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Kim A, Suzuki J. Addiction specialists' attitudes toward psychedelics: A National Survey. Am J Addict 2023; 32:606-609. [PMID: 37550848 DOI: 10.1111/ajad.13461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Revised: 06/07/2023] [Accepted: 07/25/2023] [Indexed: 08/09/2023] Open
Abstract
BACKGROUND AND OBJECTIVES In recent years, there has been accelerating scientific and public interest in the use of psychedelics to treat mental health disorders. Our study's objective was to assess the attitudes of addiction specialists regarding therapeutic psychedelics. METHODS Our study utilized an anonymous online survey to assess the opinions of 145 addiction specialists regarding the therapeutic promise, potential risks, and legalization of psychedelics in the treatment of psychiatric illness and substance use disorders. Psychedelics were defined in the survey as inclusive of nonserotonergic hallucinogens such as ketamine or MDMA in addition to "classic" serotonergic psychedelics. RESULTS Most respondents expressed positive attitudes to the therapeutic use of psychedelics, but a sizeable minority expressed concern for their addictive potential. Familiarity with psychedelic scientific literature was the strongest positive predictor of belief in the therapeutic potential of psychedelics, while concern for addictive potential was the strongest negative predictor. DISCUSSION AND CONCLUSIONS Participants overall expressed more positive attitudes to the therapeutic use of psychedelics than we had hypothesized. This may be attributable to the accelerating pace of psychedelics research in recent years. Given the strong influence of concern for addiction risk on attitudes, future study is warranted to explore the findings regarding these concerns. These findings may also represent an opportunity for improved education of physicians regarding the addictive potential, and relative risks/benefits of psychedelics. SCIENTIFIC SIGNIFICANCE Though there have been several prior studies assessing psychiatrist and psychologist attitudes toward psychedelics, we are unaware of any specifically examining the opinions of addiction specialists.
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Affiliation(s)
- Amanda Kim
- Department of Psychiatry, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Joji Suzuki
- Department of Psychiatry, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
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Syed SA, Singh J, Elkholy H, Palavra IR, Tomicevic M, Eric AP, da Costa MP, Guloksuz S, Radhakrishnan R. International perspective on physician knowledge, attitude and practices related to medical cannabis. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.07.26.23293157. [PMID: 37546945 PMCID: PMC10402227 DOI: 10.1101/2023.07.26.23293157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/08/2023]
Abstract
Background The trends of recreational use of cannabis and use of cannabis for medical indications (i.e. "medical cannabis") have grown in recent years. Despite that, there is still limited scientific evidence to guide clinical decision-making and the strength of evidence for the medical use of cannabis is currently considered to be low. In contrast, there's growing evidence for negative health outcomes related to use of cannabis. In this rapidly shifting landscape, the role of physician's attitudes regarding the therapeutic value of cannabis has become essential. This study aimed to characterize knowledge/experience, attitudes, and potential predictors of clinical practice regarding medical cannabis. Methods We conducted a cross-sectional survey of physicians from 17 countries between 2016-2018. The survey comprised of 28 questions designed to explore physician knowledge, attitude, and practices regarding the use of medical cannabis. Descriptive statistics were used to examine willingness to recommend medical cannabis for medical and psychiatric indications, followed by regression analysis to identify predictors of physician willingness to recommend medical cannabis. Results A total of 323 physicians responded to the survey. Mean age was 35.4± 9.5 years, with 10.04 ±8.6 years of clinical experience. 53 percent of physicians were women. Clinical experience with medical cannabis was overall limited (51.4% noted never having recommended medical cannabis; 33% noted inadequate knowledge regarding medical cannabis). Overall willingness to recommend medical cannabis was highest for chemotherapy-induced nausea, refractory chronic neuropathic pain, and spasticity in amyotropic lateral sclerosis (ALS). Conclusion This international study examining knowledge, attitudes and practices related to medical cannabis among physicians revealed that there are significant gaps in domain-specific knowledge related to medical cannabis. There is wide variability in willingness to recommend medical cannabis that is not consistent with the current strength of evidence. This study thus highlights the need for greater education related to domain-specific knowledge about medical cannabis.
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Affiliation(s)
| | - Jatinder Singh
- Department of Psychiatry, Penn State Milton S. Hershey Medical Center, PA, USA
| | - Hussien Elkholy
- Neurology and Psychiatry Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | | | - Marko Tomicevic
- University Hospital Dubrava, Department of Psychiatry Av, Zagreb, Croatia
| | - Anamarija Petek Eric
- Department of Psychiatry, Clinical Hospital Centre Osijek, Croatia
- Faculty of Medicine Osijek, J.J. Strossmayer University Osijek, Croatia
| | - Mariana Pinto da Costa
- Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
- Institute of Biomedical Sciences Abel Salazar, University of Porto, Porto, Portugal
| | - Sinan Guloksuz
- Department of Psychiatry, Yale School of Medicine, CT, USA
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University Medical Center, Maastricht, the Netherlands
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Sokratous S, Mpouzika M, Kaikoushi K, Alexandrou G, Karanikola M. Attitudes, beliefs, and knowledge regarding medical cannabis among healthcare students in the Republic of Cyprus: a cross-sectional descriptive correlational study. Front Psychiatry 2023; 14:1196915. [PMID: 37520218 PMCID: PMC10375702 DOI: 10.3389/fpsyt.2023.1196915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Accepted: 06/21/2023] [Indexed: 08/01/2023] Open
Abstract
Background Although international research-based literature from the last 2 decades seems to favor the use of medical cannabis (MC), there is a lack of evidence concerning healthcare students' education on MC in the Republic of Cyprus and across the world. Therefore, this study explores healthcare students' attitudes, beliefs, and knowledge regarding the use of MC. We paid special attention to differences across specific sociodemographic (gender, age, and religion status) and educational (level of study and study field) characteristics. Methods A descriptive cross-sectional study was conducted between November 2019 and March 2020. All active undergraduate and postgraduate healthcare students (nurses, physiotherapists, speech therapists, pharmacists, and occupational therapists; N = 900) studying in public and private universities in the Republic of Cyprus were eligible to participate (final sample: N = 819, response rate = 91%). To collect data on the attitudes, beliefs and knowledge of the participants, we used the Medical Cannabis Questionnaire (MCQ). To analyze the data, we employed the Pearson's chi-square test for group differences, in addition to assessing the descriptive and inferential statistics. Results Approximately 82.2% believed that MC education should be integrated into the clinical practice requirements. Statistically significant differences were observed between genders in terms of beliefs/risk associated with the use of MC, with males being more likely to believe that there are significant mental-health benefits associated with using ΜC compared to females (84.9% vs. 76.2%, p<0.05). Females were more likely than males to believe that using MC poses serious physical (76.8% vs. 60.6%, p<0.001) and mental-health (77.9% vs. 66%, p<0.001) risks. Moreover, participants who received formal education about MC during their study/training were more prepared to answer patient/client questions about ΜC (p < 0.001). In addition, participants who received formal education had more frequently friends (p < 0.001) or family members who used MC (p < 0.005). Conclusion This study provides useful information for curriculum development, educational changes, and policy decisions related to cannabis use for medical purposes in the Republic of Cyprus. The results showed that the majority of the healthcare students who participated in the study favored MC use. However, the participants reported a lack of knowledge and recommended additional evidence-based research and education to enhance their knowledge about MC use. Therefore, we recommend the implementation of formal education on MC among healthcare students in the Republic of Cyprus during their study and clinical training. Furthermore, it is important to include MC-related theoretical and clinical/laboratory courses during studies and clinical practice.
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Affiliation(s)
- Sokratis Sokratous
- Department of Nursing, School of Health Sciences, Cyprus University of Technology, Limassol, Cyprus
| | - Meropi Mpouzika
- Department of Nursing, School of Health Sciences, Cyprus University of Technology, Limassol, Cyprus
| | | | | | - Maria Karanikola
- Department of Nursing, School of Health Sciences, Cyprus University of Technology, Limassol, Cyprus
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Akiki G, Richa S, Kazour F. Medical and recreational cannabis: A cross-sectional survey assessing a sample of physicians' attitudes, knowledge and experience in a university hospital in Lebanon. L'ENCEPHALE 2023; 49:130-137. [PMID: 35016798 DOI: 10.1016/j.encep.2021.10.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Revised: 10/03/2021] [Accepted: 10/11/2021] [Indexed: 11/23/2022]
Abstract
CONTEXT A law legalizing the farming of medical cannabis for the international market was passed in Lebanese parliament in April 2020. Thus, this makes Lebanon the first Arab country to legalize medical cannabis, a law which can hold potential public health consequences. The advocates of legalization of medical cannabis in society and in the media influence the public opinion. A community of Lebanese physicians was the first to be asked about this subject. OBJECTIVE This study aims to assess a sample of physicians' opinions, knowledge and experiences with medical and non-medical cannabis. METHOD All physicians of every speciality working at the Hôtel Dieu de France-Beirut hospital (450) received by email a 33-question-online survey in French between November 2020 and December 2020. The survey was designed based on similar studies published outside of Lebanon. RESULTS Eighty-five Lebanese physicians responded to the survey and 80% of them supported the decriminalization of medical cannabis in Lebanon. But only 16% reported knowing the indications of medical cannabis, and only 24% stated that they have adequate knowledge of its secondary effects. Eighty-eight percent of them felt that they might be more comfortable discussing the option of medical cannabis if they had formal education on the subject. CONCLUSION Even though the majority of the sample who participated in this study seemed to approve the use of medical cannabis, they lacked the knowledge and confidence to do it. Therefore, this study highlights the need of physician training in the subject of medical cannabis. Future well-conducted university studies will produce evidence-based-guidelines for medical cannabis indications and side effects.
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Affiliation(s)
- G Akiki
- Faculty of Medicine, Saint Joseph University, Beirut, Lebanon; Hôtel Dieu de France Hospital, Beirut, Lebanon
| | - S Richa
- Faculty of Medicine, Saint Joseph University, Beirut, Lebanon; Hôtel Dieu de France Hospital, Beirut, Lebanon
| | - F Kazour
- Faculty of Medicine, Saint Joseph University, Beirut, Lebanon; Hôtel Dieu de France Hospital, Beirut, Lebanon; CHRU de Tours, avenue de la République, 37170 Chambray-lès-Tours, France.
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Wang K, Sun Y, Nava B, Sampiere L, Jacobs RJ. Predictors of Medical Students' Perceptions of Psilocybin-Assisted Therapy for Use in Medical Practice. Cureus 2023; 15:e37450. [PMID: 37181969 PMCID: PMC10174751 DOI: 10.7759/cureus.37450] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Accepted: 04/11/2023] [Indexed: 05/16/2023] Open
Abstract
Background Psilocybin use, along with other psychedelics, has seen an increased interest among professionals in the medical community due to its potential therapeutic benefits for psychiatric disorders, substance use disorders (SUD), and palliative care. While it is certain that more research is necessary as psychedelic-assisted therapy becomes more prevalent, it will most likely be future physicians at the forefront of this neoteric care. Currently, physicians receive minimal training because of psilocybin's contextual information and its current enlistment as a Schedule 1 drug per the United States Drug Enforcement Administration. Schedule 1 drugs, substances, or chemicals are defined as drugs with no currently accepted medical use and a high potential for abuse. As a rule, formal education on psilocybin is not included in medical school curricula, and very little is known about how medical students perceive it. The aim of this study was thus to assess current medical students' perceptions of their knowledge, concern for possible negative effects, and perceptions about medical psilocybin to provide a deeper understanding of which factors may predict their overall perceptions of its future therapeutic use. Methods Medical students' knowledge, concern for potential adverse effects, and perceptions of medical psilocybin were investigated using a cross-sectional survey study design. Data were collected in January 2023 from a convenience sample of United States medical students in years one to four of their program using a 41-item anonymous quantitative online survey. Multivariate linear regression modeling was performed to determine if perceived knowledge and beliefs about legalization would predict medical students' attitudes about psilocybin use for therapeutic purposes. Results Two hundred and thirteen medical students completed the survey. Seventy-three percent (n=155) were osteopathic medical students (OMS), and 27% (n=58) were allopathic medical students (MDS). Regression modeling produced a statistically significant equation: (F(3, 13) = 78.858, p < .001), with an R2 = 0.573 (adjusted R2 = 0.567), indicating that greater (perceived) knowledge about medical psilocybin, less concern for its possible adverse effects, and greater belief in the legalization of psilocybin for recreational use significantly contributed to positive perceptions of psilocybin use in medical practice. Conclusions In this sample, medical students with greater self-assessment of their knowledge about medical psilocybin, less concern for its potential adverse effects, and more positive views about recreational psilocybin legalization predicted positive attitudes about its medical use. Interestingly, although some participants had positive perceptions about the legalization of psilocybin for medical use, endorsing its legalization for recreation was related to greater positive attitudes toward medical psilocybin in general, a finding that appears to be somewhat counterintuitive. More research is warranted to further explore medical trainees' attitudes toward it, as psilocybin is a promising therapeutic intervention. If medicinal psilocybin continues to gain attention among patients and physicians alike, it will be imperative to evaluate its therapeutic efficacy, proper use, dosing, and potential for negative effects, in addition to preparing students to endorse therapeutic psilocybin when warranted.
