Prevalence and determinants of cannabinoid prescription for the management of chronic noncancer pain: a postal survey of physicians in the Abitibi-Temiscamingue region of Quebec

Abstract

Background: Few studies have been conducted to explore physicians' prescription practices and attitudes toward the use of cannabinoids in Canada. We measured the prevalence and identified determinants of cannabinoid prescription for the management of chronic noncancer pain among physicians in southwestern Quebec. Methods:In February 2013, we conducted a postal survey using a modified Dillman method that involved physicians practising in the Abitibi-Témiscamingue region of Quebec. We used multivariate logistic regression models to identify determinants of cannabinoid prescription.Results: A total of 166 physicians of 318 practising in the region participated in the survey (response rate 52.2%). The prevalence of cannabinoid prescription was 27.3% (45/165) for any indication and 23.0% (38/165) for the management of chronic noncancer pain; 91.1% (41/45) of the physicians prescribed cannabinoids to 5 or fewer patients. Of the 38 physicians who prescribed cannabinoids for chronic noncancer pain, 35 (92.1%) prescribed nabilone, 7 (18.4%) medical marijuana and 2 (5.3%) nabiximols. The principal determinant of cannabinoid prescription was the physician's level of comfort with prescribing cannabinoids (adjusted odds ratio 1.25, 95% confidence interval 1.01-1.55, per 1-point increase in comfort level measured on 10-point scale). Respondents reported that continuing medical education (CME) activities could increase their comfort level. They also indicated a need for guidelines or algorithms that included cannabinoid use as well as more studies about the efficacy and safety of cannabinoids for the management of chronic noncancer pain. Interpretation:We found that cannabinoids were not often prescribed for the management of chronic noncancer pain and that survey respondents were not comfortable with prescribing this drug class. This degree of discomfort could be addressed by CME activities, more effective dissemination of guidelines and more evidence regarding cannabinoid use for the management of chronic noncancer pain. Abstract Research CMAJ OPEN E252CMAJ OPEN, 3(2)force in April 2014. 18 In this context, physicians can support patients' use of marijuana for medical purposes through the completion of a medical document with specific information that is similar to a prescription. Patients can then send this document to a licensed producer, who provides the product based on the daily amount of marijuana that is recommended by the physician.The prevalence of cannabinoid use for the management of pain symptoms remains low (12%-15%). [19][20][21][22] This limited use among patients could be explained in part by the stigma associated with smoking marijuana, which also affects products offered in capsule or spray formulation. 20,23 Using medical marijuana is one of the treatments for which users are the most stigmatized regardless of their specific health condition. 24 Moreover, the situation could be explained by physicians' lack of comfort regarding these therapeutic modalities.25 Few studies have been conducted to explore phys...

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

“… In Australia, medical cannabis was illegal at the time. St-Amant 2015 [ 26 ] Canada (Quebec) To measure prevalence and identified determinants of cannabinoid prescriptions for the management of chronic noncancer pain among physicians. 166 physicians (family physicians/GPs and other specialties) answered a questionnaire (response rate of 52.2%).…”

Cannabinoids for Symptom Management and Cancer Therapy: The Evidence

“…Only 42% listed their oncologist as providing information about cannabis for their symptoms. In a survey of Québec physicians, 22 27% prescribed cannabis for various reasons, and 23% for chronic noncancer pain. Most who prescribed cannabis did so for 5 or fewer patients.…”

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

“…(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. Signi cantly higher proportions of physicians experienced in prescribing medical cannabis feel comfortable with providing it (25,26) and report themselves as having greater knowledge of medical cannabis compared to physicians who have never provided 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.…”

“…(17)(18)(19)(20)(21) The percentage of physicians reporting to have provided cannabis varies from 10% to 95%. (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.…”