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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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Hallinan CM, Gunn JM, Bonomo YA. Implementation of medicinal cannabis in Australia: innovation or upheaval? Perspectives from physicians as key informants, a qualitative analysis. BMJ Open 2021; 11:e054044. [PMID: 34686558 PMCID: PMC8543680 DOI: 10.1136/bmjopen-2021-054044] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE We sought to explore physician perspectives on the prescribing of cannabinoids to patients to gain a deeper understanding of the issues faced by prescriber and public health advisors in the rollout of medicinal cannabis. DESIGN A thematic qualitative analysis of 21 in-depth interviews was undertaken to explore the narrative on the policy and practice of medicinal cannabis prescribing. The analysis used the Diffusion of Innovations (DoI) theoretical framework to model the conceptualisation of the rollout of medicinal cannabis in the Australian context. SETTING Informants from the states and territories of Victoria, New South Wales, Tasmania, Australian Capital Territory, and Queensland in Australia were invited to participate in interviews to explore the policy and practice of medicinal cannabis prescribing. PARTICIPANTS Participants included 21 prescribing and non-prescribing key informants working in the area of neurology, rheumatology, oncology, pain medicine, psychiatry, public health, and general practice. RESULTS There was an agreement among many informants that medicinal cannabis is, indeed, a pharmaceutical innovation. From the analysis of the informant interviews, the factors that facilitate the diffusion of medicinal cannabis into clincal practice include the adoption of appropriate regulation, the use of data to evaluate safety and efficacy, improved prescriber education, and the continuous monitoring of product quality and cost. Most informants asserted the widespread assimilation of medicinal cannabis into practice is impeded by a lack of health system antecedents that are required to facilitate safe, effective, and equitable access to medicinal cannabis as a therapeutic. CONCLUSIONS This research highlights the tensions that arise and the factors that influence the rollout of cannabis as an unregistered medicine. Addressing these factors is essential for the safe and effective prescribing in contemporary medical practice. The findings from this research provides important evidence on medicinal cannabis as a therapeutic, and also informs the rollout of potential novel therapeutics in the future.
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Affiliation(s)
| | - Jane Maree Gunn
- Department of General Practice, The University of Melbourne, Melbourne, Victoria, Australia
| | - Yvonne Ann Bonomo
- Department of General Practice, The University of Melbourne, Melbourne, Victoria, Australia
- Department Of Addiction Medicine, St Vincent's Health Australia Ltd, Fitzroy, Victoria, Australia
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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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Hordowicz M, Jarosz J, Czaplińska M, Leonhard A, Klimkiewicz A. Polish Physicians' Perspectives on Medical Cannabis Policy and Educational Needs: Results of An Online Survey. J Clin Med 2021; 10:jcm10194545. [PMID: 34640561 PMCID: PMC8509273 DOI: 10.3390/jcm10194545] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2021] [Revised: 09/15/2021] [Accepted: 09/27/2021] [Indexed: 11/18/2022] Open
Abstract
(1) Background: In November 2017, medical cannabis was legalized in Poland. Until now, there have been no studies conducted to examine the perspectives of Polish physicians about their preferences regarding medical cannabis legal status and educational needs. (2) Methods: The survey was a self-developed online questionnaire with 57 participants. Participation was voluntary. The link was shared through a personal network of medical doctors, regional medical chambers, and with doctors attending palliative care courses organized by our research group. Results: Between June and October 2020, 173 HCPs from Poland completed the survey. More than half of the study participants never received any education on medical cannabis (60.1%); 71.1% declared their knowledge was insufficient to counsel patients about medical cannabis use. The majority claimed that they would like to be able to answer patient questions (92.4%); 93.1% declared a need to create clear guidelines for using cannabinoids in clinical practice. Furthermore, 71.7% believed that medicines containing cannabinoids and 52.0% that herbal cannabis should be reimbursed (3). Conclusion: Most medical doctors do not feel prepared for patient counseling. They could benefit from targeted educational interventions. We have also identified physicians’ preferences that might inspire the stakeholders involved who are critical for shaping policies regarding cannabis-based therapeutics.
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Affiliation(s)
- Martyna Hordowicz
- Hospice of St. Christopher in Warsaw, 02-781 Warsaw, Poland; (M.C.); (A.L.)
- Polish Society of Medical Cannabis and Cannabinoids, 02-781 Warsaw, Poland; (J.J.); (A.K.)
- Correspondence:
| | - Jerzy Jarosz
- Polish Society of Medical Cannabis and Cannabinoids, 02-781 Warsaw, Poland; (J.J.); (A.K.)
| | - Małgorzata Czaplińska
- Hospice of St. Christopher in Warsaw, 02-781 Warsaw, Poland; (M.C.); (A.L.)
- Polish Society of Medical Cannabis and Cannabinoids, 02-781 Warsaw, Poland; (J.J.); (A.K.)
- Medical Faculty, Medical University of Warsaw, 02-781 Warsaw, Poland
| | - Agnieszka Leonhard
- Hospice of St. Christopher in Warsaw, 02-781 Warsaw, Poland; (M.C.); (A.L.)
- Polish Society of Medical Cannabis and Cannabinoids, 02-781 Warsaw, Poland; (J.J.); (A.K.)
| | - Anna Klimkiewicz
- Polish Society of Medical Cannabis and Cannabinoids, 02-781 Warsaw, Poland; (J.J.); (A.K.)