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Affiliation(s)
- Karina Wang
- Dr. Kiran C. Patel College of Osteopathic Medicine, Nova Southeastern University, Fort Lauderdale, USA
| | - Yiqun Sun
- Dr. Kiran C. Patel College of Osteopathic Medicine, Nova Southeastern University, Fort Lauderdale, USA
| | - Brenda Nava
- Dr. Kiran C. Patel College of Osteopathic Medicine, Nova Southeastern University, Fort Lauderdale, USA
| | - Luke Sampiere
- Dr. Kiran C. Patel College of Osteopathic Medicine, Nova Southeastern University, Fort Lauderdale, USA
| | - Robin J Jacobs
- Dr. Kiran C. Patel College of Osteopathic Medicine, Nova Southeastern University, Fort Lauderdale, USA
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Arya S, Ghosh A, Kazhungil F. Early career psychiatrist’s attitude toward medicinal and recreational cannabis legalization in India; findings from an online survey. JOURNAL OF SUBSTANCE USE 2022. [DOI: 10.1080/14659891.2022.2120424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Affiliation(s)
- Sidharth Arya
- State Drug Dependence Treatment Centre, Institute of Mental Health, Pt BDS University of Health Sciences, Rohtak, India
| | - Abhishek Ghosh
- Department of Psychiatry, Postgraduate Institute of Medical Sciences and Research, Chandigarh, India
| | - Firoz Kazhungil
- Department of Psychiatry, NMC Royal Hospital, Khalifa City, Abu Dhabi, UAE
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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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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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Jacobs RJ, Kane MN, Caballero J. Predictors of Medical Students’ Perceptions About Medical Cannabis. Cureus 2022; 14:e24390. [PMID: 35619867 PMCID: PMC9126474 DOI: 10.7759/cureus.24390] [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: 04/05/2022] [Accepted: 04/22/2022] [Indexed: 11/24/2022] Open
Abstract
Background: There has been a recent uptick in interest regarding the therapeutic properties of cannabis. Evidence exists to support the role of medical cannabis (MC) in chronic illness management for conditions such as posttraumatic stress, pain, and cancer. The majority of physicians in the United States report not knowing how to prescribe or answer questions about MC and receive minimal education about it during training. As MC becomes more socially acceptable with federal legalization in process, new physicians will encounter patients looking for information on the utility and safety of MC. The goal of this research was thus to assess the perceived knowledge, beliefs, and perceptions of medical students towards MC, and to obtain a better understanding of factors that may influence their attitudes. Methods: A descriptive, cross-sectional study design was used to investigate the medical students’ knowledge, attitudes, and perceptions regarding MC. Quantitative data were collected from 526 medical students (years one to four) via an anonymous, online, 32-item questionnaire to determine if perceived knowledge, concerns about the potential negative effects of cannabis, and certain beliefs would significantly contribute to their attitudes toward MC. Hypothesis testing was conducted using Spearman-rank order correlation and multivariate linear regression analyses. Results: A statistically significant regression equation was found: (F(4, 428)=114.826, p<.001 with an R2=0.518 [adjusted R2 =0.513]) indicating greater perception of knowledge about MC, lower concern for possible negative effects of MC use, greater belief in federal legalization of MC, and greater belief in the federal legalization of recreational cannabis significantly contributed to a higher score on positive attitudes and perceptions toward MC. Moreover, while many participants reported physicians should be able to prescribe MC, they reported that little if any MC education had been provided. Conclusions: This study identified the knowledge, concerns, and perceptions of medical students regarding MC as well as several factors contributing to their attitudes about it. Favorable attitudes toward MC among patients exist and as its popularity and acceptance among patients continue, more may be asking their physicians about symptomatic and curative treatment with cannabis-based products. Results from this research have the potential to assist medical educators in understanding students’ perceptions about MC to help guide innovative and contemporary curricular advances as a public health imperative.
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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: 0] [Impact Index Per Article: 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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OUP accepted manuscript. INTERNATIONAL JOURNAL OF PHARMACY PRACTICE 2022; 30:204-214. [DOI: 10.1093/ijpp/riac005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Accepted: 01/25/2022] [Indexed: 11/14/2022]
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Gunning M, Rotenberg AD, Kelly LE, Crooks B, Oberoi S, Rapoport AL, Rassekh SR, Illes J. Clinician views on and ethics priorities for authorizing medical cannabis in the care of children and youth in Canada: a qualitative study. CMAJ Open 2022; 10:E196-E202. [PMID: 35292477 PMCID: PMC8929429 DOI: 10.9778/cmajo.20210239] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND The use of cannabis for medical purposes by pediatric patients is expanding across Canada; however, supporting evidence, federal regulations and treatment guidelines are lacking. To understand factors affecting treatment decisions in this landscape, we sought to delineate clinician perspectives, ethics priorities and values for cannabis authorization. METHODS We sampled participants purposefully through Canadian Childhood Cannabinoid Clinical Trials listservs, which include the majority of pediatric oncologists and palliative care physicians practising in Canada, among many other pediatric physicians and clinicians. Inclusion criteria were being a practising clinician in Canada, involvement in the care of children and willingness to be interviewed regardless of stance on medical cannabis. In November and December 2020, we conducted semistructured interviews focusing on principles, values and priorities, including medical, professional, regulatory, evidentiary and social considerations, for authorizing medical cannabis to children. Interviews were recorded, transcribed and analyzed by means of deductive and inductive thematic methods. RESULTS We conducted 18 interviews with a diverse group of clinicians representing a range of specialties within pediatric care, including neurology, palliative care, oncology, family medicine and pharmacology. The interviews yielded 4 themes and 12 subthemes related to a priori (medical, professional, regulatory, evidentiary and social themes) and emergent themes. The 4 themes of access, relationships and relational autonomy (autonomy within relationships), medically appropriate use and research priorities were grounded in principles of harm reduction. Participants described problematic authorization procedures that negatively affect patient use. Principles associated with relational autonomy were highlighted as a feature of open clinical communication. Benefits of appropriate medical uses weighed positively over risks, even in the context of potential effects on neurodevelopment. Participants expressed that more research is essential to align medical cannabis with biomedical standards. INTERPRETATION Clinicians reported pursuing ethical use of medical cannabis for pediatric patients and prioritizing their safety under principles of harm reduction. There is a need for evidence about neurodevelopmental risks, support for research, treatment guidelines and greater knowledge about stakeholder perspectives to alleviate burdens related to use of medical cannabis for pediatric patients in Canada.
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Affiliation(s)
- Margot Gunning
- Neuroethics Canada (Gunning, Rotenberg, Illes), Division of Neurology, Department of Medicine, University of British Columbia, Vancouver, BC; Department of Pediatrics and Child Health (Kelly), University of Manitoba; George & Fay Yee Centre for Healthcare Innovation (Kelly), Winnipeg, Man.; Division of Hematology-Oncology (Crooks), Department of Pediatrics, IWK Health Centre, Dalhousie University, Halifax, NS; Department of Pediatric Hematology-Oncology-BMT (Oberoi), CancerCare Manitoba, Winnipeg, Man.; Departments of Paediatrics and of Family and Community Medicine (Rapoport), Faculty of Medicine, University of Toronto; Emily's House Children's Hospice (Rapoport), Toronto, Ont.; Division of Pediatric Hematology/Oncology/BMT (Rassekh), Department of Pediatrics, University of British Columbia, Vancouver, BC
| | - Ari D Rotenberg
- Neuroethics Canada (Gunning, Rotenberg, Illes), Division of Neurology, Department of Medicine, University of British Columbia, Vancouver, BC; Department of Pediatrics and Child Health (Kelly), University of Manitoba; George & Fay Yee Centre for Healthcare Innovation (Kelly), Winnipeg, Man.; Division of Hematology-Oncology (Crooks), Department of Pediatrics, IWK Health Centre, Dalhousie University, Halifax, NS; Department of Pediatric Hematology-Oncology-BMT (Oberoi), CancerCare Manitoba, Winnipeg, Man.; Departments of Paediatrics and of Family and Community Medicine (Rapoport), Faculty of Medicine, University of Toronto; Emily's House Children's Hospice (Rapoport), Toronto, Ont.; Division of Pediatric Hematology/Oncology/BMT (Rassekh), Department of Pediatrics, University of British Columbia, Vancouver, BC
| | - Lauren E Kelly
- Neuroethics Canada (Gunning, Rotenberg, Illes), Division of Neurology, Department of Medicine, University of British Columbia, Vancouver, BC; Department of Pediatrics and Child Health (Kelly), University of Manitoba; George & Fay Yee Centre for Healthcare Innovation (Kelly), Winnipeg, Man.; Division of Hematology-Oncology (Crooks), Department of Pediatrics, IWK Health Centre, Dalhousie University, Halifax, NS; Department of Pediatric Hematology-Oncology-BMT (Oberoi), CancerCare Manitoba, Winnipeg, Man.; Departments of Paediatrics and of Family and Community Medicine (Rapoport), Faculty of Medicine, University of Toronto; Emily's House Children's Hospice (Rapoport), Toronto, Ont.; Division of Pediatric Hematology/Oncology/BMT (Rassekh), Department of Pediatrics, University of British Columbia, Vancouver, BC
| | - Bruce Crooks
- Neuroethics Canada (Gunning, Rotenberg, Illes), Division of Neurology, Department of Medicine, University of British Columbia, Vancouver, BC; Department of Pediatrics and Child Health (Kelly), University of Manitoba; George & Fay Yee Centre for Healthcare Innovation (Kelly), Winnipeg, Man.; Division of Hematology-Oncology (Crooks), Department of Pediatrics, IWK Health Centre, Dalhousie University, Halifax, NS; Department of Pediatric Hematology-Oncology-BMT (Oberoi), CancerCare Manitoba, Winnipeg, Man.; Departments of Paediatrics and of Family and Community Medicine (Rapoport), Faculty of Medicine, University of Toronto; Emily's House Children's Hospice (Rapoport), Toronto, Ont.; Division of Pediatric Hematology/Oncology/BMT (Rassekh), Department of Pediatrics, University of British Columbia, Vancouver, BC
| | - Sapna Oberoi
- Neuroethics Canada (Gunning, Rotenberg, Illes), Division of Neurology, Department of Medicine, University of British Columbia, Vancouver, BC; Department of Pediatrics and Child Health (Kelly), University of Manitoba; George & Fay Yee Centre for Healthcare Innovation (Kelly), Winnipeg, Man.; Division of Hematology-Oncology (Crooks), Department of Pediatrics, IWK Health Centre, Dalhousie University, Halifax, NS; Department of Pediatric Hematology-Oncology-BMT (Oberoi), CancerCare Manitoba, Winnipeg, Man.; Departments of Paediatrics and of Family and Community Medicine (Rapoport), Faculty of Medicine, University of Toronto; Emily's House Children's Hospice (Rapoport), Toronto, Ont.; Division of Pediatric Hematology/Oncology/BMT (Rassekh), Department of Pediatrics, University of British Columbia, Vancouver, BC
| | - Adam L Rapoport
- Neuroethics Canada (Gunning, Rotenberg, Illes), Division of Neurology, Department of Medicine, University of British Columbia, Vancouver, BC; Department of Pediatrics and Child Health (Kelly), University of Manitoba; George & Fay Yee Centre for Healthcare Innovation (Kelly), Winnipeg, Man.; Division of Hematology-Oncology (Crooks), Department of Pediatrics, IWK Health Centre, Dalhousie University, Halifax, NS; Department of Pediatric Hematology-Oncology-BMT (Oberoi), CancerCare Manitoba, Winnipeg, Man.; Departments of Paediatrics and of Family and Community Medicine (Rapoport), Faculty of Medicine, University of Toronto; Emily's House Children's Hospice (Rapoport), Toronto, Ont.; Division of Pediatric Hematology/Oncology/BMT (Rassekh), Department of Pediatrics, University of British Columbia, Vancouver, BC
| | - S Rod Rassekh
- Neuroethics Canada (Gunning, Rotenberg, Illes), Division of Neurology, Department of Medicine, University of British Columbia, Vancouver, BC; Department of Pediatrics and Child Health (Kelly), University of Manitoba; George & Fay Yee Centre for Healthcare Innovation (Kelly), Winnipeg, Man.; Division of Hematology-Oncology (Crooks), Department of Pediatrics, IWK Health Centre, Dalhousie University, Halifax, NS; Department of Pediatric Hematology-Oncology-BMT (Oberoi), CancerCare Manitoba, Winnipeg, Man.; Departments of Paediatrics and of Family and Community Medicine (Rapoport), Faculty of Medicine, University of Toronto; Emily's House Children's Hospice (Rapoport), Toronto, Ont.; Division of Pediatric Hematology/Oncology/BMT (Rassekh), Department of Pediatrics, University of British Columbia, Vancouver, BC
| | - Judy Illes
- Neuroethics Canada (Gunning, Rotenberg, Illes), Division of Neurology, Department of Medicine, University of British Columbia, Vancouver, BC; Department of Pediatrics and Child Health (Kelly), University of Manitoba; George & Fay Yee Centre for Healthcare Innovation (Kelly), Winnipeg, Man.; Division of Hematology-Oncology (Crooks), Department of Pediatrics, IWK Health Centre, Dalhousie University, Halifax, NS; Department of Pediatric Hematology-Oncology-BMT (Oberoi), CancerCare Manitoba, Winnipeg, Man.; Departments of Paediatrics and of Family and Community Medicine (Rapoport), Faculty of Medicine, University of Toronto; Emily's House Children's Hospice (Rapoport), Toronto, Ont.; Division of Pediatric Hematology/Oncology/BMT (Rassekh), Department of Pediatrics, University of British Columbia, Vancouver, BC
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13
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Worster B, Ashare RL, Hajjar E, Garber G, Smith K, Kelly EL. Clinician Attitudes, Training, and Beliefs About Cannabis: An Interprofessional Assessment. Cannabis Cannabinoid Res 2021. [PMID: 34978882 DOI: 10.1089/can.2021.0022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: Medical use of cannabis is growing in popularity across the United States, but medical education and clinician comfort discussing cannabis use for medical purposes have not kept pace. Materials and Methods: A total of 344 clinicians in the state of Pennsylvania (response rate 14%) completed a brief online survey about their attitudes, training, and experiences regarding medical cannabis and certifying patients to use medical cannabis. Results: Only 51% of clinicians reported completing any formal training on medical cannabis. Compared with noncertifying clinicians (pharmacists, nurse practitioners, and physician assistants), physicians were significantly more comfortable with patient use of medical cannabis, saw fewer risks, more benefits, and felt better prepared to discuss its use with vulnerable populations. All clinicians noted significant limitations to their understanding of how medical cannabis can affect patients, and many indicated a desire for more research and training to fill in gaps in their knowledge. Conclusions: Insufficient medical curricula on the medical uses of cannabis are available to interprofessional clinicians across their disciplines, and clinicians report significant deficits in their knowledge base about its effects. Additionally, these data suggest an urgent need to expand training opportunities to the full spectrum of clinicians as all are involved in caring for patients who use medical cannabis.
