Experiences, patient interactions and knowledge regarding the use of cannabis as a medicine in a cohort of New Zealand doctors in an oncology setting

Oldfield, Karen; Eathorne, Allie; Tewhaiti-Smith, Jordan; Beasley, Richard; Semprini, Alex; Braithwaite, Irene

doi:10.1136/postgradmedj-2020-139013

Cited by 10 publications

(21 citation statements)

References 15 publications

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“…Prior to the change, 55% of GPs had been asked to prescribe cannabis and over half were aware of pharmaceutical‐grade preparations [3]. In terms of barriers to prescribing, 50% of GPs indicated they did not prescribe due to insufficient evidence before the regulatory change [3] and 62% of oncology physicians said the same after the regulatory change [27]. However, 52% of oncology physicians indicated they would be ‘very likely’ to prescribe a cannabis product if there was proven efficacy and it was funded by PHARMAC [27].…”

Section: Introductionmentioning

confidence: 99%

“…In terms of barriers to prescribing, 50% of GPs indicated they did not prescribe due to insufficient evidence before the regulatory change [3] and 62% of oncology physicians said the same after the regulatory change [27]. However, 52% of oncology physicians indicated they would be ‘very likely’ to prescribe a cannabis product if there was proven efficacy and it was funded by PHARMAC [27]. This was lower than the 84% of GPs recorded before the regulatory changes [3].…”

Section: Introductionmentioning

confidence: 99%

“…This was lower than the 84% of GPs recorded before the regulatory changes [3]. The cost of medication (vs perceived benefit) was also a significant barrier to prescribing medical cannabis both before and after the regulatory change [3,27]. Furthermore, over 50% of oncology physicians also indicated they had an insufficient understanding of the prescribing process [27], versus before the regulatory change when only 14.3% of GPs indicated this barrier [3].…”

Section: Introductionmentioning

confidence: 99%

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Exploring the medical cannabis prescribing behaviours of New Zealand physicians

Manoharan

Kemper

Young

2022

Drug and Alcohol Review

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Introduction Many countries are changing their regulations for prescribing medical cannabis. As gatekeepers, physicians significantly impact patient access to cannabis treatments. It is important to explore how physicians view prescribing cannabis in terms of their existing beliefs, knowledge, possible concerns and personal perceptions. Methods Individual, semi‐structured telephone interviews were undertaken with 14 New Zealand physicians from various specialties. The interviews were thematically analysed using a phenomenological approach. Results The physician–patient relationship was of extreme importance in making prescription decisions, driven largely by trust in the patient. Barriers to prescribing included concern over possible side effects, the quality and standardisation of medication, uncertainty about indications and equity concerns from the high cost for lower socio‐economic patients. Some physicians held concerns over their liability and risks to their reputation if issues arose for patients. Discussion and Conclusion The way physicians regard prescribing medical cannabis is based on their personal beliefs and knowledge built up over their medical career. It is important that these are taken into consideration in the design of future guidelines to help alleviate uncertainties and reduce barriers for informed prescribing. While our research and previous research find that physicians generally will follow clinical guidelines based on institutional logics (i.e. the standardised approach to medicine), we find that physicians often allow their personal construals to determine their perceptions and prescribing behaviour to a considerable extent when they practice medicine. Our findings have implications for Continuing Medical Education, marketing and regulation for medical cannabis, especially about the wording of guideline adherence.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Exploring the medical cannabis prescribing behaviours of New Zealand physicians

Manoharan

Kemper

Young

2022

Drug and Alcohol Review

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“…Published research exists depicting favorable attitudes toward MC among patients and as its popularity and acceptance among patients continue, more may be asking their physicians about symptomatic and curative treatment with cannabis-based products [ 11 - 19 ]. Despite the increasing acceptance of MC and the relaxation of restrictions on its use nationwide, the medical community at large has yet to reach a consensus on the appropriate medical uses of marijuana.…”

