Reviews of controlled trials suggest that short-term, low dose administration of medical cannabis are effective to treat neuropathic pain related to cancer and other chronic conditions.However, a 4-year cohort study in Australia with over 1200 pain patients using prescription opioids reported that for most participants, cannabis use had no effect on their opioid use and actually led to greater pain severity.Some patients who reported feeling symptoms return after tapering off use of medical cannabis might have also been experiencing acute withdrawal symptoms, but this was not reported by participants. Therefore, given the complex evidence, primary care providers need to better understand the pharmacology of the cannabis plant and dosing options.Doing so will enable them to monitor for positive health outcomes and toxicity associated with its use and make informed recommendations. To meet the first objective, the research identified that patients were referred to medical cannabis by healthcare providers and encountered challenges related to cost, quality, and availability of the product in dispensaries. To meet the second objective, the survey research findings indicated that the small number of Black/African American respondents reported higher satisfaction with the effects of medical cannabis than white respondents for the following indicators: increased appetite, decreased seizures, and increased energy. The research did not identify any difference based on race and ethnicity of the patients in terms of perceived benefits or preference for administration. Most patients preferred vaping for administration. Age was negatively correlated with patient benefits for most indicators, possibly suggesting that as patients age, the perceived benefits of medical cannabis may be diminished because of more severe symptoms or possibly comorbidities reducing the efficacy of the drug. By contrast, age was positively correlated with decrease in spasms or tremors in this study. Preliminary studies have shown that modulating the cannabinoid system may be useful to treat some motor symptoms in Parkinson’s disease, mobile grow system which is more frequent in older people, but clinical studies are inconclusive regarding effectiveness of cannabinoid-based medicines.
The results for gender indicated women experienced lower benefits for decreased seizures compared to men. In the study by Crowell et al.,women experienced higher benefits for decreased inflammation and increased mood but lower benefits for increased energy. These findings suggest that there could be differential benefits depending on gender that require further study. This mixed methods research study provided valuable information about patients’ explanations for their patterns of use and rationale for using medical cannabis to address their medical conditions. The data provided preliminary findings which could be used to further examine the benefits that patients perceive from their use of the drug. Areas of future study include focusing on specific medical conditions, such as chronic pain-related conditions, and comparing pain management effectiveness between patients using prescription opioids and medical cannabis. A qualitative study in Illinois reported patients used medical cannabis as an alternative to prescription medications, as a method to wean themselves off of these medications, and as a complementary drug for their medications.Like the present study, most patients in the Illinois study used medical cannabis as an alternative to prescription medicines, citing negative side effects such as damage to the liver, and a vast majority reported daily use.Surprisingly, patients were using medical cannabis to treat several medical conditions at once, which contrasts with consumers’ typical use of a pharmaceutical drug to treat one specific medical condition . There was some underlying stigma toward the perception of the patient’s use of medical cannabis by others, relating to the fact that some patients only shared their usage with trusted family and friends and did experience some discrimination from health care workers at the office of their primary health care provider. It may be the case as was identified in another study, that patients are reluctant to share their use of medical cannabis with their primary health care provider and people outside of their immediate family.In terms of research challenges, it was difficult to recruit Black/African American and Hispanic participants to better reflect the diversity of Florida’s population, so future studies would need to design more innovative recruitment strategies to reach this population of medical marijuana patients. This study identified some areas of potential benefit in terms of symptom relief that might vary by race and ethnicity, but due to the small sample size of minority patients in the survey sample, these are tentative findings and a study limitation. For example, the significant finding that Black/African Americans experienced more benefits for increased appetite, decreased seizures, and energy than white respondents might be the result of a Type I error that could be addressed by increasing the sample size of minority participants in future studies.
From a research participation perspective, a positive study outcome was identifying the willingness of respondents to complete the survey after seeing posts on social media in Florida medical marijuana patient Facebook groups. Some members of this patient population are very focused on advocacy for medical cannabis and took a very positive view toward research participation. However, the majority of respondents were women, middle-aged, and white so there was an element of selection bias in the sample receptive to recruitment messages posted on social media group sites, and possibly fewer minority respondents who were members of these online groups. Medical marijuana patients were very willing to participate in both the surveys and interviews and took an active interest in wanting to learn about the outcomes from this research study. This finding bodes well for future research on understanding patient perspectives of the use of cannabis-based medicines.There is a growing interest in this field and the depth of research being conducted on medical cannabis is broad, but without many concrete conclusions due to current policies, limited drug supply, and methodological limitations.The limited number of double-blind clinical trials demonstrating the potential medicinal effects of cannabinoids calls for additional research questions to be explored.Moreover, most studies are equivocal due to lack of standardization and quality control of the cannabis products examined.Future research can be expected on the subject of medical cannabis, but how are physicians and healthcare trainees staying informed? Previous studies have demonstrated a large gap between the public interest, current use of medical cannabis, and medical providers’ ability to educate and counsel patients.In other words, the use of cannabis was introduced to the field of medicine by patient inquiry rather than through extensive research.Indeed, the majority of medical cannabis regulations in the United States and around the world have been implemented as a result of patient advocacy.Even in some medical schools, such as the University of Vermont Larner College of Medicine, student interest drove the university to offer an elective, and furthermore integrate medical cannabis into the curriculum due to overwhelming interest.A systematic review of healthcare professionals’ attitudes and knowledge on medical cannabis recently reported on a lack of selfperceived knowledge on medical cannabis across the fields of medicine, nursing, and pharmacy.It further demonstrated a common desire for additional education and resources to access information about medical cannabis. In general, while several studies have shown that healthcare professionals support the use of medical cannabis in clinical practice, in particular for cancer and hospice patients, mobile vertical rack others have reported on more conservative positions.Such a gap in attitudes and knowledge among healthcare professionals on this topic illustrates the need for a standardized medical cannabis education during training.
