specialists (OR 4.0, 95% CI 1.52-10.73). CONCLUSIONS Our survey revealed PCPs' differing opinions and insufficient knowledge regarding treatment with MC. These findings suggest that continuing medical education regarding MC is needed.
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Affiliation(s)
- Limor Adler
- Department of Family Medicine, Sackler Faculty of Medicine, Tal Aviv University, Tel Aviv, Israel.,Department of Family Medicine, Maccabi Healthcare Services, Tel Aviv, Israel
| | - Galia Zacay
- Department of Family Medicine, Sackler Faculty of Medicine, Tal Aviv University, Tel Aviv, Israel.,Department of Family Medicine, Meuhedet Healthcare Maintenance Organization, Tel Aviv, Israel
| | - Yochai Schonmann
- Siaal Research Center for Family Medicine and Primary Care, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel.,Department of Quality Measurements and Research, Clalit Health Services, Tel Aviv, Israel
| | - Joseph Azuri
- Department of Family Medicine, Sackler Faculty of Medicine, Tal Aviv University, Tel Aviv, Israel.,Department of Family Medicine, Maccabi Healthcare Services, Tel Aviv, Israel
| | - Ilan Yehoshua
- Department of Family Medicine, Sackler Faculty of Medicine, Tal Aviv University, Tel Aviv, Israel.,Department of Family Medicine, Maccabi Healthcare Services, Tel Aviv, Israel
| | - Shlomo Vinker
- Department of Family Medicine, Sackler Faculty of Medicine, Tal Aviv University, Tel Aviv, Israel.,Leumit Health Services, Headquarters, Medical Division, Tel Aviv, Israel
| | - Michal Shani
- Department of Family Medicine, Sackler Faculty of Medicine, Tal Aviv University, Tel Aviv, Israel.,Department of Family Medicine Central District, Clalit Health Services, Rehovot, Israel
| | - Anthony D Heymann
- Department of Family Medicine, Sackler Faculty of Medicine, Tal Aviv University, Tel Aviv, Israel.,Department of Family Medicine, Meuhedet Healthcare Maintenance Organization, Tel Aviv, Israel
| | - Robert Hoffman
- Department of Family Medicine, Sackler Faculty of Medicine, Tal Aviv University, Tel Aviv, Israel.,Department of Family Medicine, Maccabi Healthcare Services, Tel Aviv, Israel.,Department of Family Medicine, Meuhedet Healthcare Maintenance Organization, Tel Aviv, Israel
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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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To Treat or Not to Treat? Polish Physicians' Opinions about the Clinical Aspects of Cannabinoids-An Online Survey. J Clin Med 2022; 11:jcm11010236. [PMID: 35011977 PMCID: PMC8745737 DOI: 10.3390/jcm11010236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Revised: 12/22/2021] [Accepted: 12/29/2021] [Indexed: 02/04/2023] Open
Abstract
Introduction: Medical cannabis’ importance in Poland increased dramatically following its legalization as the 12th country in Europe in 2017. However, no studies have been published to give insight into Polish physicians’ opinions about medical cannabis. Objectives: To investigate physician’s opinions about cannabinoids’ utility in clinical practice, concerns regarding their safety profile, and their clinical experience with cannabinoids. Methods: The survey using a self-developed tool was conducted online; participants were physicians with or without specialist training. Participation was voluntary. Physicians were recruited through personal networks, palliative care courses, and Medical Chambers. Results: From June to October 2020, we recruited 173 physicians from 15/16 voivodeships. The largest age group (43.9%; n = 76) was 30–39 year-olds. A similar proportion declared they never used cannabis and did not receive any training regarding cannabinoids (60% for both). Only 15 (8%) ever prescribed medical cannabis, although about 50% declared knowing suitable patients for such therapy, and 53.8% had at least one patient proactively asking for such treatment in the last 6 mo. The most common indication chosen was pain: chronic cancer-related (n = 128), chronic non-cancer (n = 77), and neuropathic (n = 60). Other commonly chosen conditions were alleviation of cancer treatment side-effects (n = 56) and cachexia (n = 57). The overall safety profile of THC was assessed as similar to most commonly used medications, including opioids; NSAIDs and benzodiazepines were, however, perceived as safer. Conclusions: Polish physicians favored the legalization of medical cannabis. However, it is of concern that a limited number have any experience with prescribing cannabis. The creation of clear guidelines to advise physicians in their routine practice and education about pain management and the risks related to the consumption of recreational cannabis for medical conditions are needed.
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