- Medical Faculty, Medical University of Warsaw, 02-781 Warsaw, Poland
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Irrera N, Bitto A, Sant’Antonio E, Lauro R, Musolino C, Allegra A. Pros and Cons of the Cannabinoid System in Cancer: Focus on Hematological Malignancies. Molecules 2021; 26:molecules26133866. [PMID: 34202812 PMCID: PMC8270322 DOI: 10.3390/molecules26133866] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2021] [Revised: 06/09/2021] [Accepted: 06/20/2021] [Indexed: 11/23/2022] Open
Abstract
The endocannabinoid system (ECS) is a composite cell-signaling system that allows endogenous cannabinoid ligands to control cell functions through the interaction with cannabinoid receptors. Modifications of the ECS might contribute to the pathogenesis of different diseases, including cancers. However, the use of these compounds as antitumor agents remains debatable. Pre-clinical experimental studies have shown that cannabinoids (CBs) might be effective for the treatment of hematological malignancies, such as leukemia and lymphoma. Specifically, CBs may activate programmed cell death mechanisms, thus blocking cancer cell growth, and may modulate both autophagy and angiogenesis. Therefore, CBs may have significant anti-tumor effects in hematologic diseases and may synergistically act with chemotherapeutic agents, possibly also reducing chemoresistance. Moreover, targeting ECS might be considered as a novel approach for the management of graft versus host disease, thus reducing some symptoms such as anorexia, cachexia, fatigue, anxiety, depression, and neuropathic pain. The aim of the present review is to collect the state of the art of CBs effects on hematological tumors, thus focusing on the essential topics that might be useful before moving into the clinical practice.
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Affiliation(s)
- Natasha Irrera
- Department of Clinical and Experimental Medicine, University of Messina, 98125 Messina, Italy; (N.I.); (A.B.); (R.L.)
| | - Alessandra Bitto
- Department of Clinical and Experimental Medicine, University of Messina, 98125 Messina, Italy; (N.I.); (A.B.); (R.L.)
| | | | - Rita Lauro
- Department of Clinical and Experimental Medicine, University of Messina, 98125 Messina, Italy; (N.I.); (A.B.); (R.L.)
| | - Caterina Musolino
- Department of Human Pathology in Adulthood and Childhood, University of Messina, 98125 Messina, Italy;
| | - Alessandro Allegra
- Department of Human Pathology in Adulthood and Childhood, University of Messina, 98125 Messina, Italy;
- Correspondence: ; Tel.: +390902212364
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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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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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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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Braun IM, Wright A, Peteet J, Meyer FL, Yuppa DP, Bolcic-Jankovic D, LeBlanc J, Chang Y, Yu L, Nayak MM, Tulsky JA, Suzuki J, Nabati L, Campbell EG. Medical Oncologists' Beliefs, Practices, and Knowledge Regarding Marijuana Used Therapeutically: A Nationally Representative Survey Study. J Clin Oncol 2018; 36:1957-1962. [PMID: 29746226 DOI: 10.1200/jco.2017.76.1221] [Citation(s) in RCA: 105] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Background Although almost every state medical marijuana (MM) law identifies cancer as a qualifying condition, little research supports MM's use in oncology. We hypothesized that the discrepancy between these laws and the scientific evidence base poses clinical challenges for oncologists. Oncologists' beliefs, knowledge, and practices regarding MM were examined in this study. Methods In November 2016, we mailed a survey on MM to a nationally-representative, random sample of 400 medical oncologists. Main outcome measures included whether oncologists reported discussing MM with patients, recommended MM clinically in the past year, or felt sufficiently informed to make such recommendations. The survey also queried oncologists' views on MM's comparative effectiveness for several conditions (including its use as an adjunct to standard pain management strategies) and its risks compared with prescription opioids. Bivariate and multivariate analyses were performed using standard statistical techniques. Results The overall response rate was 63%. Whereas only 30% of oncologists felt sufficiently informed to make recommendations regarding MM, 80% conducted discussions about MM with patients, and 46% recommended MM clinically. Sixty-seven percent viewed it as a helpful adjunct to standard pain management strategies, and 65% thought MM is equally or more effective than standard treatments for anorexia and cachexia. Conclusion Our findings identify a concerning discrepancy between oncologists' self-reported knowledge base and their beliefs and practices regarding MM. Although 70% of oncologists do not feel equipped to make clinical recommendations regarding MM, the vast majority conduct discussions with patients about MM and nearly one-half do, in fact, recommend it clinically. A majority believes MM is useful for certain indications. These findings are clinically important and suggest critical gaps in research, medical education, and policy regarding MM.