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Affiliation(s)
- Brooke Worster
- Department of Medical Oncology, Sidney Kimmel Cancer Center at Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Rebecca L Ashare
- Department of Psychology, State University of New York at Buffalo, Buffalo, NY.,Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | - Emily Hajjar
- College of Pharmacy at Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Greg Garber
- Department of Medical Oncology, Sidney Kimmel Cancer Center at Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Kelsey Smith
- Department of Family and Community Medicine, Sidney Kimmel Medical School at Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Erin L Kelly
- Department of Family and Community Medicine, Sidney Kimmel Medical School at Thomas Jefferson University, Philadelphia, Pennsylvania, USA
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14
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Rønne ST, Rosenbæk F, Pedersen LB, Waldorff FB, Nielsen JB, Riisgaard H, Søndergaard J. Physicians' experiences, attitudes, and beliefs towards medical cannabis: a systematic literature review. BMC FAMILY PRACTICE 2021; 22:212. [PMID: 34674661 PMCID: PMC8532330 DOI: 10.1186/s12875-021-01559-w] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Accepted: 10/05/2021] [Indexed: 11/25/2022]
Abstract
Background An increasing number of countries legalise the use of medical cannabis or allow it for a narrow range of medical conditions. Physicians, and often the patients’ general practitioner, play a major role in implementing this policy. Many of them, however, perceive a lack of evidence-based knowledge and are not confident with providing patients with medical cannabis. The objectives of this review are to synthesise findings about hospital physicians’ and GPs’ experiences, attitudes, and beliefs towards the use of medical cannabis with the purpose of identifying barriers and facilitators towards providing it to their patients. Methods Peer-reviewed articles addressing hospital physicians’ and GPs’ experiences, attitudes, and beliefs towards the use of medical cannabis were searched systematically in PubMed, Scopus, EMBASE, and the Cochrane Library. Results Twenty-one articles were included from five different countries in which the medical cannabis laws varied. The studied physicians experienced frequent inquiries about medical cannabis from their patients (49–95%), and between 10 and 95% of the physicians were willing to prescribe and/or provide it to the patients, depending on setting, specialty and experience among the physicians. This review found that physicians experienced in prescribing medical cannabis were more convinced of its benefits and less worried about adverse effects than non-experienced physicians. However, physicians specialized in addiction treatment and certain relevant indication areas seemed more sceptical compared to physicians in general. Nevertheless, physicians generally experienced a lack of knowledge of clinical effects including both beneficial and adverse effects. Conclusion This review indicates that GPs and hospital physicians from various specialties frequently experience patient demands for medical cannabis and to some degree show openness to using it, although there was a wide gap between studies in terms of willingness to provide. Hospital physicians and GPs’ experienced in prescribing are more convinced of effects and less worried of adverse effects. However, most physicians experience a lack of knowledge of beneficial effects, adverse effects and of how to advise patients, which may comprise barriers towards prescribing. More research, including larger studies with cohort designs and qualitative studies, is needed to further examine facilitators and barriers to physicians’ prescribing practices.
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Affiliation(s)
- Sabrina Trappaud Rønne
- Research Unit of General Practice, Department of Public Health, University of Southern Denmark, J.B. Winsløws Vej 9A, 5000, Odense C, Denmark
| | - Frederik Rosenbæk
- Research Unit of General Practice, Department of Public Health, University of Southern Denmark, J.B. Winsløws Vej 9A, 5000, Odense C, Denmark.
| | - Line Bjørnskov Pedersen
- Research Unit of General Practice, Department of Public Health, University of Southern Denmark, J.B. Winsløws Vej 9A, 5000, Odense C, Denmark.,DaCHE - Danish Centre for Health Economics, Department of Public Health, University of Southern Denmark, Winsløws Vej 9B, 5000, Odense C, Denmark
| | - Frans Boch Waldorff
- Research Unit of General Practice, Department of Public Health, University of Southern Denmark, J.B. Winsløws Vej 9A, 5000, Odense C, Denmark.,The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Jesper Bo Nielsen
- Research Unit of General Practice, Department of Public Health, University of Southern Denmark, J.B. Winsløws Vej 9A, 5000, Odense C, Denmark
| | - Helle Riisgaard
- Research Unit of General Practice, Department of Public Health, University of Southern Denmark, J.B. Winsløws Vej 9A, 5000, Odense C, Denmark
| | - Jens Søndergaard
- Research Unit of General Practice, Department of Public Health, University of Southern Denmark, J.B. Winsløws Vej 9A, 5000, Odense C, Denmark
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15
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A systematic review of medical students' and professionals' attitudes and knowledge regarding medical cannabis. J Cannabis Res 2021; 3:47. [PMID: 34641976 PMCID: PMC8507207 DOI: 10.1186/s42238-021-00100-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Accepted: 08/30/2021] [Indexed: 12/17/2022] Open
Abstract
Background Recently, the renewed global interest in cannabis’ therapeutic properties has resulted in shifting attitudes and legislative policies worldwide. The aim of this systematic review is to explore the existing literature on medical professionals’ and students’ attitudes and knowledge regarding medicinal cannabis (MC) to assess any relevant and significant trends. Methods This systematic review was conducted in accordance with PRISMA guidelines. Using PubMed and Google Scholar, a literature search was performed to identify studies pertaining to healthcare professionals’ and medical students’ knowledge and attitudes regarding MC. There were no search limits on the year of publication; however, studies without primary data (e.g., abstracts, systematic reviews, meta-analyses) and non-English language papers were excluded. Studies were coded according to the following research questions: (1) Do respondents believe that cannabis should be legalized (for medicinal and/or recreational purposes)? (2) Are respondents confident in their level of knowledge regarding cannabis’ clinical applications? (3) Are respondents convinced of cannabis’ therapeutic potential? 4) What current gaps in knowledge exist, and how can the medical community become better informed about cannabis’ therapeutic uses? and (5) Are there significant differences between the knowledge and opinions of healthcare students versus healthcare professionals with respect to any of the aforementioned queries? Chi-square tests were used to assess differences between medical students and medical professionals, and Pearson’s bivariate correlations were used to analyze associations between survey responses and year of publication—as a proxy measurement to assess change over time. Results Out of the 741 items retrieved, 40 studies published between 1971 and 2019 were included in the final analyses. In an evaluation of 21 qualified studies (8016 respondents), 49.9% of all respondents favored legalization (SD = 25.7, range: 16–97%). A correlational analysis between the percentage of survey respondents who support MC legalization and year of publication suggests that both medical students’ and professionals’ support for MC legalization has increased from 1991 to 2019 (r(19) = .44, p = .045). Moreover, medical professionals favor the legalization of MC at a significantly higher rate than students (52% vs. 42%, respectively; χ2 (1, N = 9019) = 50.72 p < .001). Also, respondents consistently report a strong desire for more education about MC and a substantial concern regarding MC’s potential to cause dependence and addiction. Pearson’s correlations between year of publication and survey responses for both of these queried variables suggest minimal changes within the last decade (2011–2019 for addiction and dependence, 2012-2019 for additional education; r(13) = − .10, p = .713 and r(12) = − .12, p = .678, respectively). Conclusion The finding that both medical students’ and professionals’ acceptance of MC has significantly increased in recent decades—in conjunction with their consistent, strong desire for more educational material—suggests that the medical community should prioritize the development of MC educational programs. MC is far more likely to succeed as a safe and viable therapy if the medical professionals who administer it are well-trained and confident regarding its clinical effects. Limitations include a lack of covariate-based analyses and the exclusion of studies published after the literature search was performed (June 2019). Future research should analyze studies published post-2019 to draw temporal comparisons and should investigate the effect of numerous covariates (e.g., gender, religiosity, prior cannabis use) as newer studies gather data on these factors [PROSPERO Registration: CRD42020204382].
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16
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Affiliation(s)
- Edeltraut Kröger
- Centre d'excellence sur le vieillissement de Québec, CIUSSSS CN Hôpital St-Sacrement, Québec, QC G1S 4L8, Canada
| | - Clermont E Dionne
- Department of social and preventive medicine, Faculty of Medicine, Université Laval, Pavillon Ferdinand-Vandry, Québec, QC G1V 0A6, Canada
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17
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Barnett BS, Beaussant Y, King F, Doblin R. Psychedelic Knowledge and Opinions in Psychiatrists at Two Professional Conferences: An Exploratory Survey. J Psychoactive Drugs 2021; 54:269-277. [PMID: 34409921 DOI: 10.1080/02791072.2021.1957183] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Despite resurgent interest in psychedelic-assisted therapy, our insights into psychiatrists' knowledge and opinions about medicinal psychedelic applications are surprisingly narrow. Therefore, we anonymously surveyed psychiatrists attending psychedelic didactic presentations at two national meetings about these issues using a 26-item questionnaire. Response rate was 40.20% (106/264). Respondents were 41.73 ± 13.31 years old (range: 24-80) and 64.42% were male. They largely believed psychedelics show treatment promise and strongly supported federal funding for medicinal psychedelic research. The most common concerns were the lack of trained psychedelic-assisted therapy providers, the logistics of psychedelic-assisted therapy delivery, the administration of psychedelics for patients with contraindications, and diversion. The most desired psychedelic-related educational topics were potential benefits of psychedelic-assisted therapy, how to conduct psychedelic-assisted therapy, psychedelic pharmacology, and psychedelic side effects. Factors associated with increased belief in psychedelics' treatment potential included working primarily in research, scoring higher on a psychedelic knowledge test, and reporting less concern about psychedelics' addictive potential. Working primarily in research and consult-liaison psychiatry fellowship training were positively associated with support for medicinal psychedelic legalization, while increased concerns about addictive potential and attending psychiatrist status were negatively associated. Support for legalization of non-medicinal psychedelic use was negatively associated with age and positively associated with support for legalization of medicinal psychedelic use.
