International perspective on physician knowledge, attitude and practices related to medical cannabis

SHARIFUL A SYED ¹ Jatinder Singh ² H Elkholy ³ Irena Rojnić Palavra ⁴ Marko Tomicevic ⁵ Anamarija Petek Erić ⁶ Mariana Pinto da Costa ⁷ Sinan Guloksuz ⁸ Rajiv Radhakrishnan ^1*

• ¹ Psychiatry, School of Medicine, Yale University, New Haven, United States
• ² Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania, United States
• ³ Ain Shams University, Cairo, Cairo, Egypt
• ⁴ Psychiatric Hospital Sveti Ivan, Zagreb, Croatia
• ⁵ Department of Psychiatry, University Hospital Dubrava, Zagreb, Croatia
• ⁶ Osijek Clinical Hospital Center, Osijek, Osijek, Croatia
• ⁷ King's College London, London, England, United Kingdom
• ⁸ Maastricht University Medical Centre, Maastricht, Limburg, Netherlands

The trends of recreational use of cannabis and use of cannabis for medical indications (i.e. "medical cannabis") have grown in recent years. Despite that, there is still limited scientific evidence to guide clinical decision-making and the strength of evidence for the medical use of cannabis is currently considered to be low. In contrast, there is growing evidence for negative health outcomes related to use of cannabis. In this rapidly shifting landscape, the role of physician attitudes regarding the therapeutic value of cannabis has become essential. This study aimed to characterize knowledge/experience, attitudes, and potential predictors of clinical practice regarding medical cannabis.We conducted a cross-sectional survey of physicians from 17 countries between 2016-2018. The survey comprised of questions designed to explore physician knowledge, attitude, and practices regarding the use of medical cannabis. Descriptive statistics were used to examine willingness to recommend medical cannabis for medical and psychiatric indications, followed by regression analysis to identify predictors of physician willingness to recommend medical cannabis.A total of 323 physicians responded to the survey. Mean age was 35.4± 9.5 years, with 10.04 ±8.6 years of clinical experience. 53 percent of physicians were women. Clinical experience with medical cannabis was overall limited (51.4% noted never having recommended medical cannabis; 33% noted inadequate knowledge regarding medical cannabis). Majority of respondents (84%) recognized the risk of psychosis with cannabis use, while only 23% correctly identified the risk of addiction with daily cannabis use. Overall willingness to recommend medical cannabis was highest for chemotherapy-induced nausea (67%), refractory chronic neuropathic pain (52%), and spasticity in amyotropic lateral sclerosis (ALS) (51%).This international study examining knowledge, attitudes and practices related to medical cannabis among physicians revealed that there are significant gaps in domain-specific knowledge related to medical cannabis. There is wide variability in willingness to recommend medical cannabis that is not consistent with the current strength of evidence. This study thus highlights the need for greater education related to domain-specific knowledge about medical cannabis.