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Affiliation(s)
- Ilana M Braun
- Ilana M. Braun, Alexi Wright, John Peteet, Fremonta L. Meyer, David P. Yuppa, Manan M. Nayak, James A. Tulsky, and Lida Nabati, Dana-Farber Cancer Institute; Ilana M. Braun, Alexi Wright, John Peteet, Fremonta L. Meyer, David P. Yuppa, Yuchiao Chang, James A. Tulsky, Joji Suzuki, Lida Nabati, and Eric G. Campbell, Harvard Medical School; John Peteet, Fremonta L. Meyer, James A. Tulsky, and Joji Suzuki, Brigham and Women's Hospital; Dragana Bolcic-Jankovic, Jessica LeBlanc, and Manan M. Nayak, University of Massachusetts-Boston; and Yuchiao Chang, Liyang Yu, and Eric G. Campbell, Massachusetts General Hospital, Boston, MA
| | - Alexi Wright
- Ilana M. Braun, Alexi Wright, John Peteet, Fremonta L. Meyer, David P. Yuppa, Manan M. Nayak, James A. Tulsky, and Lida Nabati, Dana-Farber Cancer Institute; Ilana M. Braun, Alexi Wright, John Peteet, Fremonta L. Meyer, David P. Yuppa, Yuchiao Chang, James A. Tulsky, Joji Suzuki, Lida Nabati, and Eric G. Campbell, Harvard Medical School; John Peteet, Fremonta L. Meyer, James A. Tulsky, and Joji Suzuki, Brigham and Women's Hospital; Dragana Bolcic-Jankovic, Jessica LeBlanc, and Manan M. Nayak, University of Massachusetts-Boston; and Yuchiao Chang, Liyang Yu, and Eric G. Campbell, Massachusetts General Hospital, Boston, MA
| | - John Peteet
- Ilana M. Braun, Alexi Wright, John Peteet, Fremonta L. Meyer, David P. Yuppa, Manan M. Nayak, James A. Tulsky, and Lida Nabati, Dana-Farber Cancer Institute; Ilana M. Braun, Alexi Wright, John Peteet, Fremonta L. Meyer, David P. Yuppa, Yuchiao Chang, James A. Tulsky, Joji Suzuki, Lida Nabati, and Eric G. Campbell, Harvard Medical School; John Peteet, Fremonta L. Meyer, James A. Tulsky, and Joji Suzuki, Brigham and Women's Hospital; Dragana Bolcic-Jankovic, Jessica LeBlanc, and Manan M. Nayak, University of Massachusetts-Boston; and Yuchiao Chang, Liyang Yu, and Eric G. Campbell, Massachusetts General Hospital, Boston, MA
| | - Fremonta L Meyer
- Ilana M. Braun, Alexi Wright, John Peteet, Fremonta L. Meyer, David P. Yuppa, Manan M. Nayak, James A. Tulsky, and Lida Nabati, Dana-Farber Cancer Institute; Ilana M. Braun, Alexi Wright, John Peteet, Fremonta L. Meyer, David P. Yuppa, Yuchiao Chang, James A. Tulsky, Joji Suzuki, Lida Nabati, and Eric G. Campbell, Harvard Medical School; John Peteet, Fremonta L. Meyer, James A. Tulsky, and Joji Suzuki, Brigham and Women's Hospital; Dragana Bolcic-Jankovic, Jessica LeBlanc, and Manan M. Nayak, University of Massachusetts-Boston; and Yuchiao Chang, Liyang Yu, and Eric G. Campbell, Massachusetts General Hospital, Boston, MA
| | - David P Yuppa
- Ilana M. Braun, Alexi Wright, John Peteet, Fremonta L. Meyer, David P. Yuppa, Manan M. Nayak, James A. Tulsky, and Lida Nabati, Dana-Farber Cancer Institute; Ilana M. Braun, Alexi Wright, John Peteet, Fremonta L. Meyer, David P. Yuppa, Yuchiao Chang, James A. Tulsky, Joji Suzuki, Lida Nabati, and Eric G. Campbell, Harvard Medical School; John Peteet, Fremonta L. Meyer, James A. Tulsky, and Joji Suzuki, Brigham and Women's Hospital; Dragana Bolcic-Jankovic, Jessica LeBlanc, and Manan M. Nayak, University of Massachusetts-Boston; and Yuchiao Chang, Liyang Yu, and Eric G. Campbell, Massachusetts General Hospital, Boston, MA
| | - Dragana Bolcic-Jankovic
- Ilana M. Braun, Alexi Wright, John Peteet, Fremonta L. Meyer, David P. Yuppa, Manan M. Nayak, James A. Tulsky, and Lida Nabati, Dana-Farber Cancer Institute; Ilana M. Braun, Alexi Wright, John Peteet, Fremonta L. Meyer, David P. Yuppa, Yuchiao Chang, James A. Tulsky, Joji Suzuki, Lida Nabati, and Eric G. Campbell, Harvard Medical School; John Peteet, Fremonta L. Meyer, James A. Tulsky, and Joji Suzuki, Brigham and Women's Hospital; Dragana Bolcic-Jankovic, Jessica LeBlanc, and Manan M. Nayak, University of Massachusetts-Boston; and Yuchiao Chang, Liyang Yu, and Eric G. Campbell, Massachusetts General Hospital, Boston, MA
| | - Jessica LeBlanc
