Medicinal Cannabis: Policy, Patients, and Providers

Ryan, Jennie; McCabe, Sean Esteban; Boyd, Carol J.

doi:10.1177/1527154421989609

Cited by 18 publications

(16 citation statements)

References 14 publications

(23 reference statements)

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“…Following 2016 legislation permitting limited access to cannabis for research and medicinal purposes in Australia [ 51 ], a pilot study (MedCan Pilot) [ 52 ], followed by MedCan 1 [ 42 ] and 2 [ 53 ], was established to generate an evidence-base for cannabis use in palliative care [ 43 , 54 – 56 ]. Patients eligible for inclusion had advanced cancer (metastatic or locally advanced) with associated symptom burden as measured by an Edmonton Symptom Assessment Scale (ESAS) total symptom distress score (TSDS) of ≥10 for cancer-related symptoms and at least one individual ESAS score ≥3.…”

Section: Introductionmentioning

confidence: 99%

Using a qualitative sub-study to inform the design and delivery of randomised controlled trials on medicinal cannabis for symptom relief in patients with advanced cancer

Olson

Smith

Huggett

et al. 2022

Trials

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Background Recruitment for randomised controlled trials in palliative care can be challenging; disease progression and terminal illness underpin high rates of attrition. Research into participant decision-making in medicinal cannabis randomised controlled trials (RCTs) is very limited. Nesting qualitative sub-studies within RCTs can identify further challenges to participation, informing revisions to study designs and recruitment practices. This paper reports on findings from a qualitative sub-study supporting RCTs of medicinal cannabis for symptom burden relief in patients with advanced cancer in one Australian city. Methods Semi-structured qualitative interviews were conducted with 48 patients with advanced cancer, eligible to participate in a medicinal cannabis RCT (n=28 who consented to participate in an RCT; n=20 who declined). An iterative and abductive approach to thematic analysis and data collection fostered exploration of barriers and enablers to participation. Results Key enablers included participants’ enthusiasm and expectations of medicinal cannabis as beneficial (to themselves and future patients) for symptom management, especially after exhausting currently approved options, and a safer alternative to opioids. Some believed medicinal cannabis to have anti-cancer effects. Barriers to participation were the logistical challenges of participating (especially due to driving restrictions and fatigue), reluctance to interfere with an existing care plan, cost, and concerns about receiving the placebo and the uncertainty of the benefit. Some declined due to concerns about side-effects or a desire to continue accessing cannabis independent of the study. Conclusions The findings support revisions to subsequent medicinal cannabis RCT study designs, namely, omitting a requirement that participants attend weekly hospital appointments. These findings highlight the value of embedding qualitative sub-studies into RCTs. While some challenges to RCT recruitment are universal, others are context (population, intervention, location) specific. A barrier to participation found in research conducted elsewhere—stigma—was not identified in the current study. Thus, findings have important implications for those undertaking RCTs in the rapidly developing context of medical cannabis.

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Section: Introductionmentioning

confidence: 99%

Using a qualitative sub-study to inform the design and delivery of randomised controlled trials on medicinal cannabis for symptom relief in patients with advanced cancer

Olson

Smith

Huggett

et al. 2022

Trials

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“… Abuhasira, et al, 2018 ; Alharbi, 2020 ; Carliner, et al, 2017 ; Choo and Emery, 2017 ; Corroon and Kight, 2018 ; Johnson, et al, 2021 ; Mead, 2017 ; National Conferences of State Legislatures, 2022 ; ProCon, 2022 ; Ryan, et al, 2021 ; The Health Products Regulatory Authority, 2017 )…”

Section: Resultsmentioning

confidence: 99%

Cannabis for Medical Use: Analysis of Recent Clinical Trials in View of Current Legislation

