Attitudes toward medical cannabis among family physicians practising in Ontario, Canada: a qualitative research study

Abstract

Background: 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 legalization of recreational cannabis.Interpretation: Despite the increasing availability of medical cannabis, family physicians expressed reluctance to authorize 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.

Comparison of Medical Cannabis Use Reported on a Confidential Survey vs Documented in the Electronic Health Record Among Primary Care Patients

“…58 , 59 Lack of documentation may also reflect clinician reluctance to explore medical cannabis use with patients. 60 , 61 , 62 In the study by Matson et al, 5 patients with EHR documentation of medical use had a higher prevalence of health conditions with potential risks from cannabis use compared with patients with no or other past-year use, suggesting that patient comorbidity may also be associated with documentation.…”

Cannabis for pain: a cross-sectional survey of the patient information quality on the Internet

“…Similar findings have also been reported with respect to commonly used herbal products such as St. John’s wort (Thakor et al 2011 ), kratom (Ng et al 2021c ), and ephedra (Ng et al 2021d ). Another issue of concern includes the fact that across numerous jurisdictions, even where medical cannabis is legalized, physicians report lacking knowledge and information, while acknowledging their need for greater and continuing education, on this topic (Kansagara et al 2020 ; Philpot et al 2019 ; Ziemianski et al 2015 ; Ng et al 2021e ; Zolotov et al 2018 ). Collectively, it is clear that cannabis misinformation is commonly found on the internet, and the present study’s findings only reinforce the need for healthcare professionals to be actively aware of this information quality in order to better assist their patients in identifying trustworthy and accurate cannabis resources online.…”

Medical Cannabis Use Among Older Adults in Canada: Self-Reported Data on Types and Amount Used, and Perceived Effects

“…Consequently, older adults who are more likely to source cannabis legally, rely on non-clinical sources to guide cannabis use [ 19 – 21 ]. At the same time, physicians report concerns about cannabis use among older adults due to a lack of evidence for benefits and harms [ 22 ]. As such, Canadian clinical practice guidelines recommend restricted use of synthetic cannabinoids (e.g., nabilone and nabiximols) only for neuropathic pain, palliative care, nausea and vomiting associated with chemotherapy, and spasticity due to multiple sclerosis or spinal cord injury, while recommending against cannabinoids for other conditions [ 23 ].…”