- Ilana M. Braun, Alexi Wright, John Peteet, Fremonta L. Meyer, David P. Yuppa, Manan M. Nayak, James A. Tulsky, and Lida Nabati, Dana-Farber Cancer Institute; Ilana M. Braun, Alexi Wright, John Peteet, Fremonta L. Meyer, David P. Yuppa, Yuchiao Chang, James A. Tulsky, Joji Suzuki, Lida Nabati, and Eric G. Campbell, Harvard Medical School; John Peteet, Fremonta L. Meyer, James A. Tulsky, and Joji Suzuki, Brigham and Women's Hospital; Dragana Bolcic-Jankovic, Jessica LeBlanc, and Manan M. Nayak, University of Massachusetts-Boston; and Yuchiao Chang, Liyang Yu, and Eric G. Campbell, Massachusetts General Hospital, Boston, MA
| | - Yuchiao Chang
- Ilana M. Braun, Alexi Wright, John Peteet, Fremonta L. Meyer, David P. Yuppa, Manan M. Nayak, James A. Tulsky, and Lida Nabati, Dana-Farber Cancer Institute; Ilana M. Braun, Alexi Wright, John Peteet, Fremonta L. Meyer, David P. Yuppa, Yuchiao Chang, James A. Tulsky, Joji Suzuki, Lida Nabati, and Eric G. Campbell, Harvard Medical School; John Peteet, Fremonta L. Meyer, James A. Tulsky, and Joji Suzuki, Brigham and Women's Hospital; Dragana Bolcic-Jankovic, Jessica LeBlanc, and Manan M. Nayak, University of Massachusetts-Boston; and Yuchiao Chang, Liyang Yu, and Eric G. Campbell, Massachusetts General Hospital, Boston, MA
| | - Liyang Yu
- Ilana M. Braun, Alexi Wright, John Peteet, Fremonta L. Meyer, David P. Yuppa, Manan M. Nayak, James A. Tulsky, and Lida Nabati, Dana-Farber Cancer Institute; Ilana M. Braun, Alexi Wright, John Peteet, Fremonta L. Meyer, David P. Yuppa, Yuchiao Chang, James A. Tulsky, Joji Suzuki, Lida Nabati, and Eric G. Campbell, Harvard Medical School; John Peteet, Fremonta L. Meyer, James A. Tulsky, and Joji Suzuki, Brigham and Women's Hospital; Dragana Bolcic-Jankovic, Jessica LeBlanc, and Manan M. Nayak, University of Massachusetts-Boston; and Yuchiao Chang, Liyang Yu, and Eric G. Campbell, Massachusetts General Hospital, Boston, MA
| | - Manan M Nayak
- Ilana M. Braun, Alexi Wright, John Peteet, Fremonta L. Meyer, David P. Yuppa, Manan M. Nayak, James A. Tulsky, and Lida Nabati, Dana-Farber Cancer Institute; Ilana M. Braun, Alexi Wright, John Peteet, Fremonta L. Meyer, David P. Yuppa, Yuchiao Chang, James A. Tulsky, Joji Suzuki, Lida Nabati, and Eric G. Campbell, Harvard Medical School; John Peteet, Fremonta L. Meyer, James A. Tulsky, and Joji Suzuki, Brigham and Women's Hospital; Dragana Bolcic-Jankovic, Jessica LeBlanc, and Manan M. Nayak, University of Massachusetts-Boston; and Yuchiao Chang, Liyang Yu, and Eric G. Campbell, Massachusetts General Hospital, Boston, MA
| | - James A Tulsky
- Ilana M. Braun, Alexi Wright, John Peteet, Fremonta L. Meyer, David P. Yuppa, Manan M. Nayak, James A. Tulsky, and Lida Nabati, Dana-Farber Cancer Institute; Ilana M. Braun, Alexi Wright, John Peteet, Fremonta L. Meyer, David P. Yuppa, Yuchiao Chang, James A. Tulsky, Joji Suzuki, Lida Nabati, and Eric G. Campbell, Harvard Medical School; John Peteet, Fremonta L. Meyer, James A. Tulsky, and Joji Suzuki, Brigham and Women's Hospital; Dragana Bolcic-Jankovic, Jessica LeBlanc, and Manan M. Nayak, University of Massachusetts-Boston; and Yuchiao Chang, Liyang Yu, and Eric G. Campbell, Massachusetts General Hospital, Boston, MA
| | - Joji Suzuki
- Ilana M. Braun, Alexi Wright, John Peteet, Fremonta L. Meyer, David P. Yuppa, Manan M. Nayak, James A. Tulsky, and Lida Nabati, Dana-Farber Cancer Institute; Ilana M. Braun, Alexi Wright, John Peteet, Fremonta L. Meyer, David P. Yuppa, Yuchiao Chang, James A. Tulsky, Joji Suzuki, Lida Nabati, and Eric G. Campbell, Harvard Medical School; John Peteet, Fremonta L. Meyer, James A. Tulsky, and Joji Suzuki, Brigham and Women's Hospital; Dragana Bolcic-Jankovic, Jessica LeBlanc, and Manan M. Nayak, University of Massachusetts-Boston; and Yuchiao Chang, Liyang Yu, and Eric G. Campbell, Massachusetts General Hospital, Boston, MA
| | - Lida Nabati
- Ilana M. Braun, Alexi Wright, John Peteet, Fremonta L. Meyer, David P. Yuppa, Manan M. Nayak, James A. Tulsky, and Lida Nabati, Dana-Farber Cancer Institute; Ilana M. Braun, Alexi Wright, John Peteet, Fremonta L. Meyer, David P. Yuppa, Yuchiao Chang, James A. Tulsky, Joji Suzuki, Lida Nabati, and Eric G. Campbell, Harvard Medical School; John Peteet, Fremonta L. Meyer, James A. Tulsky, and Joji Suzuki, Brigham and Women's Hospital; Dragana Bolcic-Jankovic, Jessica LeBlanc, and Manan M. Nayak, University of Massachusetts-Boston; and Yuchiao Chang, Liyang Yu, and Eric G. Campbell, Massachusetts General Hospital, Boston, MA
