Cannabis in medicine: a national educational needs assessment among Canadian physicians

Background: There is increasing global awareness and interest in the use of cannabis for therapeutic purposes (CTP). It is clear that health care professionals need to be involved in these decisions, but often lack the education needed to engage in informed discussions with patients. This study was conducted to determine the educational needs of Canadian physicians regarding CTP. Methods: A national needs assessment survey was developed based on previous survey tools. The survey was approved by the Research Ethics Board of the McGill University Health Centre Research Institute and was provided online using LimeSurvey®. Several national physician organizations and medical education organizations informed their members of the survey. The target audience was Canadian physicians. We sought to identify and rank using 5-point Likert scales the most common factors involved in decision making about using CTP in the following categories: knowledge, experience, attitudes, and barriers. Preferred educational approaches and physician demographics were collected. Gap analysis was conducted to determine the magnitude and importance of differences between perceived and desired knowledge on all decision factors. Results: Four hundred and twenty six responses were received, and physician responses were distributed across Canada consistent with national physician distribution. The most desired knowledge concerned “potential risks of using CTP” and “safety, warning signs and precautions for patients using CTP”. The largest gap between perceived current and desired knowledge levels was “dosing” and “the development of treatment plans”. Conclusions: We have identified several key educational needs among Canadian physicians regarding CTP. These data can be used to develop resources and educational programs to support clinicians in this area, as well as to guide further research to inform these gaps

Cannabis in medicine: a national educational needs assessment among Canadian physicians

BACKGROUND: There is increasing global awareness and interest in the use of cannabis for therapeutic purposes (CTP). It is clear that health care professionals need to be involved in these decisions, but often lack the education needed to engage in informed discussions with patients. This study was conducted to determine the educational needs of Canadian physicians regarding CTP. METHODS: A national needs assessment survey was developed based on previous survey tools. The survey was approved by the Research Ethics Board of the McGill University Health Centre Research Institute and was provided online using LimeSurvey®. Several national physician organizations and medical education organizations informed their members of the survey. The target audience was Canadian physicians. We sought to identify and rank using 5-point Likert scales the most common factors involved in decision making about using CTP in the following categories: knowledge, experience, attitudes, and barriers. Preferred educational approaches and physician demographics were collected. Gap analysis was conducted to determine the magnitude and importance of differences between perceived and desired knowledge on all decision factors. RESULTS: Four hundred and twenty six responses were received, and physician responses were distributed across Canada consistent with national physician distribution. The most desired knowledge concerned “potential risks of using CTP” and “safety, warning signs and precautions for patients using CTP”. The largest gap between perceived current and desired knowledge levels was “dosing” and “the development of treatment plans”. CONCLUSIONS: We have identified several key educational needs among Canadian physicians regarding CTP. These data can be used to develop resources and educational programs to support clinicians in this area, as well as to guide further research to inform these gaps

Reasonable or unreasonable? : a patient-centred perspective of access to cannabis for medical purposes under different regulatory frameworks in Canada

Background: Since 2001, a medical cannabis program has existed in Canada with the goal of providing reasonable access to cannabis for medical purposes. However, reasonable access has not been defined, and few studies have investigated if reasonable access has been achieved and for whom since the implantation of the Marijuana for Medical Purposes Access Regulations (MMPR) in 2013. This dissertation sought to understand reasonable access to medical cannabis from a patient-centred perspective, including access to authorization and to sources of cannabis, during a transitionary period between regulatory frameworks. Methods: In 2014, a national sample of medical cannabis users participated in a cross-sectional, mixed methods study. A total of 369 individuals completed an online survey and 33 participated in semi-structured interviews. Bivariate and multivariate analyses were used to establish associations between patient- and system-related factors and access to authorization and sources of cannabis, and to compare satisfaction ratings between legal and illegal sources. An interpretive descriptive analysis was conducted to explore consequences of access. The Levesque patient-centred healthcare access model informed all phases of the study. Results: Few significant sociodemographic factors and medical conditions were associated with authorization status; however, associations were found regarding patterns of cannabis use. Authorized participants also experienced more problems accessing cannabis than unauthorized participants. Of legally authorized participants, half accessed illegal sources; those using only legal sources compared to those using illegal sources differed regarding the characteristics of products and services they considered important. Highest satisfaction levels were reported for sources closest to production and those providing in-person service. Participants experienced considerable health, legal, financial and social consequences from their access experiences. Conclusions: Reasonable access to medical cannabis was not achieved for many participants in this study. Patterns of use and perceived quality of products and services may have influenced both access to the program and to sources at different stages of access, resulting for some in the use of medical cannabis outside the legal framework. Patient-centred research on access to medical cannabis is necessary to establish whether reasonable access has been achieved, and future research must assess the impact of legalized recreational cannabis on access.Graduate and Postdoctoral StudiesGraduat

Perceptions of cannabis as a stigmatized medicine: a qualitative descriptive study

Abstract Background Despite its increasing prevalence and acceptance among the general public, cannabis use continues to be viewed as an aberrant activity in many contexts. However, little is known about how stigma associated with cannabis use affects individuals who use cannabis for therapeutic purposes (CTP) and what strategies these individuals employ to manage associated stigma. The aim of this Canadian study was to describe users’ perceptions of and responses to the stigma attached to using CTP. Methods Twenty-three individuals who were using CTP for a range of health problems took part in semi-structured interviews. Transcribed data were analyzed using an inductive approach and comparative strategies to explore participants’ perceptions of CTP and identify themes. Results Participant experiences of stigma were related to negative views of cannabis as a recreational drug, the current criminal sanctions associated with cannabis use, and using cannabis in the context of stigmatizing vulnerability (related to existing illness and disability). Strategies for managing the resulting stigma of using CTP included: keeping CTP ‘undercover’; educating those who did not approve of or understand CTP use; and using cannabis responsibly. Conclusions Understanding how individuals perceive and respond to stigma can inform the development of strategies aimed at reducing stigma associated with the use of CTP and thereby address barriers faced by those using this medicine.</p

Health effects of using cannabis for therapeutic purposes: a gender analysis of users’ perspectives

The purpose of this qualitative study was to describe how individuals who self-report therapeutic use of cannabis perceive its health effects. Data from 23 individual interviews were transcribed and analyzed. Understandings of gendered roles and identities were used to explore the data and interpret differences in perceptions. Descriptions of the health benefits of cannabis for therapeutic purposes included cannabis as life preserving, a disease therapy, a medicine for the mind, a means for self-management, and a way to manage addiction. Self-management of risks focused on the potential effects of excessive use, smoking-related risks, and purchasing precautions. Although the reports of women and men were similar in many respects, there were important differences in patterns and practices of use that reflected gender influences. Insights from the study provide direction for developing gender-specific information to support decision making and usage for therapeutic users