Personal experience and attitudes of pain medicine specialists in Israel regarding the medical use of cannabis for chronic pain

Abstract

IntroductionThe scientific study of the role of cannabis in pain medicine still lags far behind the growing use driven by public approval. Accumulated clinical experience is therefore an important source of knowledge. However, no study to date has targeted physicians who actually use cannabis in their daily practice.MethodsRegistered, active, board-certified pain specialists in Israel (n=79) were asked to complete a Web-based survey. The survey was developed using the Qualtrics Online Survey Software. Questions were formulated as multiple-choice questions, and these addressed three areas of interest: 1) doctors’ personal experience; 2) the role of cannabis in pain medicine; and 3) cannabis medicalization and legalization.ResultsSixty-four percent of all practicing pain specialists in Israel responded. Almost all prescribe cannabis. Among them, 63% find cannabis moderately to highly effective, 56% have encountered mild or no side effects, and only 5% perceive it as significantly harmful. Common indications are neuropathic pain (65%), oncological pain (50%), arthralgias (25%), and any intractable pain (29%). Leading contraindications are schizophrenia (76%), pregnancy/breastfeeding (65%), and age <18 years (59%). Only 12% rated cannabis as more hazardous than opiates. On a personal note, 45% prefer cannabis for themselves or a family member. Lastly, 54% would like to see cannabis legalized in Israel.ConclusionIn this survey, pain clinicians experienced in prescribing cannabis over prolonged periods view it as an effective and relatively safe treatment for chronic pain, based on their own experience. Their responses suggest a possible change of paradigm from using cannabis as the last resort.

Medical cannabis use in the Australian community following introduction of legal access: the 2018–2019 Online Cross-Sectional Cannabis as Medicine Survey (CAMS-18)

“…Over half of psychiatrists (54%) and GPs surveyed (57%) supported the availability of medical cannabis on prescription; however, a majority of GPs (52%) felt uncomfortable discussing medical cannabis with their patients, with over two-thirds of GPs reporting that they did not have good knowledge around medical cannabis. Lack of perceived knowledge on the topic is a common barrier for medical practitioners globally [42,[45][46][47], highlighting a need for improved training of medical practitioners around medical cannabis. Finally, whilst most respondents in our survey continued to express disappointment with the legal models of medical cannabis availability, those who had actually pursued the licit avenue reported quite positive experiences.…”

Medical cannabis use in the Australian community following introduction of legal access: The 2018-2019 Online Cross-Sectional Cannabis as Medicine Survey (CAMS-18)

“…Over half of psychiatrists (54%) and GPs surveyed (57%) supported the availability of medical cannabis on prescription, however, a majority of GPs (52%) felt uncomfortable discussing medical cannabis with their patients, with over two-thirds of GPs reporting that they did not have good knowledge around medical cannabis. Lack of perceived knowledge on the topic is a common barrier for medical practitioners globally [43,[46][47][48], highlighting a need for improved training of medical practitioners around medical cannabis. Finally, whilst most respondents in our survey continued to express disappointment with the legal models of medical cannabis availability, those who had actually pursued the licit avenue reported quite positive experiences.…”

Physicians’ experiences, attitudes, and beliefs towards medical cannabis: a systematic literature review

“…(17)(18)(19)(22)(23)(24)(25)(26)(27)(28)(29) Especially three studies conducted in Israel report high proportions of physicians experienced in prescribing medical cannabis, namely 48%, 60% and 95% respectively. (22,23,27) 78% of physicians, feel uncomfortable with indicating dosage, frequency, and method of administration of cannabis prescriptions. (22) Studies show signi cant associations between physicians' experiences with prescribing medical cannabis and their self-reported knowledge of it and con dence in prescribing it.…”

“…(23) Additionally, another Israeli study nds that 60% of physicians report that they would not be willing to provide medical cannabis without the Ministry of Health's licensing procedure, which means that physicians only sign a medical recommendation which is processed by the ministry afterwards. (23) Experiences with effects, adverse effects, and misuse In general, physicians experience a lack of knowledge about medical cannabis (64-90%), for instance bene cial effects and adverse effects (17,19,20,22,26,27,29,30), and they do not feel con dent using it in treatment of patients. (20) Despite this, many physicians (46-95%) still choose to provide it.…”

“…(20) Despite this, many physicians (46-95%) still choose to provide it. (20,27,29) A qualitative interview study, that included physicians' experiences with effects and adverse effects from medical cannabis, reported that some physicians describe positive impressions of how medical cannabis helps their patients, and they view it as useful. They claim to see more e cacy of medical cannabis in real life than proven in literature, and hands-on experiences are mentioned as having a crucial impact on their views and on their decisions of providing it.…”