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Affiliation(s)
- Brian S Barnett
- Department of Psychiatry and Psychology, Center for Behavioral Health, Neurological Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Yvan Beaussant
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Franklin King
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA.,Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
| | - Rick Doblin
- Multidisciplinary Association for Psychedelic Studies, Santa Cruz, CA, USA
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18
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O’Rourke R, Lima ML, Jetten J. Healthcare professionals and medical cannabis: a scoping review informed by the theoretical domains framework. J Public Health (Oxf) 2021. [DOI: 10.1007/s10389-021-01624-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
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19
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Felnhofer A, Kothgassner OD, Stoll A, Klier C. Knowledge about and attitudes towards medical cannabis among Austrian university students. Complement Ther Med 2021; 58:102700. [PMID: 33677020 DOI: 10.1016/j.ctim.2021.102700] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2020] [Revised: 02/22/2021] [Accepted: 02/22/2021] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND The relevance of medical cannabis (MC) increases; and, educating those who are at the forefront of patient care is imperative. Yet, research on medical students' expertise and opinions is still scarce. OBJECTIVE This study set out to evaluate Austrian medical students' knowledge about and attitudes towards MC and compare them with other academic disciplines. Additionally, gender was controlled for. METHODS An online survey was conducted with N = 404 students enrolled in (1) medical studies, (2) studies with a medical background and (3) studies without a medical background. RESULTS In contrast to non-medical students, 64 % of medical students said they learnt about MC at the university. Although students were confident about their knowledge, they struggled to differentiate between CBD and THC. Chronic pain, oncological diseases and palliative care were the most frequently cited indications, psychiatric indications, however, were mentioned less often. Medical students were more reserved in their attitudes towards increasing medical usage and legalizing cannabis than the two other groups. Also, they were more skeptical about whether physicians should be allowed to prescribe MC and whether they should be obliged to offer it. Males showed more confidence regarding cannabis knowledge and were more favorable of legalizing and prescribing cannabis; females perceived cannabis as more physically addictive and as a gate-way drug. CONCLUSIONS Considering that beliefs and attitudes shape behavior, it is expected that future health care professionals will struggle with recommending cannabis for medical treatment. A coordinated approach for medical training is needed to ensure high standard medical care.
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Affiliation(s)
- Anna Felnhofer
- Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Vienna, Austria; Comprehensive Center for Pediatrics, CCP, Medical University of Vienna, Austria
| | - Oswald D Kothgassner
- Department of Child and Adolescent Psychiatry, Medical University of Vienna, Vienna, Austria
| | - Astrid Stoll
- Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Vienna, Austria
| | - Claudia Klier
- Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Vienna, Austria; Comprehensive Center for Pediatrics, CCP, Medical University of Vienna, Austria.
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20
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Arnfinsen JL, Kisa A. Assessment of Norwegian physicians’ knowledge, experience and attitudes towards medical cannabis. DRUGS: EDUCATION, PREVENTION AND POLICY 2021. [DOI: 10.1080/09687637.2020.1806208] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Affiliation(s)
- John Laurence Arnfinsen
- Department of Health Management and Health Economics, Faculty of Medicine, Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Adnan Kisa
- School of Health Sciences, Kristiania University College, Oslo, Norway
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21
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Giannakopoulou M, Vouzavali F, Paikopoulou D, Paschali A, Mpouzika MDA, Karanikola MNK. Attitudes, beliefs and knowledge towards Medical Cannabis of Greek undergraduate and postgraduate university nursing students. Complement Ther Med 2021; 58:102703. [PMID: 33647397 DOI: 10.1016/j.ctim.2021.102703] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Revised: 02/16/2021] [Accepted: 02/24/2021] [Indexed: 01/10/2023] Open
Abstract
OBJECTIVES To assess attitudes, beliefs and knowledge towards medical cannabis (MC) among Greek nursing students by year of study and undergraduate/postgraduate status. METHODS 294 (229 undergraduate and 65 postgraduate) students participated in this survey. Descriptive and inferential statistics (Pearson's chi-squared, t-test) were applied using SPSS.24 (p ≤ 0.05). RESULTS Participant mean age (SD) was 23.1(6.6) years and 80.0 % of the study cohort was female. Senior undergraduate participants (3rd/4th year of study) reported more positive attitudes about MC benefits for mental health treatment compared to junior participants (1st/2nd year) (p = 0.017). Junior participants were more inclined to believe there are serious physical health risks associated with cannabis use (p = 0.038). Undergraduates, more than postgraduates, expressed a need for MC education and training for academic and practice purposes (p = 0.015); and, that there are physical and mental health risks associated with cannabis use (p = 0.007). Additionally, undergraduate nursing students were less likely than postgraduates to report knowledge about MC effectiveness for a variety of medical conditions (p ≤ 0.047); personal cannabis use for recreational purposes (p < 0.001); and, medical (p = 0.018) or recreational (p < 0.001) cannabis use among family members. The vast majority of all nursing students surveyed reported the need for formal education about MC (i.e., theoretical, clinical, laws and regulations) as part of their studies. CONCLUSION Greek nursing student attitudes, beliefs and knowledge about MC vary according to year of study and undergraduate/postgraduate status. From this study, formal education on MC is recommended for Greek nursing students.
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Affiliation(s)
| | - Fotini Vouzavali
- Department of Nursing, National & Kapodistrian University of Athens, Greece
| | | | - Antonia Paschali
- Department of Nursing, Section of Mental Health & Behavioral Sciences, National and Kapodistrian University of Athens, Greece
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22
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Szaflarski M, McGoldrick P, Currens L, Blodgett D, Land H, Szaflarski JP, Segal E. Attitudes and knowledge about cannabis and cannabis-based therapies among US neurologists, nurses, and pharmacists. Epilepsy Behav 2020; 109:107102. [PMID: 32442891 DOI: 10.1016/j.yebeh.2020.107102] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2020] [Accepted: 04/06/2020] [Indexed: 10/24/2022]
Abstract
Use of cannabinoid therapies is on the rise in the United States, but responses of healthcare professionals and their knowledge of these therapies have been mixed. More information is needed about factors associated with healthcare professionals' attitudes and knowledge about medical cannabis. We conducted an online survey of US-based neurologists, nurse practitioners (NPs)/nurses, and pharmacists in August-September of 2018 (n = 451). We constructed perceived knowledge and attitudes scales and a knowledge index from multiple items and assessed state cannabis laws, participant's sociodemographics, workplace type and policies, and patient population. We used ordinary least-squares regression to examine associations among study variables. Over 80% of participants supported use and legalization of medical cannabis, especially cannabidiol (CBD) for epilepsy and when prescribed by a medical provider, but 40-50% (depending on item) felt unfamiliar with cannabinoid pharmacology and clinical applications. A total of 43% favored legal recreational cannabis. Pharmacists scored higher on the knowledge test than neurologists and NPs/nurses, but NPs/nurses had more favorable attitudes than neurologists and higher perceived knowledge than pharmacists. Both knowledge indicators predicted attitudes. State cannabis access and favorable workplace policies were associated with higher knowledge and more favorable attitudes. Healthcare professionals see potential in cannabis therapies but report significant knowledge gaps. Professional cannabinoid education is needed to address growing patient and provider demand for knowledge about cannabinoid therapies.
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Affiliation(s)
- Magdalena Szaflarski
- Department of Sociology, University of Alabama at Birmingham (UAB), HHB 460H, 1720 2nd Ave South, Birmingham, AL 35294-1152, USA.
| | - Patricia McGoldrick
- Division of Child Neurology and Epilepsy, Boston Children's Health Physicians of Westchester and Maria Fareri Children's Hospital, Valhalla, NY, 141 South Central Ave, Hartsdale, NY 10530, USA
| | - Lauryn Currens
- Department of Neurology, University of Massachusetts, 55 Lake Ave North, Worcester, MA 01655, USA.
| | - Dustin Blodgett
- Department of Psychiatry, University of Kentucky, 245 Fountain Court, Lexington, KY 40509, USA.
| | - Hunter Land
- Canopy Health Innovations, Smiths Falls, Ontario, Canada
| | - Jerzy P Szaflarski
- UAB Epilepsy Center, Department of Neurology, University of Alabama at Birmingham, 312 Civitan International Research Center (CIRC 312), 1720 2nd Avenue South, Birmingham, AL 35294-0021, USA.
| | - Eric Segal
- Northeast Regional Epilepsy Group, Hackensack University Medical Center and Hackensack Meridian School of Medicine, 20 Prospect Avenue, Suite 800, Hackensack, NJ 07601, USA.
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23
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Azcarate PM, Zhang AJ, Keyhani S, Steigerwald S, Ishida JH, Cohen BE. Medical Reasons for Marijuana Use, Forms of Use, and Patient Perception of Physician Attitudes Among the US Population. J Gen Intern Med 2020; 35:1979-1986. [PMID: 32291715 PMCID: PMC7352011 DOI: 10.1007/s11606-020-05800-7] [Citation(s) in RCA: 56] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Accepted: 03/12/2020] [Indexed: 12/16/2022]
Abstract
BACKGROUND The use of marijuana for medical purposes is increasing in parallel with expanding legalization and decreased public perception of harm. Despite this increase in use, it is unclear which medical conditions patients are attempting to treat with marijuana and whether they are communicating with medical providers about their use. OBJECTIVE To understand the medical reasons for marijuana use, forms of marijuana used for medical purposes, and disclosure of use to physicians. DESIGN National, probability-based online survey. SETTING The USA, 2017. PARTICIPANTS 16,280 US adults. MAIN MEASURE Proportion of US adults who agreed with a statement. KEY RESULTS A total of 9003 participants completed the survey (55% response rate). Five hundred ninety-one (7% of US adults) reported using marijuana for medical purposes. The most common medical reasons for marijuana use were anxiety (49%), insomnia (47%), chronic pain (42%), and depression (39%). The most common forms of use for all medical conditions were smoking and edibles, followed by vaping, concentrate, and topical. We found women were more likely to use marijuana for posttraumatic stress disorder, sleep, anxiety, and migraines. We did not find substantial variation in medical reasons for marijuana use by race. Among those using marijuana for medical purposes, 21% did not have a doctor. Among those with doctors, 33% did not inform them, 28% reported their doctor was neutral on their use, 32% reported their doctor was supportive, and 8% reported their doctor was not supportive. Those who lived in states where medical marijuana was illegal were less likely to disclose use to their doctor. LIMITATION The online format of the survey may have caused selection bias. Wording of the questions may have affected interpretation. Doctors were not queried directly, rather participants were asked about their perception of doctor attitudes. CONCLUSION Americans are using marijuana to treat medical conditions despite lack of evidence of efficacy.
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Affiliation(s)
- Patrick M Azcarate
- Department of Internal Medicine, University of California, San Francisco, San Francisco, CA, USA. .,Division of General Internal Medicine, University of California San Francisco, San Francisco, CA, USA. .,Cardiovascular Medicine, University of California San Diego, San Diego, USA.
| | - Alysandra J Zhang
- Northern California Institute for Education and Research, San Francisco VA Medical Center, San Francisco, CA, USA.,Department of Medicine, UCSF Division of General Internal Medicine, San Francisco VA Medical Center, San Francisco, CA, USA.,San Francisco Veterans Affairs Medical Center, San Francisco, CA, USA
| | - Salomeh Keyhani
- Department of Internal Medicine, University of California, San Francisco, San Francisco, CA, USA.,Northern California Institute for Education and Research, San Francisco VA Medical Center, San Francisco, CA, USA.,Department of Medicine, UCSF Division of General Internal Medicine, San Francisco VA Medical Center, San Francisco, CA, USA.,San Francisco Veterans Affairs Medical Center, San Francisco, CA, USA
| | - Stacey Steigerwald
- Northern California Institute for Education and Research, San Francisco VA Medical Center, San Francisco, CA, USA.,San Francisco Veterans Affairs Medical Center, San Francisco, CA, USA
| | - Julie H Ishida
- Department of Medicine, UCSF Division of Nephrology, San Francisco VA Medical Center, San Francisco, CA, USA.,Department of Nephrology, University of California, San Francisco, San Francisco, CA, USA
| | - Beth E Cohen
- Department of Internal Medicine, University of California, San Francisco, San Francisco, CA, USA.,Department of Medicine, UCSF Division of General Internal Medicine, San Francisco VA Medical Center, San Francisco, CA, USA.,San Francisco Veterans Affairs Medical Center, San Francisco, CA, USA
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24
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Szyliowicz D, Hilsenrath P. Medical Marijuana Knowledge and Attitudes: A Survey of the California Pharmacists Association. J Prim Care Community Health 2020; 10:2150132719831871. [PMID: 30795717 PMCID: PMC6388448 DOI: 10.1177/2150132719831871] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Views on the medical efficacy and acceptability of marijuana have changed over the years. California was the first state permitting individuals to use medical marijuana. Even with a long history of use and widespread agreement around the effectiveness of medical marijuana, the literature is sparse about the role health care providers, including pharmacists, play in this interaction. The purpose of this article is to shed light on knowledge and attitudes of pharmacists regarding medical marijuana. We developed a survey for pharmacists about their level of knowledge and attitudes toward medical marijuana. The survey was distributed using SurveyMonkey. It consisted of 44 questions and an opportunity to provide comments. We collaborated with the California Pharmacists Association who provided a link to the survey in October 2017 to their members. Results from 474 responses indicate a majority of providers believe that marijuana has medical efficacy. Yet most providers report that they neither have much information about medical marijuana nor do they know where to get such information. One area of particular concern is the potential for drug interactions. Pharmacists would feel more comfortable discussing medical marijuana if it was approved by the Food and Drug Administration. Moreover, they believe more research needs to occur. The variance between California and federal policy leads to dysfunction among pharmacists providing information to patients. We believe federal policy should change.
