Medical Students’ Attitudes, Knowledge, and Beliefs about Medical Cannabis: A Qualitative Descriptive Study

The role of stigma in cannabis use disclosure: an exploratory study

BACKGROUND

Although cannabis use incidence, societal acceptance, and legislation all trend positively, cannabis remains federally illegal in the USA. Prior studies have revealed that patients are reluctant to disclose their cannabis use history in the healthcare system, which can negatively impact patient care. This study reports the frequency of cannabis use disclosure with special considerations for stigmatization. To better understand the limitations, providers face in providing collaborative, comprehensive, and informed care, this study evaluated four domains of stigma: perceived, anticipated, enacted, and internalized.

METHODS

This study used a descriptive exploratory design. Data collection occurred using an anonymous, online national survey with a convenience sample in the USA. Recruitment relied on electronic media and occurred between July and December 2022. Participants were adults older than 21 years and self-identified as having used cannabis and accessed the healthcare system within the last five years. The survey measured demographic characteristics, cannabis use, and disclosure patterns. Stigma was measured using the Stigma Use Stigma Mechanism Scale (SU-SMS) and Substance Abuse Use Self-Stigma Scale (SASSS) with language modifications for cannabis. Ordinal logistic regression models were performed to evaluate associations between the frequency of cannabis use disclosure patterns and each stigma category. Associations were assessed using Chi-squared or Fisher's exact tests.

RESULTS

Data were available for 249 respondents. Most participants (57.1%) reported initiating a conversation about cannabis with their healthcare provider; 27.8% of the time, cannabis is never discussed, and healthcare providers initiate only 15.1% of related discussions. Anticipated stigma [95% CI 1.045-1.164] and total stigma [95% CI 1.001-1.039] had statistically significant associations with nondisclosure. Annual household income (p = .04), chronicity of cannabis use (p = .03), frequency of cannabis use (p = .02), and a known amount of CBD in products consumed (p = .01) had statistically significant associations with the frequency of cannabis use disclosure.

CONCLUSIONS

Patients who use cannabis experience stigmatization in the healthcare setting that may limit disclosure of cannabis use history. Future studies would be well served to explore anticipated stigma more deeply. Healthcare providers should be knowledgeable to lead such conversations relating to cannabis while maintaining an unbiased perspective.

Predictors of Pharmacy Students' Attitudes About the Therapeutic Use of Psilocybin

Background Psilocybin has been studied for its potential therapeutic benefits, particularly for the treatment of psychiatric disorders such as anxiety, depression, and obsessive-compulsive disorder. While more research is needed as psilocybin-assisted therapy becomes more prevalent, future pharmacists will probably be involved at some level. At present, pharmacists receive minimal training on psilocybin, and little is known about their attitudes toward its use for medical purposes. Findings from recent clinical studies have attempted to establish the safety and medical efficacy of psilocybin, leading to an increased interest in therapeutic psilocybin use in the United States. This study aimed to assess if self-assessed knowledge of psilocybin, concerns about adverse effects, and opinions about legalization will make statistically significant contributions to pharmacy students' attitudes about psilocybin use in practice. Methods Pharmacy students' self-assessed knowledge, concern for potential adverse effects, and perceptions of psilocybin were investigated using a cross-sectional survey study design. Data were collected from March 13 to April 7, 2023, from a convenience sample of 161 pharmacy students enrolled in an accredited pharmacy school in the southern region of the United States using a 41-item anonymous quantitative survey developed by the researchers that contained validated scales. The survey was delivered electronically. Multiple regression modeling was conducted to determine if self-assessed knowledge, concerns for adverse effects, and opinions about legalization would predict pharmacy students' attitudes about therapy-assisted psilocybin use. This study was approved by the Institutional Review Board of the authors' university. Results The mean age of the 161 participants was 24 years (SD = 2.981; range 20-40 years). Twenty (12.4%) participants reported previous use of psilocybin for recreational purposes and two (1.2%) reported having used it therapeutically. Many (n =121; 75.2%) of the participants believed that psilocybin should be decriminalized for therapeutic use, but only 54 (33.5%) thought it should be decriminalized for recreational use. A multiple linear regression model predicting "attitudes about psilocybin" (dependent variable) produced significant results: (F(4, 122) = 40.575, p < 0.001), with an R2 = 0.571 (adjusted R2 = 0.557). Greater "self-assessed knowledge about psilocybin," less "concern about possible negative effects," greater "belief in the decriminalization of psilocybin for recreational use," and greater "belief in the decriminalization of psilocybin for therapeutic use" (all independent variables) were associated with more positive perceptions about medical psilocybin. The percentage of variance in the scores accounted for by the model was 57%. Conclusions Pharmacy students may lack information and training regarding psilocybin and report a desire to learn more about it. Their attitudes about medical psilocybin may be driven by this desire to learn in addition to concerns about adverse effects and legalization issues. Due to the dearth of published information regarding the knowledge and acceptance of psilocybin as a viable treatment option for patients, further research in psychedelic-assisted treatments may be warranted.

Predictors of Medical Students' Perceptions of Psilocybin-Assisted Therapy for Use in Medical Practice

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.