| | - Eric G Campbell
- Ilana M. Braun, Alexi Wright, John Peteet, Fremonta L. Meyer, David P. Yuppa, Manan M. Nayak, James A. Tulsky, and Lida Nabati, Dana-Farber Cancer Institute; Ilana M. Braun, Alexi Wright, John Peteet, Fremonta L. Meyer, David P. Yuppa, Yuchiao Chang, James A. Tulsky, Joji Suzuki, Lida Nabati, and Eric G. Campbell, Harvard Medical School; John Peteet, Fremonta L. Meyer, James A. Tulsky, and Joji Suzuki, Brigham and Women's Hospital; Dragana Bolcic-Jankovic, Jessica LeBlanc, and Manan M. Nayak, University of Massachusetts-Boston; and Yuchiao Chang, Liyang Yu, and Eric G. Campbell, Massachusetts General Hospital, Boston, MA
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Khwaja S, Yacoub A, Cheema A, Rihana N, Russo R, Velez AP, Nanjappa S, Sandin RL, Bohra C, Gajanan G, Greene JN. Marijuana Smoking in Patients With Leukemia. Cancer Control 2017; 23:278-83. [PMID: 27556668 DOI: 10.1177/107327481602300311] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Worldwide, marijuana (cannabis) is a widely used drug. The incidence of marijuana smoking is increasing and is second only to tobacco as the most widely smoked substance in the general population. It is also the second most commonly used recreational drug after alcohol. Some adverse effects of marijuana smoking have been documented; however, the number of studies on the pulmonary effects of marijuana in individuals with leukemia is limited. In our case series, we report on 2 men with acute myeloid leukemia with miliary nodular lung patterns on computed tomography of the chest due to heavy marijuana use. We also report on 2 patients with acute lymphocytic leukemia who had a history of smoking marijuana and then developed lung opacities consistent with mold infection.
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Affiliation(s)
- Sara Khwaja
- Department of Infectious Diseases and Tropical Medicine, Moffitt Cancer Center, Tampa, FL 33612, USA.
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14
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Braun IM, Meyer FL, Gagne JJ, Nabati L, Yuppa DP, Carmona MA, Burstein HJ, Suzuki J, Nayak MM, Martins Y. Experts' perspectives on the role of medical marijuana in oncology: A semistructured interview study. Psychooncology 2017; 26:1087-1092. [PMID: 28040884 DOI: 10.1002/pon.4365] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2016] [Revised: 12/07/2016] [Accepted: 12/23/2016] [Indexed: 02/06/2023]
Abstract
BACKGROUND Expansion of medical marijuana (MM) laws in the United States may offer oncology new therapeutic options. However, the scientific evidence for MM remains in infancy. This study qualitatively explored professional opinion around the role of MM in cancer care. METHODS Semistructured interviews were administered to a sample of individuals with expertise at the interface of MM and oncology nationally. Key informant criteria included an oncologic clinical or research background and any of the following: publications, research, or lectures on cannabinoids or cancer symptoms; involvement in the development of MM dispensaries or legislation; and early adoption of state MM certification procedures. A gold standard, grounded, inductive approach was used to identify underlying themes. RESULTS Participants (N = 15) were predominantly male, in their sixth decade, working in academic settings. Themes ranged from strong beliefs in marijuana's medical utility to reservations about this notion, with calls for expansion of the scientific evidence base and more stringent MM production standards. All participants cited nausea as an appropriate indication, and 13 of 15 pain. Over one-third believed MM to have a more attractive risk profile than opioids and benzodiazepines. CONCLUSIONS Expert opinion was divided between convictions in marijuana's medicinal potential and guardedness in this assertion, with no participant refuting MM's utility outright. Emergent themes included that MM ameliorates cancer-related pain and nausea and is safer than certain conventional medications. Participants called for enhanced purity and production standards, and further research on MM's utility.
