Pharmacists’ perceptions and experiences of medicinal cannabis dispensing: A narrative review with a systematic approach

Abstract

Objectives Medicinal cannabis was introduced with limited understanding of effect, and minimal rigorous evidence supporting efficacy, yet the global demand for medicinal cannabis continues to increase. In Australia, pharmacists remain a key conduit between the prescriber and patient, as most medicinal cannabis products are available only through approved prescriptions. This places pharmacists in a strong position to inform the evolving policy and practice of medicinal cannabis. This review aims to explore pharmacists’ experiences and perceptions on medicinal cannabis in the global context by conducting a narrative review with a systematic approach. Method MEDLINE (Ovid), EMBASE, and PubMed were searched on July 2021 using keywords and MeSH terms, with studies independently screened for eligibility. Of 278 identified studies, five met inclusion criteria, and were subjected to thematic synthesis for emergent themes. Key findings Whilst pharmacists valued being central to medicinal cannabis access, a repeating theme was that pharmacists perceived they were underprepared when engaging with patients about medicinal cannabis. These perceptions were congruent with their dispensing experiences, as most pharmacists reported patients seeking guidance on medicinal cannabis from them, yet only a small proportion felt comfortable in providing this guidance. Underpinning this was a lack of knowledge and low uptake of educational resources. Conclusions Pharmacists are key in providing access to medicinal cannabis, yet they are expected to provide guidance with limited education. These limitations necessitate further investment in ongoing education to pharmacists in countries wishing to involve them in dispensing medicinal cannabis.

A cross-sectional survey exploring the knowledge, experiences and attitudes of Australian pharmacists toward medicinal cannabis

“…This may reflect the fact that no Pharmacist Only CBD products are currently registered or marketed, meaning that pharmacists may not consider competency in this area a priority. The low levels of knowledge observed in this study are consistent with numerous surveys of pharmacists around cannabis-based medicines [ 31 – 34 , 50 , 51 ]. Indeed, the piecemeal approach to legalising MC has been identified as creating gaps in knowledge [ 51 ].…”

“…Few respondents felt confident discussing customers’ enquiries about MC products despite the rise in such enquiries, and only around half of the respondents felt comfortable supplying MC. Similar findings are observed in many international surveys of pharmacists around MC [ 1 , 31 – 34 , 47 ]. These results may reflect pharmacists’ need to navigate the broad range of clinical applications for cannabis-based medicines [ 2 , 5 , 42 ], only some of which are supported by high-quality evidence [ 48 ], and the extensive product range in Australia involving around 240 individual preparations [ 2 , 5 ].…”

“…Indeed, the piecemeal approach to legalising MC has been identified as creating gaps in knowledge [ 51 ]. In one review, 58.9–81.9% of pharmacists were predicted to have a low perceived knowledge around MC [ 34 ], while only 5% of pharmacists in another survey of Californian pharmacists reported having ‘professional level’ knowledge around MC [ 33 ]. When Pharmacist Only CBD products become available, knowledge development in this area will be essential for optimal patient care and to actualise health professionals’ roles to their full potential [ 33 , 36 ], particularly with pharmacists set to become the ‘frontline suppliers’ of Pharmacist Only CBD products.…”

“…Almost all survey respondents strongly endorsed the need for further training. This need has been repeatedly highlighted as a priority in surveys of pharmacists around MC [ 1 , 31 , 33 , 34 , 47 , 50 , 51 ], at times, in equally high numbers, i.e., ~ 70–90% of pharmacists surveyed [ 33 , 34 ]. A significant obstacle to pharmacists’ education around cannabis-based therapy has been noted as a lack of access to reliable resources and training activities [ 34 , 50 , 51 ].…”

“…This need has been repeatedly highlighted as a priority in surveys of pharmacists around MC [ 1 , 31 , 33 , 34 , 47 , 50 , 51 ], at times, in equally high numbers, i.e., ~ 70–90% of pharmacists surveyed [ 33 , 34 ]. A significant obstacle to pharmacists’ education around cannabis-based therapy has been noted as a lack of access to reliable resources and training activities [ 34 , 50 , 51 ]. Currently, an array of MC resources, guidelines, and policies are available from Australian government organisations such as the TGA and pharmacy-specific organisations [ 4 , 48 , 52 – 56 ].…”