Knowledge, experiences, and attitudes of Australian General Practitioners towards medicinal cannabis: a 2021–2022 survey

Abstract

Background Medicinal cannabis (MC) products have been available on prescription in Australia for around six years. General practitioners (GPs) are at the forefront of MC prescribing and recent years have seen substantial increases in prescription numbers. This study examined the current knowledge, experiences, and attitudes of Australian GPs around MC. We also compared our findings to those of an earlier 2017 investigation. Method We conducted a cross-sectional study using a 42-item on-line questionnaire adapted from our earlier 2017 survey. The current survey was completed by GPs attending an on-line, multi-topic educational seminar. Australian GPs (n = 505) completed the survey between November 2021 and February 2022. Data were synthesised using descriptive statistics. MC ‘prescribers’ and ‘non-prescribers’ responses were compared using Pearson’s χ2 tests. Results While most GPs (85.3%) had received patient enquiries about MC during the last three months, only half (52.3%) felt comfortable discussing MC with patients. Around one fifth (21.8%) had prescribed a MC product. GPs strongly supported MC prescribing for palliative care, cancer pain, chemotherapy-induced nausea and vomiting, and epilepsy, more so than in our 2017 survey. Prescribing for mental health conditions (e.g., depression, anxiety) and insomnia received less support. Opioids, benzodiazepines, and chemotherapy drugs were rated as more hazardous than MC. GPs correctly endorsed concerns around Δ9-tetrahydrocannabinol-related driving impairment and drug-seeking behaviour. However, additional concerns endorsed around cannabidiol causing addiction and driving impairment do not agree with current evidence. Consistent with this, many GPs (66.9%) felt they had inadequate knowledge of MC. Conclusion Acceptance of MC as a treatment option has increased among Australian GPs since 2017. However, there is a clear need for improved training and education of GPs around cannabis-based medicines to provide increased numbers of skilled prescribers in the community.

Medical cannabis use in Australia seven years after legalisation: findings from the online Cannabis as Medicine Survey 2022–2023 (CAMS-22)

“…The differences in main condition treated between prescribed and illicit users may stem from prescribed users’ receiving guidance from trained health professionals whose job is to be informed about the existing evidence for clinical indications for medications. Results from a recent survey of n = 505 Australian general practitioners support this interpretation, with respondents indicating they are much less comfortable with the idea of prescribing cannabis for anxiety, depression and sleep conditions than they are for pain, epilepsy, and chemotherapy-induced nausea [ 21 ]. Alternatively, it may be that the type of person who is already well-informed about the clinical evidence for effectiveness of cannabis for certain conditions is also more likely to seek their medical cannabis through legal channels.…”

“…The dramatic increase in prescriptions reflects changing attitudes among doctors towards medical cannabis. Recent surveys and meta-analyses indicate that health professionals in Australia and the rest of the world are increasingly positive in their attitudes towards medical cannabis [ 21 – 25 ]. However, many clinicians remain concerned about their lack of experience prescribing; the increase in prescribing for conditions where there is limited empirical evidence for efficacy, such as mental health and sleep conditions; and the potential for harm to patients and society generally due to inappropriate prescribing [ 24 – 28 ].…”

Barriers and facilitators to prescribing medicinal cannabis in New Zealand

“…[33][34][35][36] In accordance with the findings of other studies, our participants agreed that MC education and training are imperative to improve understanding and preparedness to discuss MC in clinical settings. 37,38 The MC information sheet developed by the Best Practice Advocacy Centre New Zealand may support health professionals to facilitate MC discussions and prescribe confidently. 39 Research suggests experienced and educated cannabis prescribers may be better placed to evaluate the benefits and harms of prescribing cannabis, and discuss the trade-offs with patients.…”

Cannabis use among workers with work-related injuries and illnesses: results from a cross-sectional study of workers’ compensation claimants in Ontario, Canada

“…A qualitative study of family physicians demonstrated they were often hesitant to guide patients on medical cannabis use, including a reluctance to authorise its use, due to concerns about the potential for harm and a feeling they lacked education about its therapeutic benefit 42. Studies conducted in other jurisdictions and with other specialties have reported similar findings 43 44…”