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Affiliation(s)
- I M Braun
- Harvard Medical School, Boston, MA, USA.,Dana-Farber Cancer Center, Boston, MA, USA
| | - F L Meyer
- Harvard Medical School, Boston, MA, USA.,Dana-Farber Cancer Center, Boston, MA, USA.,Brigham and Women's Hospital, Boston, MA, USA
| | - J J Gagne
- Dana-Farber Cancer Center, Boston, MA, USA
| | - L Nabati
- Harvard Medical School, Boston, MA, USA.,Dana-Farber Cancer Center, Boston, MA, USA
| | - D P Yuppa
- Harvard Medical School, Boston, MA, USA.,Dana-Farber Cancer Center, Boston, MA, USA
| | - M A Carmona
- Harvard Medical School, Boston, MA, USA.,Dana-Farber Cancer Center, Boston, MA, USA.,Brigham and Women's Hospital, Boston, MA, USA
| | - H J Burstein
- Harvard Medical School, Boston, MA, USA.,Dana-Farber Cancer Center, Boston, MA, USA
| | - J Suzuki
- Harvard Medical School, Boston, MA, USA.,Brigham and Women's Hospital, Boston, MA, USA
| | - M M Nayak
- Dana-Farber Cancer Center, Boston, MA, USA
| | - Y Martins
- Dana-Farber Cancer Center, Boston, MA, USA
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15
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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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16
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Irish General Practitioner (GP) Perspectives Toward Decriminalisation, Legalisation and Cannabis for Therapeutic Purposes (CTP). Int J Ment Health Addict 2016. [DOI: 10.1007/s11469-016-9710-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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17
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Moeller KE, Woods B. Pharmacy Students' Knowledge and Attitudes Regarding Medical Marijuana. AMERICAN JOURNAL OF PHARMACEUTICAL EDUCATION 2015; 79:85. [PMID: 26430272 PMCID: PMC4584377 DOI: 10.5688/ajpe79685] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/30/2014] [Accepted: 02/17/2015] [Indexed: 05/25/2023]
Abstract
OBJECTIVE To determine pharmacy students' knowledge of and attitudes toward medical marijuana and to determine if pharmacy students need additional education on the topic. METHODS Pharmacy students were asked to complete a survey on medical marijuana that assessed their knowledge of, medical uses of, adverse effects with, and attitudes toward medical marijuana through 23 Likert-scale questions. RESULTS Three hundred eleven students completed the survey. Fifty-eight percent of the students felt that medical marijuana should be legalized in all states. However, the majority of students did not feel comfortable answering consumers' questions regarding efficacy, safety, or drug interactions related to the substance. Accurate responses for diseases or conditions for permitted medical marijuana use was low, with only cancer (91%) and glaucoma (57%) identified by more than half the students. CONCLUSION With an increasing number of states adopting medical marijuana use, pharmacy schools need to evaluate the adequacy of medical marijuana education in their curriculum.
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Ziemianski D, Capler R, Tekanoff R, Lacasse A, Luconi F, Ware MA. Cannabis in medicine: a national educational needs assessment among Canadian physicians. BMC MEDICAL EDUCATION 2015; 15:52. [PMID: 25888752 PMCID: PMC4374299 DOI: 10.1186/s12909-015-0335-0] [Citation(s) in RCA: 78] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/29/2014] [Accepted: 03/05/2015] [Indexed: 05/16/2023]
Abstract
BACKGROUND There is increasing global awareness and interest in the use of cannabis for therapeutic purposes (CTP). It is clear that health care professionals need to be involved in these decisions, but often lack the education needed to engage in informed discussions with patients. This study was conducted to determine the educational needs of Canadian physicians regarding CTP. METHODS A national needs assessment survey was developed based on previous survey tools. The survey was approved by the Research Ethics Board of the McGill University Health Centre Research Institute and was provided online using LimeSurvey®. Several national physician organizations and medical education organizations informed their members of the survey. The target audience was Canadian physicians. We sought to identify and rank using 5-point Likert scales the most common factors involved in decision making about using CTP in the following categories: knowledge, experience, attitudes, and barriers. Preferred educational approaches and physician demographics were collected. Gap analysis was conducted to determine the magnitude and importance of differences between perceived and desired knowledge on all decision factors. RESULTS Four hundred and twenty six responses were received, and physician responses were distributed across Canada consistent with national physician distribution. The most desired knowledge concerned "potential risks of using CTP" and "safety, warning signs and precautions for patients using CTP". The largest gap between perceived current and desired knowledge levels was "dosing" and "the development of treatment plans". CONCLUSIONS We have identified several key educational needs among Canadian physicians regarding CTP. These data can be used to develop resources and educational programs to support clinicians in this area, as well as to guide further research to inform these gaps.
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Affiliation(s)
- Daniel Ziemianski
- Alan Edwards Pain Management Unit, McGill University Health Center Research Institute; Canadian Consortium for the Investigation of Cannabinoids, A5.140 Montreal General Hospital, 1650 Cedar Avenue, Montreal, Quebec, H3G 1A4, Canada.
| | - Rielle Capler
- Interdisciplinary Studies Graduate Program, University of British Columbia, Vancouver, Canada.
| | - Rory Tekanoff
- Community Programs, Urban Care Health Group, Toronto, Ontario, Canada.
| | - Anaïs Lacasse
- Département des sciences de la santé, Université du Québec en Abitibi-Témiscamingue, Québec, Canada.
| | - Francesca Luconi
- Continuing Health Professional Education, Faculty of Medicine, McGill University, Montreal, Québec, Canada.
| | - Mark A Ware
- Alan Edwards Pain Management Unit, McGill University Health Center Research Institute; Canadian Consortium for the Investigation of Cannabinoids, A5.140 Montreal General Hospital, 1650 Cedar Avenue, Montreal, Quebec, H3G 1A4, Canada.
