Over half of Canadian healthcare practitioners ‘uncomfortable’ about their cannabis knowledge

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Canadians seeking healthcare providers (HCPs) to authorize their use of medical cannabis (MC) likely face hurdles in not only finding someone to do that, but also someone who feels well-versed in the drug’s health-related applications.

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Canadian researchers gathered the opinions, knowledge, comfort levels and practices of HCPs, such as attending physicians, nurses and pharmacists, in prescribing MC. To get a broad cross-section of participants, the related survey was distributed by 24 health care associations to their members between Apr. 13 and Dec. 13, 2021, according to the study, published this month in BMC Complementary Medicine and Therapies.

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Fully completed surveys were received from 70 people, 71 per cent of whom were attending physicians or medical residents, with nurses, pharmacists and other HCPs accounting for the remainder.

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Just a handful, six per cent, of responding HCPs reported having received MC training in professional school, although 60 per cent of those polled said they had obtained training through events like workshops and conferences.

“The most common symptoms for recommending MC were pain and nausea, whereas the most common conditions for recommending it were cancer and intractable pain,” study authors point out.

Although recreational cannabis was legalized in 2018, medicinal marijuana was legalized in Canada almost two decades earlier, in 2001.

While 57 per cent of respondents noted they were receiving more MC questions since adult-use cannabis was okayed, and 82 per cent reported having patients who used MC, comfort prescribing the drug was not there for all.

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Indeed, 56 per cent of HCPs surveyed “felt uncomfortable or ambivalent regarding their knowledge of MC, and 27 per cent were unfamiliar with the requirements for obtaining MC in Canada,” the study abstract reads.

“The strongest barrier to authorizing MC was uncertainty in safe and effective dosage and routes of administration,” the authors write. “The strongest barrier to recommending or authorizing MC was the lack of research evidence demonstrating its safety and efficacy.”

That being the case, investigators note that “increasing research, training and knowledge may help HCPs feel more equipped to make informed treatment/prescribing decisions, which may help to improve access to MC.”

The National Organization for the Reform of Marijuana Laws reports that Canadian results “are consistent with numerous other surveys from the United States and abroad finding that health professionals seldom receive any formal training about cannabis and that most lack sufficient understanding of the subject.”

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A study by McMaster University researchers, released in 2021 and involving 11 doctors, showed Ontario physicians are still hesitant to prescribe MC to patients suffering long-term pain 20 years after medicinal marijuana was first introduced.

Beyond surveyed physicians voicing concern over possible ill-effects and a lack of understanding regarding MC’s effectiveness as painkillers, they also reported worry about potentially harmful effects on cognitive development and the drug’s effects in older adults, perhaps including dizziness or drowsiness.

A half world away, a study comparing the views of medical students in Israel to their counterparts in Thailand showed the former felt unprepared to use MC to treat pain, despite being more supportive of medicinal cannabis than the latter.

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There also appears to be some reticence among patients. Results of a poll of 1,000 primary care patients in Vermont, which has had legal MC since 2004, showed that just 18 per cent of respondents felt their physician was a good source of information on cannabis.

Add to that results from another Canadian poll from 2020. The survey indicated Canadian MC patients felt disadvantaged when it comes to access and pricing.

“Right now, accessing medical cannabis is unnecessarily expensive and difficult, and people are being pushed back to the illicit market,” Joel Taylor, co-founder of Patient Choice, a Health Canada-licensed online medical platform, argued at the time.

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