Doctors in Ontario in Canada are still hesitant to prescribe medical cannabis to patients suffering long-term pain – 20 years after it was first introduced and despite hundreds of thousands of Canadians using medical cannabis – says a study carried out at McMaster University and published in the Canadian Medical Association Journal Open.
Physicians surveyed in the small qualitative study said their main concerns relate to possible ill-effects and a lack of understanding regarding their effectiveness as painkillers, the university reported in material published on 12 April 2021.
Of particular concern among doctors were potentially harmful effects on cognitive development, a possible worsening of existing mental illnesses in patients and the drug’s effects in older adults, which may include dizziness or drowsiness.
Meanwhile, the number of Canadians using medical cannabis has soared from just under 24,000 in June 2015 to 377,000 by September 2020.
“This paper is demonstrating that there is a real perceived need by family physicians that more evidence, education and guidance is needed, so they can better help patients who are asking about this treatment,” said Associate Professor Jason Busse of the Michael G DeGroote Centre for Medicinal Cannabis Research at McMaster.
Six of the 11 physicians surveyed also raised the issue of how legal recreational cannabis affected its medical counterpart, but 10 said therapeutic variants should remain an option.
Recreational cannabis, which has different formulation than medical cannabis, was legalised in Canada in October 2018.
The report says the “increased use of medical cannabis was likely the result of the easing of regulations, greater availability given the growing numbers of producers and cannabis clinics and reduced stigma around the use of cannabis for therapeutic purposes.”
However, doctors are still hampered by a lack of proper guidance, while medical cannabis products have not undergone the same rigorous trials as other pharmaceutical drugs on the market, said Busse, associate professor of anaesthesia.
In 2019, the Canadian Medical Association said that although cannabis may offer patients relief when conventional therapies fail, a lack of evidence surrounding the risks and benefits of its use makes it difficult for physicians to advise patients properly.
“When you have such widespread recreational and medical cannabis use, there is a real challenge for healthcare providers who are not trained in prescribing it,” said Busse.
Researchers conducted telephone interviews with the doctors between January and October 2019 and published their findings in the Canadian Medical Association Journal Open. No external funding was received for the study.
Study details
Attitudes toward medical cannabis among family physicians practising in Ontario, Canada: A qualitative research study
Jeremy Y Ng, Kevin Gilotra, Sana Usman, Yaping Chang and Jason W Busse
Author affiliations: Faculty of Health Sciences at McMaster University; the Chronic Pain Centre of Excellence for Canadian Veterans; and the Michael G DeGroote Centre for Medicinal Cannabis Research at McMaster University in Hamilton, Ontario, Canada.
Published in the Canadian Medical Association Journal Open on 13 April 2021.
Abstract
Medical cannabis has been legally available in Canada since 2001, but its benefits and harms remain uncertain. We explored attitudes toward medical cannabis among family physicians practising in Ontario.
Methods
Between January and October 2019 we conducted a qualitative study of Ontario family physicians using semistructured telephone interviews. We applied thematic analysis to interview transcripts and identified representative quotes.
Results
Eleven physicians agreed to be interviewed, and 3 themes regarding medical cannabis emerged: reluctance to authorize use, concern over harms and lack of practical knowledge.
Participants raised concerns about the limited evidence for, and their lack of education regarding, the therapeutic use of cannabis, particularly the harms associated with neurocognitive development, exacerbation of mental illness and drug interactions in older adults. Some participants thought medical cannabis was overly accessible and questioned their role following legalisation of recreational cannabis.
Interpretation
Despite the increasing availability of medical cannabis, family physicians expressed reluctance to authorise its use because of lack of knowledge and concerns regarding harms.
Family physicians may benefit from guidance and education that address concerns they have surrounding medical cannabis.
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