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Kaplan L, Klein T, Wilson M, Graves J. Knowledge, Practices, and Attitudes of Washington State Health Care Professionals Regarding Medical Cannabis. Cannabis Cannabinoid Res 2020; 5:172-182. [PMID: 32656349 DOI: 10.1089/can.2019.0051] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Introduction: Health care providers in Washington State practice in a unique environment where both medical and recreational cannabis use are legal. Five types of health care providers can authorize medical cannabis. State-certified medical cannabis consultants may advise patients in a cannabis retail store regarding use and consumption. Washington State's health care professionals' perspectives about medical cannabis can inform policy-makers nationwide who are navigating challenges posed by legalization of medical and recreational cannabis. Materials and Methods: A cross-sectional mixed-mode survey using a 26-item questionnaire was administered to a random sample of actively licensed health care professionals legally permitted to provide medical cannabis authorizations in Washington State. We describe participant demographics and summarize responses to survey questions. We report comparisons across provider types using Fisher's exact tests with a level of significance of p<0.01. Results: Among the 1440 health care professionals invited to participate in the study, 310 respondents met eligibility criteria (response rate 24%). Only 57 respondents (18.4%) indicated having ever issued a medical cannabis authorization. Among them, 6, all naturopaths, had provided more than 500. Over half (58%) reported that they did not feel they had the knowledge and skills necessary to provide authorizations. Depending on the condition, 29-93% of respondents correctly identified conditions that qualified a patient to receive a medical cannabis authorization. Very few knew that employers are not required to provide accommodations for medical cannabis. Health care professionals (64.8%) served as the most frequent source of information regarding cannabis risks and benefits. Over half (62%) strongly or somewhat agreed that the Drug Enforcement Agency should reschedule cannabis to make it legal at the federal level. Conclusion: A wide range of knowledge was exhibited within our sample of health care professionals regarding qualifying conditions for medical cannabis. As more states adopt comprehensive medical cannabis laws, health care professionals must be prepared to provide information to patients regarding the effects, risks, and benefits of cannabis. Standardized education could ensure that health care professionals are prepared to responsibly promote the use of cannabis when indicated for medically appropriate symptoms and conditions. A rational approach to medical cannabis is needed to assure that unforeseen consequences are mitigated.
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Affiliation(s)
- Louise Kaplan
- College of Nursing, Washington State University Vancouver, Vancouver, Washington, USA
| | - Tracy Klein
- College of Nursing, Washington State University Vancouver, Vancouver, Washington, USA
| | - Marian Wilson
- College of Nursing, Washington State University Spokane, Spokane, Washington, USA
| | - Janessa Graves
- College of Nursing, Washington State University Spokane, Spokane, Washington, USA
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Lombardi E, Gunter J, Tanner E. Ohio physician attitudes toward medical Cannabis and Ohio's medical marijuana program. J Cannabis Res 2020; 2:16. [PMID: 33526115 PMCID: PMC7819327 DOI: 10.1186/s42238-020-00025-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2019] [Accepted: 04/03/2020] [Indexed: 12/19/2022] Open
Abstract
Background Ohio’s medical cannabis program is one of three states that require physicians to become certified to recommend medical cannabis to their patients. The current study examines the attitudes of Ohio physicians toward medical cannabis and Ohio’s program to ascertain how likely physicians are to participate in Ohio’s program. Methods Physicians were invited to complete an internet survey that asked them about their concerns regarding medical marijuana, Ohio’s program, their likelihood of recommending medical cannabis, and becoming certified within the state. Ordinal and logistic regressions were used to understand the physicians’ likelihood of recommending cannabis, of becoming certified to recommend cannabis, and their attitude toward Ohio’s program. Results In total, 11,665 physicians licensed to practice in Ohio were contacted by email, and 344 responses were received for a response rate of 2.9%. Only 42 physicians reported being certified or had plans to become certified to recommend marijuana, and 62% were unlikely to recommend marijuana to their patients. Overall, the belief that medical cannabis should be legal had the greatest association with the likelihood of recommending cannabis (OR = .37, 95% CI = .24–.54), of becoming certified (OR = .21, 95% CI = .10–.38), and believing that Ohio’s program is too strict (OR = .39, 95% CI = .30–.51). However, the study sample precludes generalizing the results beyond this study. The 2.9% response rate could indicate a bias toward physicians who have strong opinions about the legality of medical cannabis. Conclusion The results show that many physicians have concerns about medical cannabis and Ohio’s program, and many physicians may not participate in the program. This could be a problem for patients who would like to use cannabis for medical reasons; therefore, these patients, may need to utilize one physician for cannabis and another for regular care. Physicians will likely be caring for patients who are using cannabis regardless of their own beliefs about it. The lack of training regarding cannabis in healthcare, along with requiring “certified recommenders” to have training could result in a fractured healthcare system.
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Affiliation(s)
- Emilia Lombardi
- Department of Public Health and Prevention Sciences, Baldwin Wallace University, 275 Eastland Rd, Berea, OH, 44017, USA.
| | - Joshua Gunter
- Department of Public Health and Prevention Sciences, Baldwin Wallace University, 275 Eastland Rd, Berea, OH, 44017, USA
| | - Erin Tanner
- Department of Public Health and Prevention Sciences, Baldwin Wallace University, 275 Eastland Rd, Berea, OH, 44017, USA
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Pereira L, Núñez-Iglesias MJ, Domínguez-Martís EM, López-Ares D, González-Peteiro M, Novío S. Nursing Students' Knowledge and Attitudes Regarding Medical Marijuana: A Descriptive Cross-Sectional Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17072492. [PMID: 32268474 PMCID: PMC7177422 DOI: 10.3390/ijerph17072492] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Revised: 03/27/2020] [Accepted: 04/03/2020] [Indexed: 01/06/2023]
Abstract
Marijuana use for medical purposes dates back to ancient times. Despite its high therapeutic potential, its adverse effects have raised important legal restrictions. However, this situation in Spain may soon undergo significant changes, without anyone so far having studied the knowledge and/or the level of acceptance of medical marijuana by future healthcare professionals. The aim of the present study was to determine nursing students’ knowledge of and attitudes towards medical marijuana. A cross-sectional design was used. A total of 578 nursing students from the University of Santiago de Compostela (Spain), ≥18 years old and of both sexes, were invited to complete the Spanish version of the questionnaire “Medical Marijuana” between January and May 2019. A total of 364 students decided to participate in the study. More than 75% of the students agreed with the legalization of medical marijuana, although their knowledge and confidence levels regarding efficacy, safety and drug interactions of medical marijuana were low. Nursing students showed a clear lack of knowledge about medical marijuana and thus, in light of possible regulatory changes, it would be necessary to strengthen the training of nurses with respect to medical marijuana in order to make responsible use of it.
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Affiliation(s)
- Laura Pereira
- Galician Public Health Care Service, Lugar Bouza 6, 36164 A Coruña, Spain;
| | - María Jesús Núñez-Iglesias
- School of Nursing, University of Santiago de Compostela, Av. Xoán XXIII, s/n, 15782 Coruña, Spain;
- Correspondence: (M.J.N.-I.); (S.N.); Tel.: +34-881-812-374 (M.J.N.-I. & S.N.)
| | - Eva María Domínguez-Martís
- Galician Public Health Care Service, Health Care Centre of Concepción Arenal, C/ Santiago León de Caracas 12, 15701 A Coruña, Spain;
| | - David López-Ares
- Galician Public Health Care Service, University Hospital Complex of A Coruña (CHUAC), C/ Xubias de Arriba, 84, 15006 A Coruña, Spain;
| | | | - Silvia Novío
- School of Nursing, University of Santiago de Compostela, Av. Xoán XXIII, s/n, 15782 Coruña, Spain;
- Correspondence: (M.J.N.-I.); (S.N.); Tel.: +34-881-812-374 (M.J.N.-I. & S.N.)
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Melnikov S, Aboav A, Shalom E, Phriedman S, Khalaila K. The effect of attitudes, subjective norms and stigma on health-care providers' intention to recommend medicinal cannabis to patients. Int J Nurs Pract 2020; 27:e12836. [PMID: 32237017 DOI: 10.1111/ijn.12836] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2019] [Revised: 02/27/2020] [Accepted: 03/12/2020] [Indexed: 11/28/2022]
Abstract
AIM The aim of this study was to explore the effect of health-care providers' attitudes towards the medical use of cannabis, subjective norms and perceived stigma towards medicinal cannabis users on health-care providers' intention to recommend medicinal cannabis for patients with qualifying conditions. METHODS A cross-sectional correlational study included 221 health-care providers (mean age, 42.2 ± 11.2; 74.2% women and 76.5% nurses) who completed a questionnaire examining theory-based variables and stigma towards medicinal cannabis users. RESULTS More positive attitudes towards the medical use of cannabis were associated with lower stigma towards medicinal cannabis users, which, in turn, was associated with a higher intention of recommending medicinal cannabis for patients with qualifying conditions. The relationship between attitudes towards the medical use of cannabis and the intention to recommend medicinal cannabis varies according to subjective norms. CONCLUSIONS Among nurses and physicians, stigma towards medicinal cannabis users mediated the relationship between attitudes towards the medical use of cannabis and the intention to recommend medicinal cannabis for patients with qualifying conditions, whereas subjective norms moderated this relationship. Effective treatment with medicinal cannabis might be compromised by health-care providers' negative attitudes, stigma and subjective norms.
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Affiliation(s)
- Semyon Melnikov
- Nursing Department, Steyer School of Health Professions, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Anat Aboav
- Department of Medicine A, Wolfson Medical Center, Holon, Israel
| | - Ester Shalom
- Department of Medicine F, Wolfson Medical Center, Holon, Israel
| | | | - Khaled Khalaila
- Department of Medicine F, Wolfson Medical Center, Holon, Israel
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Leeds FS, Levinthal RK, Alexander MT, Crawford TN. The distribution of Ohio's Certificates to Recommend: who will "prescribe" medical marijuana? J Cannabis Res 2020; 2:11. [PMID: 33526104 PMCID: PMC7819336 DOI: 10.1186/s42238-020-00019-z] [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: 08/23/2019] [Accepted: 02/18/2020] [Indexed: 11/30/2022] Open
Abstract
Background Under Ohio Medical Marijuana Control Program rules, Ohio physicians that recommend medical marijuana (MMJ) to patients must possess a Certificate to Recommend (CTR) from the State Medical Board. Although a pre-program state survey indicated that more than a quarter of Ohio physicians were likely to recommend MMJ, only 473 physicians obtained CTRs in the first year of the program, amounting to just 1.39% of the physician workforce. The purpose of this study is to evaluate demographic factors that influence a physician’s decision to obtain the CTR. Method Using physician demographic data extracted from Ohio’s databases of medical licensees and CTR holders, as well as the American Medical Association Physician Masterfile, prevalence ratios for CTR holders were calculated for specialty, medical degree (Doctor of Medicine, MD, vs. Doctor of Osteopathy, DO), age and gender. A multivariate model was implemented to generate adjusted prevalence ratios (aPRs) reflecting the independent effects of specialty, degree, and age. To assess temporal variations in CTR acquisition, per-specialty CTR counts were also plotted as a function of program month. Results The best-represented specialties among CTR holders were Family Medicine (29.11%), Internal Medicine and its subspecialties (22.57%), and Anesthesiology (9.07%). Expressed as an adjusted per-specialty prevalence ratio in reference to Family Medicine, the dominant specialty was Physical Medicine and Rehabilitation (aPR 2.08, 95% CI 1.34–3.24), with the lowest measurable prevalence ratios found in Pediatrics (aPR 0.17, 95% CI 0.10–0.30) and Surgery (aPR 0.33, 95% CI 0.22–0.50). DOs were more likely to obtain CTRs than MDs (aPR 1.72, 95% CI 1.39–2.15). The mean age of CTR holders was 54.03 +/− 11.43, vs. 51.13 +/− 13.38 for non-CTR holders (p < .0001). Although gender could not be included in the multivariate model, males were more likely than females to obtain a CTR (PR 1.54, 95%CI 1.26–1.89). A plot of per-month CTR acquisition by specialty demonstrated a fairly consistent specialty distribution of CTRs in the first year, as well as variations in overall CTR acquisition that may correspond to program-operational events. Conclusion Specialty, type of medical degree, and age all correlate independently with the likelihood of registering to recommend medical marijuana in Ohio. Specialty distribution of CTRs remained fairly consistent in the program’s first year, although overall CTR acquisition may be sensitive to program-operational events such as delays in dispensary opening or product availability.