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Lombard C, Hegde VL, Nagarkatti M, Nagarkatti PS. Perinatal exposure to Δ9-tetrahydrocannabinol triggers profound defects in T cell differentiation and function in fetal and postnatal stages of life, including decreased responsiveness to HIV antigens. J Pharmacol Exp Ther 2011; 339:607-17. [PMID: 21831965 DOI: 10.1124/jpet.111.181206] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
Marijuana abuse is very prominent among pregnant women. Although marijuana cannabinoids have been shown to exert immunosuppression in adults, virtually nothing is known about the effects of marijuana use during pregnancy on the developing immune system of the fetus and during postnatal life. We noted that murine fetal thymus expressed high levels of the cannabinoid receptors CB1 and CB2. Moreover, perinatal exposure to Δ(9)-tetrahydrocannabinol (THC) had a profound effect on the fetus as evidenced by a decrease in thymic cellularity on gestational days 16, 17, and 18 and postgestational day 1 and marked alterations in T cell subpopulations. These outcomes were reversed by CB1/CB2 antagonists, suggesting that THC-mediated these effects through cannabinoid receptors. Thymic atrophy induced in the fetus correlated with caspase-dependent apoptosis in thymocytes. Thymic atrophy was the result of direct action of THC and not based on maternal factors inasmuch as THC was able to induce T cell apoptosis in vitro in fetal thymic organ cultures. It is noteworthy that perinatal exposure to THC also had a profound effect on the immune response during postnatal life. Peripheral T cells from such mice showed decreased proliferative response to T cell mitogen as well as both T cell and antibody response to HIV-1 p17/p24/gp120 antigens. Together, our data demonstrate for the first time that perinatal exposure to THC triggers profound T cell dysfunction, thereby suggesting that the offspring of marijuana abusers who have been exposed to THC in utero may be at a higher risk of exhibiting immune dysfunction and contracting infectious diseases including HIV.
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Affiliation(s)
- Catherine Lombard
- Department of Pathology and Microbiology, University of South Carolina School of Medicine, 6311 Garners Ferry Road, Columbia, SC 29208, USA
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20
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Cescon DW, Page AV, Richardson S, Moore MJ, Boerner S, Gold WL. Invasive pulmonary aspergillosis associated with marijuana use in a man with colorectal cancer. J Clin Oncol 2008; 26:2214-5. [PMID: 18445848 DOI: 10.1200/jco.2007.15.2777] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- David W Cescon
- Department of Medicine, University of Toronto, Toronto, Canada
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Charuvastra A, Friedmann PD, Stein MD. Physician attitudes regarding the prescription of medical marijuana. J Addict Dis 2006; 24:87-93. [PMID: 16186085 DOI: 10.1300/j069v24n03_07] [Citation(s) in RCA: 65] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Surveys of physicians' attitudes regarding the therapeutic value of marijuana are rare. Drawing on a national sample of family physicians, general internists, obstetrician-gynecologists, psychiatrists, and addiction specialists, 960 (adjusted response rate 66%) offered opinions about the legal prescription of marijuana as medical therapy. Thirty-six percent believed prescribed marijuana should be legal and 26% were neutral to the proposition. Non-moralistic attitudes toward substance use were significantly associated with support for physician prescription, as was internal medicine and obstetrics-gynecology specialization. Physicians are, in general, less supportive than the general American public regarding the use of medical marijuana.
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Abstract
The smoking of marijuana for medicinal applications is a volatile and difficult issue for the medical and regulatory communities which has reached the forefront of discussions of public policy. Any consideration of this issue must take into account the substantial toxicity, impurity, and morbidity associated with marijuana use. Several states have passed ballot initiatives or legislation that allow a medical excuse for possession of marijuana. These initiatives bypass the Food and Drug Administration process of proving safety and efficacy, and they have created serious regulatory dilemmas for state regulatory boards. Several examinations of the issue have consistently drawn question to the validity of smoking an impure substance while voicing concern for the well being of patients in need. The historical, social, medical, and legal issues are examined.
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Affiliation(s)
- Eric A Voth
- The Institute on Global Drug Policy, St. Petersburg, FL, USA.
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23
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Abstract
In 1984, I published in this journal a review entitled "Marijuana: A Crude Drug With a Spectrum of Underappreciated Toxicity." In the introduction to that article, I disclosed that our son Keith, who was 15 years old at the time, was in a long-term, modified outpatient adolescent drug and alcohol rehabilitation program because he had become dependent on marijuana with its associated behavioral, interpersonal, scholastic, and antisocial problems. Keith and most of his friends had experimented several times with LSD, beer, and several other drugs but never used injection drugs. Marijuana was clearly Keith's drug of choice and the only drug he used with regularity. Approximately 1 year later, Keith graduated from the treatment program. He completed the early aftercare component, relapsed several times, and completed a 4-month refresher drug rehabilitation program in another state. Nine years after admission to the first rehabilitation program, Keith finally attained some adult goals. Now 34 years old, he has been drug-free for 10 years. He is the president and owner of a successful discount cellular phone business that he started. More important, a decade ago, he reestablished an excellent and close relationship with his parents. As far as I can tell, Keith remains drug-free except for an occasional beer.
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Affiliation(s)
- Richard H Schwartz
- Department of Pediatrics, Inova Fairfax Hospital for Children, Falls Church, Virginia, USA.