et al. 2022

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Cannabis has long been regarded as a recreational substance in the Western world. The recent marketing authorization of some medicinal products of industrial origin and the introduction onto the market of inflorescences for medical use mean that medical doctors can now prescribe Cannabis-based medicines in those countries which allow it. Nevertheless, there is still considerable controversy on this topic in the scientific community. In particular, this controversy concerns: the plant species to be used; the pathologies that can be treated and consequently the efficacy and safety of use; the routes of administration; the methods of preparation; the type and dosage of cannabinoids to be used; and, the active molecules of interest. As such, although medical Cannabis has been historically used, the results of currently completed and internationally published studies are inconclusive and often discordant. In light of these considerations, the aim of this work is to analyse the current legislation in countries that allow the use of medical Cannabis, in relation to the impact that this legislation has had on clinical trials. First of all, a literature search has been performed (PubMed and SciFinder) on clinical trials which involved the administration of Cannabis for medical use over the last 3 years. Of the numerous studies extrapolated from the literature, only about 43 reported data on clinical trials on medical Cannabis, with these mainly being performed in Australia, Brazil, Canada, Denmark, Germany, Israel, Netherlands, Switzerland, the United Kingdom and the United States of America. Once the reference countries were identified, an evaluation of the legislation in relation to Cannabis for medical use in each was carried out via the consultation of the pertinent scientific literature, but also of official government documentation and that of local regulatory authorities. This analysis provided us with an overview of the different legislation in these countries and, consequently, allowed us to analyse, with greater awareness, the results of the clinical trials published in the last 3 years in order to obtain general interest indications in the prosecution of scientific research in this area.

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“…In addition, higher concentrations of cannabinoid psychoactive compounds further complicate recreational and illicit use compared to the prior century [18][19][20]. As mentioned earlier, legal and societal background determines the likelihood that anesthesiologists will encounter individuals consuming cannabinoids for various reasons [12,28,37,38,64]. However, the increased prevalence of cannabinoid compounds is such that accidental intake has been reported in all ages, including newborns [65][66][67][68].…”

Section: Utilization Of Cannabinoidsmentioning

confidence: 99%

“…The scientific opinions about the use and danger of opioids often juxtapose one another, while the robust clinical evidence is frequently dated to the time before the "War on Drugs" was initiated in the 1980s [12,14,25,26,33,34]. There are also a significant number of claims in the media that are difficult to validate but influence patients' consumption of cannabinoid products [17,19,25,[35][36][37][38]. Patients often consume cannabinoids regardless of their efficacy [39,40].…”

Section: Introductionmentioning

confidence: 99%

“…Neocannabinoids are frequently added as adulterators or potentiators to natural cannabinoid preparations [9,10,17,43]. Illicit or recreational marijuana use often affects individuals from disadvantaged backgrounds, thus adding to their illness burden while interacting with their primary treatment [24,38,[44][45][46]. Finally, cannabinoid-based compounds are becoming more commonly approved and regulated in drugs such as Nabilone (Cesamet™), Cannabidiol (Epidiolex™), Nabiximols (Sativex™), Dronabinol (Marinol™, Adversa™, Syndros™, and Reduvo™), and Rimonabant/SR141716 (Acomplia™ and Zi-multi™) [47][48][49][50].…”

Section: Introductionmentioning

confidence: 99%

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Considerations for Cannabinoids in Perioperative Care by Anesthesiologists

Laudański

Wain

2022

JCM

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Increased usage of recreational and medically indicated cannabinoid compounds has been an undeniable reality for anesthesiologists in recent years. These compounds’ complicated pharmacology, composition, and biological effects result in challenging issues for anesthesiologists during different phases of perioperative care. Here, we review the existing formulation of cannabinoids and their biological activity to put them into the context of the anesthesia plan execution. Perioperative considerations should include a way to gauge the patient’s intake of cannabinoids, the ability to gain consent properly, and vigilance to the increased risk of pulmonary and airway problems. Intraoperative management in individuals with cannabinoid use is complicated by the effects cannabinoids have on general anesthetics and depth of anesthesia monitoring while simultaneously increasing the potential occurrence of intraoperative hemodynamic instability. Postoperative planning should involve higher vigilance to the risk of postoperative strokes and acute coronary syndromes. However, most of the data are not up to date, rending definite conclusions on the importance of perioperative cannabinoid intake on anesthesia management difficult.

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Medicinal Cannabis: Policy, Patients, and Providers

Cited by 18 publications

References 14 publications

Using a qualitative sub-study to inform the design and delivery of randomised controlled trials on medicinal cannabis for symptom relief in patients with advanced cancer

Using a qualitative sub-study to inform the design and delivery of randomised controlled trials on medicinal cannabis for symptom relief in patients with advanced cancer

Cannabis for Medical Use: Analysis of Recent Clinical Trials in View of Current Legislation

Considerations for Cannabinoids in Perioperative Care by Anesthesiologists

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