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Affiliation(s)
- Frederic Stuart Leeds
- Department of Family Medicine, Wright State University Boonshoft School of Medicine, Dayton, OH, USA.
| | - Ryan K Levinthal
- Department of Family Medicine, Wright State University Boonshoft School of Medicine, Dayton, OH, USA
| | - Morgan T Alexander
- Department of Family Medicine, Wright State University Boonshoft School of Medicine, Dayton, OH, USA
| | - Timothy N Crawford
- Department of Family Medicine, Wright State University Boonshoft School of Medicine, Dayton, OH, USA.,Department of Population and Public Health Sciences, Wright State University Boonshoft School of Medicine, Dayton, OH, USA
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Russian Federation medical student knowledge, attitudes and beliefs toward medical cannabis. Complement Ther Med 2020; 48:102274. [DOI: 10.1016/j.ctim.2019.102274] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Revised: 11/26/2019] [Accepted: 11/27/2019] [Indexed: 11/22/2022] Open
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Exploring cancer survivors’ attitudes, perceptions, and concerns about using medical cannabis for symptom and side effect management: A qualitative focus group study. Complement Ther Med 2019; 47:102204. [DOI: 10.1016/j.ctim.2019.102204] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2019] [Revised: 08/24/2019] [Accepted: 09/29/2019] [Indexed: 01/28/2023] Open
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Wildberger J, Katz EC. Attitudes toward medical marijuana among substance use clinicians. JOURNAL OF SUBSTANCE USE 2019. [DOI: 10.1080/14659891.2019.1638458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Zolotov Y, Vulfsons S, Sznitman S. Predicting Physicians' Intentions to Recommend Medical Cannabis. J Pain Symptom Manage 2019; 58:400-407. [PMID: 31145978 DOI: 10.1016/j.jpainsymman.2019.05.010] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Revised: 05/16/2019] [Accepted: 05/18/2019] [Indexed: 10/26/2022]
Abstract
CONTEXT Although medical cannabis (MC) policies continue to evolve around the world, the integration of MC into clinical practice remains highly debated within the medical community. OBJECTIVES Relying on the Theory of Planned Behavior (TPB), this study aim was to identify underlying factors that influence physicians' intentions to recommend MC to patients and to examine whether there are differences in the strength of these associations across three medical specialties (family medicine, oncology, and pain medicine). METHODS 247 physicians completed questionnaires including measures of TPB constructs (attitudes, subjective norms, and perceived behavioral control) and intentions to recommend MC to two clinical vignettes describing medical background of a cancer and a chronic pain patient. Regression models were used to measure the extent to which perceived knowledge and TPB constructs predict physicians' intentions to recommend MC. RESULTS Physicians' intentions to recommend MC to the cancer patient vignette was higher than their intentions to recommend to the chronic pain patient vignette. Intentions to recommend MC to the patient with cancer were associated with more favorable attitudes toward MC, whereas intentions to recommend MC to the patient with chronic pain were associated with more favorable attitudes, higher levels of perceived control, and lower levels of perceived knowledge. CONCLUSION Clinical practices related to MC may be influenced by nonmedical factors, and this may be particularly prevailing in the field of chronic pain, suggesting that MC may be particularly contentious in this field.
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Affiliation(s)
- Yuval Zolotov
- School of Public Health, Faculty of Social Welfare and Health Sciences, University of Haifa, Haifa, Israel; Institute for Pain Medicine, Rambam Health Care Campus, Haifa, Israel; Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, Israel.
| | - Simon Vulfsons
- School of Public Health, Faculty of Social Welfare and Health Sciences, University of Haifa, Haifa, Israel; Institute for Pain Medicine, Rambam Health Care Campus, Haifa, Israel; Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, Israel
| | - Sharon Sznitman
- School of Public Health, Faculty of Social Welfare and Health Sciences, University of Haifa, Haifa, Israel; Institute for Pain Medicine, Rambam Health Care Campus, Haifa, Israel; Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, Israel
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Kosiba JD, Maisto SA, Ditre JW. Patient-reported use of medical cannabis for pain, anxiety, and depression symptoms: Systematic review and meta-analysis. Soc Sci Med 2019; 233:181-192. [PMID: 31207470 DOI: 10.1016/j.socscimed.2019.06.005] [Citation(s) in RCA: 120] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Revised: 05/17/2019] [Accepted: 06/03/2019] [Indexed: 12/20/2022]
Abstract
RATIONALE Certifications for medical cannabis are generally restricted to a small number of specific medical conditions, yet patients frequently report symptoms of pain, anxiety, and depression as reasons for use. This is a critical concern for researchers, healthcare providers, and policymakers, yet research in this area is currently obstructed by the lack of a focused review or empirical synthesis on patient-reported reasons for medical cannabis use. OBJECTIVES AND METHOD: The first aim of this project was to conduct the first systematic review and meta-analysis of empirical studies of patient-reported symptoms of pain, anxiety, and depression as reasons for medical cannabis use. The second aim was to conduct an empirical assessment of the methodological quality of extant research, test for publication bias, and test sex composition and quality scores of individual studies as possible sources of observed heterogeneity. RESULTS Meta-analytic results indicated that pain (64%), anxiety (50%), and depression/mood (34%) were common reasons for medical cannabis use. No evidence for publication bias was detected, despite heterogeneity in prevalence rates. A comprehensive assessment of study quality identified a number of specific methodological limitations of the existing research, including challenges in patient recruitment, use of restrictive sampling frames, and a lack of randomized recruitment methods and validated assessment measures. CONCLUSION Findings are discussed with regard to possible explanations for current results, clinical considerations, and areas of future research that are needed to move the field forward.
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Affiliation(s)
- Jesse D Kosiba
- Department of Psychology, Syracuse University, United States.
| | | | - Joseph W Ditre
- Department of Psychology, Syracuse University, United States
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Gardiner KM, Singleton JA, Sheridan J, Kyle GJ, Nissen LM. Health professional beliefs, knowledge, and concerns surrounding medicinal cannabis - A systematic review. PLoS One 2019; 14:e0216556. [PMID: 31059531 PMCID: PMC6502454 DOI: 10.1371/journal.pone.0216556] [Citation(s) in RCA: 80] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Accepted: 04/23/2019] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND The number of jurisdictions allowing access to medicinal cannabis has been steadily increasing since the state of California introduced legislation in 1996. Although there is a high degree of legislative heterogeneity across jurisdictions, the involvement of a health professional is common among all. This places health professionals at the forefront of therapy, yet no systematic review of literature has offered insight into the beliefs, knowledge, and concerns of health professionals regarding medicinal cannabis. METHODS Using a predetermined study protocol, PubMed, EMBASE, PsycINFO, CINAHL, and Scopus databases were searched for studies indexed up to the 1st August 2018. Pre-defined inclusion and exclusion criteria were applied uniformly. Screening for relevancy, full-text review, data extraction, and risk of bias were completed by two independent investigators. Risk of bias was assessed using CASP criteria (qualitative) and a modified domain-based risk assessment tool (quantitative). RESULTS Of the 15,775 studies retrieved, 106 underwent full-text review and of these, 26 were included. The overall risk of bias was considered low across all included studies. The general impression was that health professionals supported the use of medicinal cannabis in practice; however, there was a unanimous lack of self-perceived knowledge surrounding all aspects of medicinal cannabis. Health professionals also voiced concern regarding direct patient harms and indirect societal harms. CONCLUSION This systematic review has offered a lens through which to view the existing literature surrounding the beliefs, knowledge, and concerns of health professionals regarding medicinal cannabis. These results are limited, however, by the implicit common-sense models of behaviour utilised by the included studies. Before strategies can be developed and implemented to change health professional behaviour, a more thorough understanding of the factors that underpin the delivery of medicinal cannabis is necessary.
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Affiliation(s)
- Kyle M. Gardiner
- Discipline of Pharmacy, School of Clinical Sciences, Queensland University of Technology, Brisbane, Australia
- * E-mail:
| | - Judith A. Singleton
- Discipline of Pharmacy, School of Clinical Sciences, Queensland University of Technology, Brisbane, Australia
| | - Janie Sheridan
- School of Pharmacy, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Gregory J. Kyle
- Discipline of Pharmacy, School of Clinical Sciences, Queensland University of Technology, Brisbane, Australia
| | - Lisa M. Nissen
- Discipline of Pharmacy, School of Clinical Sciences, Queensland University of Technology, Brisbane, Australia
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Tatterton MJ, Walker C. The Prevalence of Nonprescription Cannabinoid-Based Medicines in British Children's Hospices: Results of a National Survey. J Palliat Med 2019; 22:1185-1190. [PMID: 30715962 DOI: 10.1089/jpm.2018.0522] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: Almost 50,000 children and young people are affected by life-limiting conditions in the United Kingdom, around a third of which use children's hospices. Anecdotal evidence suggests that cannabinoid-based medicines (CBMs), specifically cannabis oil (CO), are being used by families with increasing frequency to manage distressing symptoms. The use of most nonprescription CBMs in the United Kingdom remains illegal. Objective: The objective of the study was to identify the prevalence of CO use by families who use children's hospices in the United Kingdom, and the approaches taken by those services to manage it. Design: An electronic survey was sent to each of the 54 children's hospices in the United Kingdom between May and July 2018, comprising 10 questions. Results: Forty children's hospices from across the four countries of the United Kingdom responded to the survey, representing 74% of British children's hospices. About 87.5% of hospices knew of children who use CO therapeutically. Sixty-nine percent of those hospices have received requests to administer CO during an episode of care. Approaches by organizations around CO management varied across the sectors, including arrangements for storage, administration, and recording of its use. Hospices highlighted how the lack of available guidance made decision making more challenging. Only a third of responding organizations routinely questioned families about the use of cannabis when prescribing medicines. Conclusion: CO is used extensively by children who use children's hospices. Despite recognizing the use of CO, many hospices are unable to support it. There is a need for clear guidelines on how hospices should approach the care needs of children, allowing hospices to meet the needs of children who use CO, and families in a safe, consistent, and relevant way, safeguarding all children, families, and professionals within the organization.
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Saadeh CE, Rustem DR. Medical Marijuana Use in a Community Cancer Center. J Oncol Pract 2018; 14:e566-e578. [DOI: 10.1200/jop.18.00057] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
Purpose: The primary purpose of this study was to compare the incidence of marijuana use between patients with early- versus advanced-stage cancers. Differences in adverse effects, drug-drug interactions, and drug-disease interactions between those who use marijuana and those who do not were also compared. Methods: Patients age 18 years and older who were receiving chemotherapy were asked to complete an electronic self-reported questionnaire. In addition to questions about patient demographics, current adverse effects, cancer type and stage, comorbidities, performance status, treatment regimen, and general marijuana use, those patients who used marijuana within the last 30 days (current marijuana users) were asked additional questions about the route and frequency of marijuana administration, about reason(s) for use, about possession of a marijuana card, and if they had received any counseling about marijuana. Drug-drug and drug-disease interactions were also analyzed. Results: The overall incidence of marijuana use was 18.3% (32 of 175 patients). The incidence of marijuana use in patients with early- versus advanced-stage cancers was 19.6% (11 of 56 patients) versus 17.6% (21 of 119 patients; P = .75). Patients who use marijuana reported more pain, nausea, appetite issues, and anxiety. There were more drug-drug interactions associated with marijuana use, primarily with concurrent CNS depressants. The frequency of drug-disease interactions between those who use marijuana versus those who do not was similar. Conclusion: Approximately one in five patients with cancer who were receiving chemotherapy were using marijuana, and the frequency was equal in early- and advanced-stage cancer groups. The risks versus benefits should be discussed with all patients who use marijuana.
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Affiliation(s)
- Claire E. Saadeh
- Ferris State University College of Pharmacy, Big Rapids; and Herbert Herman Cancer Center, Lansing, MI
| | - Danielle R. Rustem
- Ferris State University College of Pharmacy, Big Rapids; and Herbert Herman Cancer Center, Lansing, MI
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Sharon H, Goldway N, Goor-Aryeh I, Eisenberg E, Brill S. Personal experience and attitudes of pain medicine specialists in Israel regarding the medical use of cannabis for chronic pain. J Pain Res 2018; 11:1411-1419. [PMID: 30104896 PMCID: PMC6074811 DOI: 10.2147/jpr.s159852] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Introduction The scientific study of the role of cannabis in pain medicine still lags far behind the growing use driven by public approval. Accumulated clinical experience is therefore an important source of knowledge. However, no study to date has targeted physicians who actually use cannabis in their daily practice. Methods Registered, active, board-certified pain specialists in Israel (n=79) were asked to complete a Web-based survey. The survey was developed using the Qualtrics Online Survey Software. Questions were formulated as multiple-choice questions, and these addressed three areas of interest: 1) doctors’ personal experience; 2) the role of cannabis in pain medicine; and 3) cannabis medicalization and legalization. Results Sixty-four percent of all practicing pain specialists in Israel responded. Almost all prescribe cannabis. Among them, 63% find cannabis moderately to highly effective, 56% have encountered mild or no side effects, and only 5% perceive it as significantly harmful. Common indications are neuropathic pain (65%), oncological pain (50%), arthralgias (25%), and any intractable pain (29%). Leading contraindications are schizophrenia (76%), pregnancy/breastfeeding (65%), and age <18 years (59%). Only 12% rated cannabis as more hazardous than opiates. On a personal note, 45% prefer cannabis for themselves or a family member. Lastly, 54% would like to see cannabis legalized in Israel. Conclusion In this survey, pain clinicians experienced in prescribing cannabis over prolonged periods view it as an effective and relatively safe treatment for chronic pain, based on their own experience. Their responses suggest a possible change of paradigm from using cannabis as the last resort.
