The Role of Medicinal Cannabis in Clinical Therapy: Pharmacists' Perspectives

Abstract

BackgroundMedicinal cannabis has recently attracted much media attention in Australia and across the world. With the exception of a few countries, cannabinoids remain illegal–known for their adverse effects rather than their medicinal application and therapeutic benefit. However, there is mounting evidence demonstrating the therapeutic benefits of cannabis in alleviating neuropathic pain, improving multiple sclerosis spasticity, reducing chemotherapy induced nausea and vomiting, and many other chronic conditions. Many are calling for the legalisation of medicinal cannabis including consumers, physicians and politicians. Pharmacists are the gatekeepers of medicines and future administrators/dispensers of cannabis to the public, however very little has been heard about pharmacists’ perspectives. Therefore the aim of this study was to explore pharmacists’ views about medicinal cannabis; its legalisation and supply in pharmacy.MethodsSemi-structured interviews with 34 registered pharmacists in Australia were conducted. All interviews were audio-recorded, transcribed ad verbatim and thematically analysed using the NVivo software.ResultsEmergent themes included stigma, legislation, safety and collaboration. Overall the majority of pharmacists felt national legalisation of a standardised form of cannabis would be suitable, and indicated various factors and strategies to manage its supply. The majority of participants felt that the most suitable setting would be via a community pharmacy setting due to the importance of accessibility for patients.DiscussionThis study explored views of practicing pharmacists, revealing a number of previously undocumented views and barriers about medicinal cannabis from a supply perspective. There were several ethical and professional issues raised for consideration. These findings highlight the important role that pharmacists hold in the supply of medicinal cannabis. Additionally, this study identified important factors, which will help shape future policies for the successful implementation of medicinal cannabis in healthcare. We recommend that these views and strategies be incorporated in the development of policies and legislations.

Health professional beliefs, knowledge, and concerns surrounding medicinal cannabis – A systematic review

“…[24] There were 18 studies that sampled medical practitioners,[21, 24–26, 28–32, 34, 36, 37, 40–42, 44–46] and three studies that sampled pharmacists. [33, 35, 39] An additional five studies included in this review were grouped according to the high proportion of nursing professionals sampled. [22, 23, 27, 38, 43] One study sampled exclusively nurse practitioners[23] while the other four studies sampled a mixed cohort of medical and allied health professionals of which nurses were the predominant population.…”

“…Overall, pharmacists’ self-reported knowledge was quite low. [33, 35, 39] Hwang et . al [33] reported that pharmacists considered themselves to be lacking knowledge surrounding the pharmacology, pharmacokinetics and pharmacodynamics of medicinal cannabis.…”

“…[39] There was a self-reported desire from sampled Minnesotan and Australian pharmacists for further education. [33, 35] Finally, pharmacists stated that a lack of accessible and robust literature was a major limitation such that when faced with a clinical question, the majority of pharmacists used self-directed online learning to inform practice. [39]…”

“…Pharmacists reported a number of concerns surrounding a lack of quality controlled formulations, the potential for recreational misuse, the possibility for diversion into illicit channels, psychiatric co-morbidities, and the risk of drug-drug interactions. [33, 35, 39] When considering overall patient safety, Mitchell et . al [39] reported that 55% of Canadian hospital pharmacists either disagreed or were unsure whether medicinal cannabis was safe.…”

Chromatographic characterisation of 11 phytocannabinoids: Quantitative and fit‐to‐purpose performance as a function of extra‐column variance

“…The use of Cannabis sativa L. (cannabis; ssp sativa and indica ) has been suggested as a treatment for a variety of medical conditions in recent reviews, including chronic pain, asthma, nausea associated with chemotherapy, multiple sclerosis and glaucoma . Phytocannabinoids are putatively believed to be the primary bioactive constituents, although terpenes and flavonoids may also contribute to the overall bioactivity of cannabis .…”