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

Abstract

Background There is a growing literature on the potential medical uses of Cannabis sativa and cannabinoid compounds. Although these have only been approved by regulatory agencies for a few indications, there is a hype about their possible benefits in a variety of conditions and a large market in the wellness industry. As in many cases patients search for information on cannabis products online, we have analyzed the information on medical cannabis available on the Internet. Therefore, this study aims at assessing the quality of the information available online on medical cannabis. Methods We searched “medical cannabis” on June 2019 using google.com and downloaded the first 243 websites. After excluding dead links or websites with no information about cannabis, 176 websites were included. They were then classified for their typology (e.g., commercial, government, news outlets). As an indicator of trustworthiness, we used the Journal of American Medical Association (JAMA) score, which assesses the indication of date, author, ownership of the website, and the presence of references. We also considered if a website is certified by Health-On-the-Net (HON), an independent organization, by displaying a HONCode symbol. Subsequently, we performed a content analysis to assess both the medical cannabis indications mentioned by webpages and the completeness of the information provided (whether they mentioned potential side effects and legal/regulatory issues or not). Results Analyzing 176 webpages returned by a search engine, we found that 52% of them were news websites. Pain, epilepsy, and multiple sclerosis were the most frequently mentioned therapeutic areas (cited in 92, 84 and 80 webpages, respectively), which did not always match those for which there is regulatory approval. Information was also incomplete, with only 22% of the webpages mentioning potential side effects. Health portal websites provided the most complete information, with all of them (n = 7) reporting side effects. On average, 80% of webpages had a neutral stance on the potential benefits of medical cannabis, with commercial websites having more frequently a positive stance (67%). Conclusions We conclude that the information that can be found online is not always aligned in terms of the therapeutic areas for which science-based evidence is often still weak.

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

“…First and foremost, these web sites were commercial in nature; vendors are motivated to present information in a sensational rather than objective manner, aiming to persuade consumers to buy their products. Naturally, this results inthe provision of biased and unbalanced information, with a greater focus on the benefits of cannabis use and less focus on the risks, as evident by the present study's results, along with other published studies [ 26 , 27 ]. Presenting information that could potentially detract consumers from buying products, such as the side effects of cannabis use, is not in the interest of many online vendors [ 28 ].…”

“…In agreement with this finding, one study noted that these effects were magnified by commercial web sites compared to other sources of online information (e.g., government, health portal, non-profit), indicating the biases associated with commercial interests [ 26 ]. Across other forms of media such as news outlets and online discussion forums, the quality and accuracy of cannabis-related health information, as well as reporting of risks, was also found to be poor [ 26 , 39 – 41 ]. It is worth mentioning that these aforementioned studies did not use the DISCERN instrument, which in addition to quality, assesses the reliability of consumer health information, as opposed to accuracy.…”

“…Aligning with the findings from our study, Luc et al and Kruger et al also reported that there was limited mention of potential side effects or risks associated with cannabis use [ 36 , 38 ]. Moreover, a study from the United Kingdom found that much of the online information about medical cannabis would raise unrealistic expectations of benefits and downplay potential side effects [ 26 ]. In agreement with this finding, one study noted that these effects were magnified by commercial web sites compared to other sources of online information (e.g., government, health portal, non-profit), indicating the biases associated with commercial interests [ 26 ].…”

“…Moreover, a study from the United Kingdom found that much of the online information about medical cannabis would raise unrealistic expectations of benefits and downplay potential side effects [ 26 ]. In agreement with this finding, one study noted that these effects were magnified by commercial web sites compared to other sources of online information (e.g., government, health portal, non-profit), indicating the biases associated with commercial interests [ 26 ]. Across other forms of media such as news outlets and online discussion forums, the quality and accuracy of cannabis-related health information, as well as reporting of risks, was also found to be poor [ 26 , 39 – 41 ].…”

A review of studies evaluating medical cannabis for the chronic pain management

“…It could raise unrealistic expectations in the public and contribute to a hype that could potentially lead patients to use cannabis-based products as self-medication in case of absence of medical prescription for indications without strong evidence of efficacy. In addition, self-initiated use may lead to side effects and drug interactions [20].…”