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Jatoi A, Windschitl HE, Loprinzi CL, Sloan JA, Dakhil SR, Mailliard JA, Pundaleeka S, Kardinal CG, Fitch TR, Krook JE, Novotny PJ, Christensen B. Dronabinol versus megestrol acetate versus combination therapy for cancer-associated anorexia: a North Central Cancer Treatment Group study. J Clin Oncol 2002; 20:567-73. [PMID: 11786587 DOI: 10.1200/jco.2002.20.2.567] [Citation(s) in RCA: 211] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE To determine whether dronabinol administered alone or with megestrol acetate was more, less, or equal in efficacy to single-agent megestrol acetate for palliating cancer-associated anorexia. PATIENTS AND METHODS Four hundred sixty-nine assessable advanced cancer patients were randomized to (1) oral megestrol acetate 800 mg/d liquid suspension plus placebo, (2) oral dronabinol 2.5 mg twice a day plus placebo, or (3) both agents. Eligible patients acknowledged that loss of appetite or weight was a problem and reported the loss of 5 pounds or more during 2 months and/or a daily intake of less than 20 calories/kg of body weight. RESULTS Groups were comparable at baseline in age, sex, tumor type, weight loss, and performance status. A greater percentage of megestrol acetate-treated patients reported appetite improvement and weight gain compared with dronabinol-treated patients: 75% versus 49% (P =.0001) for appetite and 11% versus 3% (P =.02) for > or = 10% baseline weight gain. Combination treatment resulted in no significant differences in appetite or weight compared with megestrol acetate alone. The Functional Assessment of Anorexia/Cachexia Therapy questionnaire, which emphasizes anorexia-related questions, demonstrated an improvement in quality of life (QOL) among megestrol acetate-treated and combination-treated patients. The single-item Uniscale, a global QOL instrument, found comparable scores. Toxicity was also comparable, with the exception of an increased incidence of impotence among men who received megestrol acetate. CONCLUSION In the doses and schedules we studied, megestrol acetate provided superior anorexia palliation among advanced cancer patients compared with dronabinol alone. Combination therapy did not appear to confer additional benefit.
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Affiliation(s)
- Aminah Jatoi
- Mayo Clinic and Mayo Foundation, Rochester, MN 55905, USA.
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DuPont RL. Examining the debate on the use of medical marijuana. PROCEEDINGS OF THE ASSOCIATION OF AMERICAN PHYSICIANS 1999; 111:166-72. [PMID: 10220812 DOI: 10.1046/j.1525-1381.1999.09252.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The opium poppy and the coca leaf offer useful perspectives on the current controversies over medical marijuana. In both cases, purified synthetic analogues of biologically active components of ancient folk remedies have become medical mainstays without undermining efforts to reduce nonmedical drug use. A decade ago, a campaign strove to legalize heroin for the compassionate treatment of pain in terminally ill patients. Like the current campaign to legalize medical marijuana, many well-meaning people supported this effort. The campaign for medical heroin was stopped by science when double-blind studies showed that heroin offered no benefits over the standard opioid analgesics in the treatment of severe cancer pain. Scientific medicine requires purified chemicals in carefully controlled doses without contaminating toxic substances. That a doctor would one day write a prescription for leaves to be burned is unimaginable. The Controlled Substances Act and international treaties limit the use of abused drugs or medicines. In contrast to smoked marijuana, specific chemicals in marijuana or, more likely, synthetic analogues, may prove to be of benefit to some patients with specific illnesses. Most opponents of medical use of smoked marijuana are not hostile to the medical use of purified synthetic analogues or even synthetic tetrahydrocannabinol (THC), which has been available in the United States for prescription by any licensed doctor since 1985. In contrast, most supporters of smoked marijuana are hostile to the use of purified chemicals from marijuana, insisting that only smoked marijuana leaves be used as "medicine," revealing clearly that their motivation is not scientific medicine but the back door legalization of marijuana.
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Affiliation(s)
- R L DuPont
- Institute for Behavior and Health, Inc., Rockville, MD 20815, USA
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Taylor HG. Analysis of the medical use of marijuana and its societal implications. JOURNAL OF THE AMERICAN PHARMACEUTICAL ASSOCIATION (WASHINGTON, D.C. : 1996) 1998; 38:220-7. [PMID: 9654850 DOI: 10.1016/s1086-5802(16)30318-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
OBJECTIVE To review the pharmacology, therapeutics, adverse effects, and societal implications of the medical use of marijuana. DATA SOURCES MEDLINE and manual searches of English-language marijuana literature, supplemented with interviews of scientists currently conducting cannabinoid research. Search terms included pain OR palliative care AND cannabis or ALL marijuana; cachexia OR appetite OR appetite stimulants; muscle spasticity OR spasm; immune system and cannabis; nausea and vomiting and cancer and cannabis. MEDLINE search terms: cannabis OR marijuana smoking OR marijuana abuse; all glaucoma; multiple sclerosis AND cannabis OR marijuana smoking OR marijuana abuse. STUDY SELECTION Studies on pharmacology, risks, and medical potential of marijuana. DATA EXTRACTION Not applicable. DATA SYNTHESIS The most prominent effects of marijuana are mediated by receptors in the brain. Acute intoxication is characterized by euphoria, loss of short-term memory, stimulation of the senses, and impaired linear thinking. Depersonalization and panic attacks are adverse effects. Increased heart rate and reddened conjunctivae are common physical effects. Chronic, high doses may cause subtle impairment of cognitive abilities that are appear to be long-term, but of unknown duration. Marijuana may be a risk factor for individuals with underlying mental illness. It causes dependence, but compared with cocaine, alcohol, heroin, and nicotine, marijuana has little addictive power and produces only mild withdrawal symptoms. Marijuana shows clinical promise for glaucoma, nausea and vomiting, analgesia, spasticity, multiple sclerosis, and AIDS wasting syndrome. CONCLUSION As a recreational drug, marijuana poses dangers, particularly to social and emotional development during adolescence and young adulthood. As a medical drug, marijuana should be available for patients who do not adequately respond to currently available therapies.
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Affiliation(s)
- H G Taylor
- Sparrow Hospital, Lansing, Michigan 48826, USA.
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