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Affiliation(s)
- Haggai Sharon
- Institute of Pain Medicine, Department of Anesthesiology and Critical Care Medicine, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel, .,Center for Brain Functions, Wohl Institute for Advanced Imaging, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel, .,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel, .,Pain Management and Neuromodulation Centre, Guy's and St Thomas' Hospital, London, UK,
| | - Noam Goldway
- Center for Brain Functions, Wohl Institute for Advanced Imaging, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel,
| | | | - Elon Eisenberg
- Institute for Pain Medicine, Rambam Health Care Campus, Haifa, Israel.,Rappaport Faculty of Medicine, Technion Institute for Technology, Haifa, Israel
| | - Silviu Brill
- Institute of Pain Medicine, Department of Anesthesiology and Critical Care Medicine, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel, .,Goldman School of Medicine, Faculty of Health Sciences, Ben Gurion University of the Negev, Beer Sheva, Israel
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Karanges EA, Suraev A, Elias N, Manocha R, McGregor IS. Knowledge and attitudes of Australian general practitioners towards medicinal cannabis: a cross-sectional survey. BMJ Open 2018; 8:e022101. [PMID: 29970456 PMCID: PMC6042562 DOI: 10.1136/bmjopen-2018-022101] [Citation(s) in RCA: 78] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
OBJECTIVES To examine the knowledge and attitudes of Australian general practitioners (GP) towards medicinal cannabis, including patient demand, GP perceptions of therapeutic effects and potential harms, perceived knowledge and willingness to prescribe. DESIGN, SETTING AND PARTICIPANTS A cross-sectional survey completed by 640 GPs (response rate=37%) attending multiple-topic educational seminars in five major Australian cities between August and November 2017. MAIN OUTCOME MEASURES Number of patients enquiring about medicinal cannabis, perceived knowledge of GPs, conditions where GPs perceived it to be beneficial, willingness to prescribe, preferred models of access, perceived adverse effects and safety relative to other prescription drugs. RESULTS The majority of GPs (61.5%) reported one or more patient enquiries about medicinal cannabis in the last three months. Most felt that their own knowledge was inadequate and only 28.8% felt comfortable discussing medicinal cannabis with patients. Over half (56.5%) supported availability on prescription, with the preferred access model involving trained GPs prescribing independently of specialists. Support for use of medicinal cannabis was condition-specific, with strong support for use in cancer pain, palliative care and epilepsy, and much lower support for use in depression and anxiety. CONCLUSIONS The majority of GPs are supportive or neutral with regards to medicinal cannabis use. Our results highlight the need for improved training of GPs around medicinal cannabis, and the discrepancy between GP-preferred models of access and the current specialist-led models.
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Affiliation(s)
- Emily A Karanges
- The Lambert Initiative for Cannabinoid Therapeutics, The University of Sydney, Sydney, New South Wales, Australia
- School of Psychology, The University of Sydney, Sydney, New South Wales, Australia
| | - Anastasia Suraev
- The Lambert Initiative for Cannabinoid Therapeutics, The University of Sydney, Sydney, New South Wales, Australia
- School of Psychology, The University of Sydney, Sydney, New South Wales, Australia
| | - Natalie Elias
- The Lambert Initiative for Cannabinoid Therapeutics, The University of Sydney, Sydney, New South Wales, Australia
- School of Psychology, The University of Sydney, Sydney, New South Wales, Australia
| | | | - Iain S McGregor
- The Lambert Initiative for Cannabinoid Therapeutics, The University of Sydney, Sydney, New South Wales, Australia
- School of Psychology, The University of Sydney, Sydney, New South Wales, Australia
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Caligiuri FJ, Ulrich EE, Welter KJ. Pharmacy Student Knowledge, Confidence and Attitudes Toward Medical Cannabis and Curricular Coverage. AMERICAN JOURNAL OF PHARMACEUTICAL EDUCATION 2018; 82:6296. [PMID: 30013243 PMCID: PMC6041497 DOI: 10.5688/ajpe6296] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/24/2017] [Accepted: 02/11/2017] [Indexed: 05/25/2023]
Abstract
Objective. To assess pharmacy student confidence in their knowledge of qualifying conditions for medical cannabis use in the US and their attitudes toward curricular coverage of medical cannabis. Methods. Students were asked to complete an electronic survey to measure knowledge and confidence in various domains of medical cannabis treatment, including qualifying conditions, adverse effects, and other patient care skills. Results. There were 238 students who completed the survey. Responses to all domains and their corresponding confidence levels displayed a lack in confidence. The only domain wherein students had confidence in was their ability to retrieve related drug information. Nearly 80% of students felt that the topic of medical cannabis should be added to existing curricula within the next five years. Conclusion. With the prevalence of cannabis programs and knowledge gap, pharmacy schools should consider coverage of medical cannabis in the curricula.
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Affiliation(s)
- Frank J Caligiuri
- Drake University College of Pharmacy and Health Sciences, Des Moines, Iowa
| | - Erin E Ulrich
- Drake University College of Pharmacy and Health Sciences, Des Moines, Iowa
| | - Kelli Jo Welter
- Drake University College of Pharmacy and Health Sciences, Des Moines, Iowa
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Luba R, Earleywine M, Farmer S, Slavin M. Cannabis in End-of-Life Care: Examining Attitudes and Practices of Palliative Care Providers. J Psychoactive Drugs 2018; 50:348-354. [PMID: 29714640 DOI: 10.1080/02791072.2018.1462543] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Medical cannabis research has become quite extensive, with indications ranging from glaucoma to chemotherapy-induced nausea. Despite increased interest in cannabis' potential medical uses, research barriers, cannabis legislation, stigma, and lack of dissemination of data contribute to low adoption for some medical populations. Of interest, cannabis use appears low in palliative care settings, with few guidelines available to palliative care providers. The present study sought to examine the attitudes, beliefs, and practices of palliative care providers regarding the use of cannabis for terminally ill patients. Palliative care providers (N = 426) completed a one-time online survey assessing these attitudes, beliefs, and practices. Results demonstrated that palliative care providers endorse cannabis for a wide range of palliative care symptoms, end-of-life care generally, and as an adjuvant medication. Nevertheless, the gap between these beliefs and actual recommendation or prescription appears vast. Many who support the use of cannabis in palliative care do not recommend it as a treatment. These data suggest recommendations for healthcare providers and palliative care organizations.
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Affiliation(s)
- Rachel Luba
- a Department of Psychology , University at Albany, State University of New York , Albany , NY , USA
| | - Mitch Earleywine
- a Department of Psychology , University at Albany, State University of New York , Albany , NY , USA
| | - Stacey Farmer
- a Department of Psychology , University at Albany, State University of New York , Albany , NY , USA
| | - Melissa Slavin
- a Department of Psychology , University at Albany, State University of New York , Albany , NY , USA
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43
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Zolotov Y, Vulfsons S, Zarhin D, Sznitman S. Medical cannabis: An oxymoron? Physicians' perceptions of medical cannabis. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2018; 57:4-10. [PMID: 29653439 DOI: 10.1016/j.drugpo.2018.03.025] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2017] [Revised: 03/11/2018] [Accepted: 03/20/2018] [Indexed: 10/17/2022]
Abstract
BACKGROUND Medical cannabis policies are changing in many places around the world, and physicians play a major role in the implementation of these policies. The aim of this study was to gain a deeper understanding of physicians' views on medical cannabis and its possible integration into their clinic, as well as to identify potential underlying factors that influence these perceptions. METHODS Qualitative narrative analysis of in-depth interviews with twenty-four Israeli physicians from three specialties (pain medicine, oncology and family medicine). FINDINGS Physicians disclosed contrasting narratives of cannabis, presenting it as both a medicine and a non-medicine. These divergent positions co-existed and were intertwined in physicians' accounts. When presenting cannabis as a non-medicine, physicians drew on conventional medicine and prohibition as narrative environments. They emphasized the incongruence of cannabis with standards of biomedicine and presented cannabis as an addictive drug of abuse. In contrast, physicians drew upon unconventional medicine and palliative care as narrative environments while presenting cannabis as a medicine. In this narrative, physicians emphasized positive hands-on experiences with cannabis, and pointed to the limits of conventional medicine. CONCLUSION Physicians did not have a consolidated perspective as to whether cannabis is a medicine or not, but rather struggled with this question. The dualistic narratives of cannabis reflect the lack of a dominant narrative environment that supports the integration of cannabis into medical practice. This may in turn indicate barriers to the implementation of medical cannabis policies. An awareness of physicians' views and the different levels of their willingness to implement medical cannabis policies is essential for policy developments in this evolving field.
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Affiliation(s)
- Yuval Zolotov
- School of Public Health, Faculty of Social Welfare and Health Sciences, University of Haifa, Israel.
| | - Simon Vulfsons
- Institute for Pain Medicine, Rambam Health Care Campus, Haifa, Israel; Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, Israel
| | - Dana Zarhin
- School of Public Health, Faculty of Social Welfare and Health Sciences, University of Haifa, Israel
| | - Sharon Sznitman
- School of Public Health, Faculty of Social Welfare and Health Sciences, University of Haifa, Israel
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44
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Sideris A, Khan F, Boltunova A, Cuff G, Gharibo C, Doan LV. New York Physicians' Perspectives and Knowledge of the State Medical Marijuana Program. Cannabis Cannabinoid Res 2018; 3:74-84. [PMID: 29662957 PMCID: PMC5899285 DOI: 10.1089/can.2017.0046] [Citation(s) in RCA: 48] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Introduction: In 2014, New York (NY) became the 23rd state to legalize medical marijuana (MMJ). The purpose of this survey was to collect data about practicing NY physicians' comfort level, opinions, and experience in recommending or supporting patient use of MMJ. Materials and Methods: An anonymous web-based survey was distributed to medical societies and to academic departments in medical schools within NY. Results: A total of 164 responses were analyzed. Physician participants were primarily located in New York City and surrounding areas. The majority (71%) agreed that MMJ should be an option available to patients. Most respondents were not registered to certify MMJ in NY, but were willing to refer patients to registered physicians. Common reasons for not registering included specialty and federal status of cannabis. More than 75% reported having patients who used cannabis for symptom control, and 50% reported having patients who inquired about MMJ within the past year. Most respondents are willing to discuss MMJ with their patients, but had little familiarity with the state program and a modest knowledge of the endocannabinoid system. Pain was a common symptom for which cannabis was recommended by registered physicians (69%) and purportedly used by patients (83%). Most respondents would consider MMJ as an adjuvant to opioids, and 84% believed opioids have greater risks than MMJ. Conclusion: Given that the majority of surveyed physicians support MMJ as an option for patients, few are registered and have adequate knowledge of MMJ. Although our study sample is small and geographically limited, our survey results highlight key physician issues that are likely applicable to practitioners in other states. Concerted efforts are needed at the federal, state, and academic levels to provide practitioners with evidence-based guidelines for the safe use of MMJ.
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Affiliation(s)
- Alexandra Sideris
- Department of Anesthesiology, Perioperative Care and Pain Medicine, New York University Langone Health, New York, New York
| | - Fahad Khan
- Department of Anesthesiology, Perioperative Care and Pain Medicine, New York University Langone Health, New York, New York
| | - Alina Boltunova
- Department of Anesthesiology, Perioperative Care and Pain Medicine, New York University Langone Health, New York, New York
| | - Germaine Cuff
- Department of Anesthesiology, Perioperative Care and Pain Medicine, New York University Langone Health, New York, New York
| | - Christopher Gharibo
- Department of Anesthesiology, Perioperative Care and Pain Medicine, New York University Langone Health, New York, New York
| | - Lisa V Doan
- Department of Anesthesiology, Perioperative Care and Pain Medicine, New York University Langone Health, New York, New York
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45
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Balneaves LG, Alraja A, Ziemianski D, McCuaig F, Ware M. A National Needs Assessment of Canadian Nurse Practitioners Regarding Cannabis for Therapeutic Purposes. Cannabis Cannabinoid Res 2018; 3:66-73. [PMID: 29588917 PMCID: PMC5868330 DOI: 10.1089/can.2018.0002] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Introduction: In Canada, the Access to Cannabis for Medical Purposes Regulations (ACMPR) has given nurse practitioners (NPs) the power to authorize cannabis for therapeutic purposes (CTP) to eligible patients. This expansion in NPs' scope of practice underscores the importance of delivering balanced, evidence-based education on cannabis to NPs. The aim of this national study was to assess NPs' knowledge and practice gaps related to CTP to inform the development of future education resources that increase NPs' clinical competence and improve patient care related to medical cannabis. Methods: This is a quantitative, descriptive exploratory design study. A national online survey of NPs was conducted from August 2013 to June 2014. NPs were recruited through email lists held by numerous Canadian nursing organizations. The survey was adapted from a previous national survey that assessed CTP educational needs among Canadian physicians. The survey assessed NPs' knowledge, experience, barriers, and attitudes related to CTP as well as preferred format for future CTP education. Results: The sample consisted of 182 NPs from across Canada. The largest knowledge gap was related to dosing and creating effective treatment plans for patients using CTP. The majority of respondents (76.3%) ranked the need for education on CTP to be either strong or very strong. Over half (57%) reported that they would be comfortable authorizing medical cannabis through the ACMPR; this number increased to 64% if they were to receive appropriate education. Conclusion: Nursing regulatory organizations, in partnership with academic institutions and government agencies, must work toward the development of educational and clinical competencies specific to CTP. Tailored education programs are needed to address the knowledge gaps held by NPs and the clinical barriers they face to including CTP as part of their care.