The use of medical cannabis is supported by scientific evidence for only a few conditions, such as chronic pain and chemotherapy-induced nausea and vomiting.In addition, two cannabis-based pharmaceuticals have regulatory approval in many countries, namely Nabiximols for spasticity of multiple sclerosis patients,and Epidiolex for refractory seizures.Nevertheless, the lack of quality research due to regulatory restrictions makes it difficult for healthcare professionals to address growing questions by the public.For example, it is important for clinicians to have sufficient knowledge of the interaction between cannabis and the novel coronavirus, SARS-CoV-2 . It has been stated that smoking results in airway inflammation, putting COVID-19 patients at increased risk for severe complications, including cerebrovascular dysfunction.While inhaled cannabis was included in the previous statement, other studies currently in progress are evaluating the potential use of cannabinoids as an adjunct to antiviral treatments for patients with COVID-19.The COVID-19 pandemic emphasizes the lack of in-depth understanding of the effects of cannabis on the human body and its therapeutic effects. It is integral to bridge this gap in knowledge, which may be possible only with proper training and education of healthcare professionals. Some countries and states that have legalized medical cannabis require general education for recommending providers; however, the standards vary significantly.This often results in superficial counseling for patients.Only a handful of states have established a requirement for licensed professionals to give medical advice. For example, Connecticut requires every dispensary to have a pharmacist on staff.Part of the current gap between public demand and education provided by healthcare providers is in large due to major lack of education at all levels of healthcare.For example, the 2017 National Academies of Sciences, Engineering, and Medicine Report concluded that medical cannabis is effective for the management of chronic pain in adults.However, the recommendation of medical cannabis to patients has not been widely adopted by physicians.In order to create specific educational recommendations for schools, this gap of education and mixed beliefs within healthcare education needs to be bridged. Therefore, the aim of this study was to analyze the existing literature surrounding the education of medical cannabis in allied health professional training programs worldwide. Additionally, we report the beliefs and views of trainees and faculty surrounding medical cannabis as treatment, as well as the depth of understanding of the therapeutic benefits and potential risks of medical cannabis.
This scoping review on medical cannabis education among medical and allied healthcare trainees was based on online database searches for peer-reviewed publications in English. The research team generated a list of search terms relevant to this topic and modeled after previous studies’ search syntax and keywords.This list was then expanded to include other common terminology and synonyms so that they could be included in the search syntax [see supplementary materials. These terms were used to generate a syntax for searching through PubMed, ERIC, CINAHL, and Web of Science. To expand the scope of this review, relevant “grey literature” was also searched to account for non-published academic material. Finally, the search included all references of the papers selected, as well as any other articles that referenced our selection. This consisted of searching Google Scholar, MedEd, Medline, and Dissertations and Theses section of Proquest using the same search terms. The literature search took place between June 10th, 2020 and July 1st, 2020. The search resulted in a total of 412 articles, which were imported into Covidence for duplicate removals. Two hundred and fourteen duplicate articles were removed, resulting in 198 articles for title and abstract screening. These articles were reviewed independently by two members of the team, who discussed any conflicts that arose concerning their inclusion or exclusion. Of the 198 articles, 167 were deemed out ofscope of this study and were excluded. The remaining 31 articles were then assessed with a full text review, and 8 publications were subsequently excluded. The exclusion criteria consisted of findings that were not based on an empirical study, examined populations outside the scope of this review, or studied substance use or misuse among students. The full text screening was done by multiple members of the research team independently, so that each study was examined by a minimum of three members. The data of the included studies were analyzed, extracted, and categorized by healthcare field, study design, study location, and important outcomes. The process of data search and extraction is presented in a PRISMA diagram in Fig. 1. A summary of the 23 studies that were included for the current analysis is presented in Table 1. The vast majority of studies assessed attitudes, beliefs, and knowledge about medical cannabis among trainees or faculty using a survey that included Likert scales to rate levels of agreement with various statements. In contrast, the 2020 study by Moeller et al. administered a quiz to pharmacy students to determine student knowledge about medical cannabis.