Section: Introductionmentioning

confidence: 99%

Predictors of Medical Students’ Perceptions About Medical Cannabis

Jacobs¹,

Kane²,

Caballero³

2022

Cureus

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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 R 2 =0.518 [adjusted R 2 =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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“…This chapter contains excerpts from Oldfield et al's. "Medical cannabis: knowledge and expectations in a cohort of North Island New Zealand general practitioners"219 and Oldfield et al's, "Experiences, patient interactions and knowledge regarding the use of cannabis as a medicine in a cohort of New Zealand doctors in an oncology setting"220 and has been reproduced with permission from the New Zealand Medical Journal and BMJ publishing groups. Dr Jordan Tewhaiti-Smith assisted with data collection, Allie Eathorne assisted with statistical analysis, all other authors were involved in study planning and review of the final papers.…”

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confidence: 99%

Framing the use of cannabis as a medicine in New Zealand: Regulatory, Clinician and Patient contexts

Oldfield¹

Self Cite

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A medicine is a substance developed for administration to humans for therapeutic purposes that achieves its action by pharmacological, immunological or metabolic means. Pharmaceutical medications undergo years of pre-clinical and clinical trials to establish their safety, tolerability and efficacy. Cannabis, whether in raw or processed form, sits predominantly outside this remit. Its use falls broadly into four categories; recreational, plant used for medicinal purposes, cannabis-based products marketed for medical purposes and pharmaceutical grade cannabinoid medications. The use of cannabis as a medicine involves complex interactions across social, health and political domains, at both a global and national level. New Zealand has attempted to address this with the implementation of the Medicinal Cannabis Scheme in April 2020. This research was undertaken to develop an understanding of what effect cannabis regulations have had on multiple jurisdictions enacting them and applying this to the New Zealand context, and to understand specific groups of patient-doctor interactions regarding the use of cannabis as a medicine. First, I undertook a meta-narrative qualitative review synthesising themes relating to the outcomes of cannabis regulatory change across multiple jurisdictions. Five super-ordinate themes were identified in the meta-narrative review; Normalisation, Gatekeeping, Economics, Community and Health, which were applied in framing the conclusion of this thesis. I then completed a systematic review / meta-analysis examining label accuracy and contaminants in cannabis-based products in regulated markets. Labelling accuracy ranged from 17 to ~86%. Contaminants included microbes, solvents, pesticides and adulterants. Meta-analysis of pesticide contamination showed that the overall proportion of contaminated samples was 0.25 (95% CI: 0.10 to 0.40, Heterogeneity: I2=79%, X12=4.74, p=0.03). Finally, I completed six observational studies within New Zealand to determine knowledge, beliefs and reported interactions of doctors and patients regarding the use of cannabis as a medicine in three medical disciplines; general practice (GP), oncology and neurology. Doctors reported that patients were requesting medical cannabis prescriptions (GP: 55%, Neurology: 63%. Oncology: 84% respectively), and informing them of using illicit cannabis for medical symptoms. All doctors were concerned about prescribing cannabis as a medicine due to lack of evidence and lack of understanding of the prescription processes. Despite this, the majority were willing to prescribe a funded cannabis-based product backed by evidence of efficacy in traditional clinical trials. Patients in all three disciplines indicated comfort discussing cannabis with GPs and specialists (GP patients: 91.7%, 92.1%, neurology patients: 88.2%, 90.6%, oncology patients: 85.8%, 88.2% respectively). All groups reported low levels of prescriptions received (<20%). Patients reported illicit use of cannabis for medical reasons (11.2%, 34.6% and 35.5% in GP, neurology and oncology patients respectively), with reported effectiveness of illicit cannabis for their condition ranging from 86.7 to 94.0%. Patients in all three fields wished to know the benefits, side effects and availability of cannabis-based products and had concerns regarding access and cost. The use of cannabis as a medicine remains a complex situation within the NZ context. Significant implementation issues remain for the Medicinal Cannabis Scheme to ensure the safety and wellbeing of patients in New Zealand.

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Experiences, patient interactions and knowledge regarding the use of cannabis as a medicine in a cohort of New Zealand doctors in an oncology setting

Cited by 10 publications

References 15 publications

Exploring the medical cannabis prescribing behaviours of New Zealand physicians

Exploring the medical cannabis prescribing behaviours of New Zealand physicians

Predictors of Medical Students’ Perceptions About Medical Cannabis

Framing the use of cannabis as a medicine in New Zealand: Regulatory, Clinician and Patient contexts

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