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Affiliation(s)
- Lynda G Balneaves
- College of Nursing, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Abeer Alraja
- Manitoba Centre for Nursing and Health Research, University of Manitoba, Winnipeg, Canada
| | - Daniel Ziemianski
- Canadian Consortium for the Investigation of Cannabinoids, Montreal, Canada.,School of Physical and Occupational Therapy, McGill University, Montreal, Canada
| | - Fairleth McCuaig
- School of Nursing, Faculty of Applied Science, University of British Columbia, Vancouver, Canada
| | - Mark Ware
- Canadian Consortium for the Investigation of Cannabinoids, Montreal, Canada.,Department of Anesthesia, McGill University, Montreal, Canada.,Department of Family Medicine, McGill University, Montreal, Canada.,Alan Edwards Pain Management Unit, McGill University, Montreal, Canada
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46
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Ananth P, Reed-Weston A, Wolfe J. Medical marijuana in pediatric oncology: A review of the evidence and implications for practice. Pediatr Blood Cancer 2018; 65. [PMID: 28926679 DOI: 10.1002/pbc.26826] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2017] [Revised: 08/30/2017] [Accepted: 08/30/2017] [Indexed: 12/12/2022]
Abstract
Medical marijuana (MM) has become increasingly legal at the state level and accessible to children with serious illness. Pediatric patients with cancer may be particularly receptive to MM, given purported benefits in managing cancer-related symptoms. In this review, we examine the evidence for MM as a supportive care agent in pediatric oncology. We describe the current legal status of MM, mechanism of action, common formulations, and potential benefits versus risks for pediatric oncology patients. We offer suggestions for how providers might approach MM requests. Throughout, we comment on avenues for future investigation on this growing trend in supportive care.
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Affiliation(s)
- Prasanna Ananth
- Department of Pediatric Hematology/Oncology, Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, Massachusetts
| | - Anne Reed-Weston
- Columbia University College of Physicians and Surgeons, New York, New York
| | - Joanne Wolfe
- Department of Pediatric Hematology/Oncology, Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, Massachusetts.,Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts
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47
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Ananth P, Ma C, Al-Sayegh H, Kroon L, Klein V, Wharton C, Hallez E, Braun I, Michelson K, Rosenberg AR, London W, Wolfe J. Provider Perspectives on Use of Medical Marijuana in Children With Cancer. Pediatrics 2018; 141:peds.2017-0559. [PMID: 29233937 PMCID: PMC5744275 DOI: 10.1542/peds.2017-0559] [Citation(s) in RCA: 48] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/23/2017] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Although medical marijuana (MM) may have utility in the supportive care of children with serious illness, it remains controversial. We investigated interdisciplinary provider perspectives on legal MM use in children with cancer. METHODS We sent a 32-item, cross-sectional survey to 654 pediatric oncology providers in Illinois, Massachusetts, and Washington characterizing MM practices, knowledge, attitudes, and barriers. Forty-eight percent responded; 44% (n = 288) were included in analyses. Providers were stratified by status as legally eligible to certify (ETC) for MM. We used Fisher's exact and Wilcoxon rank tests and univariate and multivariate logistic regression models for group comparisons. RESULTS The provider median age was 35 years (range 22-70 years); 33% were ETC (83 physicians; 13 Washington state advance practice providers). Thirty percent of providers received ≥1 request for MM in the previous month. Notably, only 5% of all providers knew state-specific regulations. ETC providers were more likely to know that MM is against federal laws (P < .0001). Whereas most providers (92%) reported willingness to help children with cancer access MM, in adjusted models, ETC providers were less likely to indicate approval of patient MM use by smoking, oral formulations, as cancer-directed therapy, or to manage symptoms (P < .005 for all). Forty-six percent of all providers cited the absence of standards around formulations, potency, or dosing to be the greatest barrier to recommending MM. CONCLUSIONS Most pediatric oncology providers are willing to consider MM use in children with cancer and receive frequent inquiries. However, ETC providers endorse less favorable attitudes overall. The absence of standards is an important barrier to recommending MM.
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Affiliation(s)
- Prasanna Ananth
- Section of Pediatric Hematology/Oncology, Department of Pediatrics, Yale School of Medicine, New Haven, Connecticut;
| | - Clement Ma
- Department of Pediatric Hematology/Oncology, Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, Massachusetts;,Harvard Medical School, Boston, Massachusetts
| | - Hasan Al-Sayegh
- Department of Pediatric Hematology/Oncology, Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, Massachusetts
| | - Leah Kroon
- Seattle Children's Cancer and Blood Disorders Center, Seattle, Washington;,Treuman Katz Center for Pediatric Bioethics, Seattle, Washington
| | - Victoria Klein
- Seattle Children's Cancer and Blood Disorders Center, Seattle, Washington
| | - Claire Wharton
- Seattle Children's Cancer and Blood Disorders Center, Seattle, Washington
| | - Elise Hallez
- Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
| | - Ilana Braun
- Harvard Medical School, Boston, Massachusetts;,Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Kelly Michelson
- Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois;,Center for Bioethics and Medical Humanities, Northwestern University Feinberg School of Medicine, Chicago, Illinois; and
| | - Abby R. Rosenberg
- Seattle Children's Cancer and Blood Disorders Center, Seattle, Washington;,Treuman Katz Center for Pediatric Bioethics, Seattle, Washington;,University of Washington School of Medicine, Seattle, Washington
| | - Wendy London
- Department of Pediatric Hematology/Oncology, Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, Massachusetts;,Harvard Medical School, Boston, Massachusetts
| | - Joanne Wolfe
- Department of Pediatric Hematology/Oncology, Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, Massachusetts;,Harvard Medical School, Boston, Massachusetts;,Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts
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48
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Chan MH, Knoepke CE, Cole ML, McKinnon J, Matlock DD. Colorado Medical Students' Attitudes and Beliefs About Marijuana. J Gen Intern Med 2017; 32:458-463. [PMID: 28097606 PMCID: PMC5377890 DOI: 10.1007/s11606-016-3957-y] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2016] [Revised: 07/14/2016] [Accepted: 12/02/2016] [Indexed: 11/25/2022]
Abstract
BACKGROUND Over the past two decades, state and local governments across the U.S. have been increasingly reforming marijuana laws. Despite growing support for marijuana as a medical treatment, little is known about medical students' perceptions of marijuana use. OBJECTIVE To assess Colorado medical students' personal and professional opinions on current and future marijuana use in a healthcare setting. DESIGN A voluntary, anonymous, online cross-sectional survey. PARTICIPANTS Medical students (n = 624) at the University of Colorado School of Medicine between January and February 2014 were invited to participate. MAIN MEASURES Numerical responses were quantified using counts and percentages, and Likert scale responses were collapsed for bivariate analysis. Items were gathered thematically and additively scored for each subscale. Internal consistency reliability statistics were calculated for each subscale to ensure that items were assessing similar constructs. Unadjusted t tests and one-way analysis of variance (ANOVA) were used to calculate mean differences in subscale scores between subgroups. KEY RESULTS We received 236 responses (37%). Students indicated support for marijuana legalization (64%), and few believed that physicians should be penalized for recommending marijuana to patients (6%). Nearly all (97%) believed that further marijuana research should be conducted, and believed marijuana could play a role in the treatment of various medical conditions. Seventy-seven percent reported that they believed marijuana use had the potential for psychological harm, and 68% indicated concern for potential physical harm. Only a minority of students would recommend marijuana to a patient under current law (29%), or if it were legally available (45%). Acceptability of marijuana for treatment of approved conditions was not correlated with age or gender, but was positively correlated with living in Colorado prior to medical school (p < 0.001) and with prior marijuana use (p < 0.001). CONCLUSIONS Medical students support marijuana legal reform, medicinal uses of marijuana, and increased research, but have concerns regarding risks of marijuana use, and appear hesitant to recommend marijuana to patients.
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Affiliation(s)
- Michael H Chan
- University of Colorado School of Medicine, 13199 E. Montview Blvd., Suite 210; Mail Stop F443, Aurora, CO, 80045, USA
- University of Texas Health Sciences Center at Houston, Houston, TX, 77030, USA
| | - Christopher E Knoepke
- University of Colorado School of Medicine, 13199 E. Montview Blvd., Suite 210; Mail Stop F443, Aurora, CO, 80045, USA
| | - Madeline L Cole
- University of Colorado School of Medicine, 13199 E. Montview Blvd., Suite 210; Mail Stop F443, Aurora, CO, 80045, USA
- MetroHealth Medical Center, Case Western Reserve University, Cleveland, OH, 44109, USA
| | - James McKinnon
- University of Colorado School of Medicine, 13199 E. Montview Blvd., Suite 210; Mail Stop F443, Aurora, CO, 80045, USA
| | - Daniel D Matlock
- University of Colorado School of Medicine, 13199 E. Montview Blvd., Suite 210; Mail Stop F443, Aurora, CO, 80045, USA.
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49
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Gazibara T, Prpic M, Maric G, Pekmezovic T, Kisic-Tepavcevic D. Medical Cannabis in Serbia: The Survey of Knowledge and Attitudes in an Urban Adult Population. J Psychoactive Drugs 2017. [DOI: 10.1080/02791072.2017.1292434] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Affiliation(s)
- Tatjana Gazibara
- Teaching Assistant, Institute of Epidemiology, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Milica Prpic
- Medical Student, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Gorica Maric
- Teaching Assistant, Institute of Epidemiology, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Tatjana Pekmezovic
- Professor, Institute of Epidemiology, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Darija Kisic-Tepavcevic
- Associate Professor, Institute of Epidemiology, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
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50
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Crowley D, Collins C, Delargy I, Laird E, Van Hout MC. Irish general practitioner attitudes toward decriminalisation and medical use of cannabis: results from a national survey. Harm Reduct J 2017; 14:4. [PMID: 28086792 PMCID: PMC5237358 DOI: 10.1186/s12954-016-0129-7] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2016] [Accepted: 12/23/2016] [Indexed: 11/23/2022] Open
Abstract
Background Governmental debate in Ireland on the de facto decriminalisation of cannabis and legalisation for medical use is ongoing. A cannabis-based medicinal product (Sativex®) has recently been granted market authorisation in Ireland. This unique study aimed to investigate Irish general practitioner (GP) attitudes toward decriminalisation of cannabis and assess levels of support for use of cannabis for therapeutic purposes (CTP). Methods General practitioners in the Irish College of General Practitioner (ICGP) database were invited to complete an online survey. Anonymous data yielded descriptive statistics (frequencies, percentages) to summarise participant demographic information and agreement with attitudinal statements. Chi-square tests and multi-nominal logistic regression were included. Results The response rate was 15% (n = 565) which is similar to other Irish national GP attitudinal surveys. Over half of Irish GPs did not support the decriminalisation of cannabis (56.8%). In terms of gender, a significantly higher proportion of males compared with females (40.6 vs. 15%; p < 0.0001) agreed or strongly agreed with this drug policy approach. A higher percentage of GPs with advanced addiction specialist training (level 2) agreed/strongly agreed that cannabis should be decriminalised (54.1 vs. 31.5%; p = 0.021). Over 80% of both genders supported the view that cannabis use has a significant effect on patients’ mental health and increases the risk of schizophrenia (77.3%). Over half of Irish GPs supported the legalisation of cannabis for medical use (58.6%). A higher percentage of those who were level 1-trained (trained in addiction treatment but not to an advanced level) agreed/strongly agreed cannabis should be legalised for medical use (p = 0.003). Over 60% agreed that cannabis can have a role in palliative care, pain management and treatment of multiple sclerosis (MS). In the regression response predicator analysis, females were 66.2% less likely to agree that cannabis should be decriminalised, 42.5% less likely to agree that cannabis should be legalised for medical use and 59.8 and 37.6% less likely to agree that cannabis has a role in palliative care and in the treatment of multiple sclerosis (respectively) than males. Conclusions The majority of Irish GPs do not support the present Irish governmental drug policy of decriminalisation of cannabis but do support the legalisation of cannabis for therapeutic purposes. Male GPs and those with higher levels of addiction training are more likely to support a more liberal drug policy approach to cannabis for personal use. A clear majority of GPs expressed significant concerns regarding both the mental and physical health risks of cannabis use. Ongoing research into the health and other effects of drug policy changes on cannabis use is required.
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Affiliation(s)
- Des Crowley
- Irish College of General Practitioners, Dublin, Ireland
| | | | - Ide Delargy
- Irish College of General Practitioners, Dublin, Ireland
| | - Eamon Laird
- School of Biochemistry and Immunology, Trinity College Dublin, Dublin, Ireland
| | - Marie Claire Van Hout
- School of Health Sciences, Waterford Institute of Technology, Waterford, Ireland. .,Irish College of General Practitioners, Dublin, Ireland.
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