Clinician Knowledge, Attitudes, and Practice Regarding Cannabis: Results from a National Veterans Health Administration Survey

Abstract

Background Cannabis is increasingly available and used for medical and recreational purposes, but few studies have assessed provider knowledge, attitudes, and practice regarding cannabis. Methods We administered a 47-item electronic survey to assess nationwide Veterans Health Administration (VHA) clinician knowledge, beliefs, attitudes, and practice regarding patients’ use of cannabis. Results We received 249 completed surveys from 39 states and the District of Columbia. Fifty-five percent of respondents were female, 74% were white, and the mean age was 50 years. There were knowledge gaps among a substantial minority of respondents in specific areas: terminology, psychoactive effects of cannabis components, VHA policy, and evidence regarding benefits and harms of cannabis. Most respondents were likely or very likely to plan to taper opioids if urine drug testing was positive for tetra-hydro cannabinol (THC; 73%). A significantly greater proportion of respondents from states in which cannabis is illegal for any purpose (odds ratio [OR] = 4.9, 95% confidence interval [CI] = 2.0–10.8) or is recreationally illegal (OR = 5.0, 95% CI = 2.4–10.8) reported being likely or very likely to taper opioids as compared with respondents from states in which cannabis is legal for medical and recreational purposes. Conclusions Among the sample, we found knowledge gaps, areas of discomfort discussing key aspects of cannabis use with their patients, and variation in practice regarding opioids in patients also using THC. These results suggest a need for more widespread clinician education about cannabis, as well as an opportunity to develop more robust guidance and evidence regarding management of patients using prescription opioids and cannabis concomitantly.

Prevalence of Medical Cannabis Use and Associated Health Conditions Documented in Electronic Health Records Among Primary Care Patients in Washington State

“…In light of limited or conflicting evidence on the safety and effectiveness of medical cannabis, health care practitioners may not know how to advise patients who disclose cannabis use for medical or other reasons. 49 , 50 Practitioner training about potential risks and benefits of medical cannabis use could prepare practitioners for complex decision-making and support improved primary care for patients with medical cannabis use. 50 Identifying and documenting medical cannabis use and offering patients information from epidemiologic research on how to minimize risks of cannabis use 51 , 52 , 53 could ensure that patients are aware of risks as well as potential benefits of medical cannabis use.…”

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.…”

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

“…Research should further investigate the needs of family physicians, as well as medical students and residents, regarding cannabis education. 34,56 Increased knowl edge of the evidence for the benefits and harms of medical can nabis may improve physician comfort with discussing this topic with interested patients [57][58][59] and reduce patient reliance on can nabis clinics that may not always provide impartial advice. 9…”