Medical professionals want more information about medicinal cannabis before they start prescribing it to patients, a new study has found.
Researchers from the Queensland University of Technology conducted a wide-ranging review of 26 published studies across Australia, the United States, Canada and Ireland.
QUT pharmacy PhD candidate Kyle Gardiner led the analysis and said the main theme running through all the studies was that medical professionals broadly supported the idea of medicinal cannabis but lacked information about it.
“Health professionals support medicinal cannabis but that support is sometimes offset by their concerns,” Mr Gardiner said.
In particular, a major concern among many of the health professionals surveyed was the psychiatric effect of medicinal cannabis, which it was felt had not been researched thoroughly enough.
In nearly every jurisdiction where medicinal cannabis is legal, at least one medical professional is required to sign off for a person to access it.
“There’s a big difference between being supportive of medicinal cannabis and actually delivering medicinal cannabis on the ground,” Mr Gardiner said.
“There’s still a lot we don’t know about medicinal cannabis … when it comes to the pharmacology, what does it do on a molecular level and how does it affect things like chronic pain or symptoms of MS [multiple sclerosis]?”
Mr Gardiner stressed the study – supervised by Professor Lisa Nissen, Head of QUT’s Faculty of Health School of Clinical Sciences – wasn’t about the benefits of medicinal cannabis itself, but how medical professionals reacted to the emerging treatment.
- Published: May 6, 2019
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.
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).
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.
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.
Citation: Gardiner KM, Singleton JA, Sheridan J, Kyle GJ, Nissen LM (2019) Health professional beliefs, knowledge, and concerns surrounding medicinal cannabis – A systematic review. PLoS ONE 14(5): e0216556. https://doi.org/10.1371/journal.pone.0216556
Editor: Katie MacLure, Robert Gordon University, UNITED KINGDOM
Received: December 17, 2018; Accepted: April 23, 2019; Published: May 6, 2019
Copyright: © 2019 Gardiner et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Data Availability: All relevant data are within the paper and its Supporting Information files.
Funding: The author(s) received no specific funding for this work.
Competing interests: The authors have declared that no competing interests exist.
Current literature suggests that cannabis was first used medicinally by the ancient Chinese before spreading throughout the rest of the world.[1, 2] Although there is difficulty discerning medicinal and non-secular use during early periods, it was by anecdote that cannabis was passed down and considered medically useful.[2, 3] Cannabis continued to be used medicinally until the early-20th century. It was this period of time that saw the prohibition of opium and coca leaves with prohibition extending to cannabis due to its psychoactive properties. The penultimate prohibitive effort was the signing of the 1961 United Nations Single Convention on Narcotic Drugs. Under this convention, cannabis was considered to have an extremely limited therapeutic value while simultaneously being considered to be a high risk of dependence and misuse. Subsequently, generations of health professionals were educated in a system where cannabis was considered purely illicit. More recent studies have demonstrated, however, a plausible rationale for therapeutic action.[6–8] Yet, there are difficulties translating these findings into practice due to a number of issues surrounding the creation of evidence. For instance, it has been very challenging to perform clinical trials on herbal cannabis due to the enduring illicit status of cannabis across much of the world. Furthermore, studies performed on pharmaceutical cannabis preparations often lack consistency in the products and composition of cannabinoids used which makes comparison of trial results hard. Among others, these difficulties are commonly acknowledged in studies examining cannabinoid preparations alongside calls for further large, robust randomised controlled trials to confirm the effects of cannabinoids relative to safety and efficacy.[9–12]
A public vote saw the State of California approve the use of medicinal cannabis in 1996. Since this time, many other jurisdictions have legislated for medicinal cannabis. Although all jurisdictions are using different regulatory frameworks, common among all is the involvement of a health professional in the delivery of medicinal cannabis.[15, 16] For purposes of this study, ‘delivery’ includes authorisation and supply. Depending on the jurisdiction, authorisation can include medical recommendations or prescribing, while supply involves the dispensing and administration of medicinal cannabis.[15, 16] It is for this reason that a review of health professionals’ beliefs and knowledge of medicinal cannabis is important. Without the support of these key stakeholders it is likely that many who may benefit from medicinal cannabis will not receive therapy. By working to better understand the broader context in which health professionals deliver medicinal cannabis, further strategies can be devised to change health professional behaviour moving forward.
The principal aim of this study is to systematically review the existing literature surrounding health professional beliefs, knowledge, and concerns within the context of delivering medicinal cannabis. It is important to note that this study is neither positioned in support or against the availability of medicinal cannabis. As per the aim, the position of this study is to strictly report the beliefs, knowledge, and concerns of health professional delivering medicinal cannabis.