Cannabis for pain: a cross-sectional survey of the patient information quality on the Internet

Abstract

Background Cannabis has increasingly become an alternative treatment for chronic pain, however, there is evidence of concomitant negative health effects with its long-term usage. Patients contemplating cannabis use for pain relief commonly see information online but may not be able to identify trustworthy and accurate sources, therefore, it is imperative that healthcare practitioners play a role in assisting them in discerning the quality of information. The present study assesses the quality of web-based consumer health information available at the intersection of cannabis and pain. Methods A cross-sectional quality assessment of website information was conducted. Three countries were searched on Google: Canada, the Netherlands, and the USA. The first 3 pages of generated websites were used in each of the 9 searches. Eligible websites contained cannabis consumer health information for pain treatment. Only English-language websites were included. Encyclopedias (i.e. Wikipedia), forums, academic journals, general news websites, major e-commerce websites, websites not publicly available, books, and video platforms were excluded. Information presented on eligible websites were assessed using the DISCERN instrument. The DISCERN instrument consists of three sections, the first focusing on the reliability of the publication, the second investigating individual aspects of the publication, and the third providing an overall averaged score. Results Of 270 websites identified across searches, 216 were duplicates, and 18 were excluded based on eligibility criteria, resulting in 36 eligible websites. The average summed DISCERN score was 48.85 out of 75.00 (SD = 8.13), and the average overall score (question 16) was 3.10 out of 5.00 (SD = 0.62). These overall scores were calculated from combining the scores for questions 1 through 15 in the DISCERN instrument for each website. Websites selling cannabis products/services scored the lowest, while health portals scored the highest. Conclusion These findings indicate that online cannabis consumer health information for the treatment/management of pain presents biases to readers. These biases included websites: (1) selectively citing studies that supported the benefits associated with cannabis use, while neglecting to mention those discussing its risks, and (2) promoting cannabis as “natural” with the implication that this equated to “safe”. Healthcare providers should be involved in the guidance of patients’ seeking and use of online information on this topic.

Online information on medical cannabis is not always aligned with scientific evidence and may raise unrealistic expectations

“…While it would be desirable that news outlets and commercial websites provided more complete information, our findings suggest that health professionals should point their patients toward websites from non-profit organizations or health portals to get more comprehensive information and allow them to make informed decisions. It is reassuring, in this respect, that our study shows that the ranking provided by Google gives higher visibility to health portals and non-profit organizations, in agreement with the findings by Ng et al for websites on medical cannabis and chronic pain (Ng et al, 2021). The number of webpages mentioning medical cannabis in the context of specific indications not aligned with regulatory approval might indicate both where public health authorities should focus their strategies to disseminate information and, potentially, where a clear answer from clinical trials or systematic reviews are needed.…”

“…(Jia et al, 2021 ) A study by Jia et al found that 24% of the webpages returned by Google (and 59% of YouTube videos) had a positive stance on the use of medical cannabis in glaucoma (Jia et al, 2021 ). Ng et al (Ng et al, 2021 ), although not specifically investigating the stance of the websites, have shown that they often were of low quality according to standard measures of information quality and that quality was higher for health portals and lower for commercial websites.…”

The quality of health information provided on web sites selling cannabis to consumers in Canada is poor

“…This is the first study to broadly evaluate the quality of health information provided by online cannabis vendors selling to Canadian consumers, with no restrictions on health conditions or purpose of use. Ng et al recently used the DISCERN instrument to evaluate the quality of web-based consumer health information at the intersection of cannabis and pain [ 34 ]. Although the averaged DISCERN scores were found to be higher than those in our study, the quality of health information in this area was still concluded to be poor.…”

The Quality, Readability, and Accuracy of the Information on Google About Cannabis and Driving: Quantitative Content Analysis

“…Web pages categorized as peer-reviewed (ie, peer-reviewed journal articles) were not included in the accuracy analysis, as peer-reviewed literature was used to create the evidence-based summary used in the content assessment. This approach has been used by others conducting similar content analyses [ 21 ].…”

“…Among studies that specifically looked at cannabis health claims on the internet, one found only 5% of claims on the health benefits of cannabis aligned with evidence [ 20 ]. Other studies reported that web-based information about cannabis use for pain was biased as sources often neglected to discuss potential risks [ 21 ] or were just unreliable [ 22 ]. This points to variable quality of cannabis-related information available on the internet [ 20 , 23 - 26 ].…”