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      The Role of Medicinal Cannabis in Clinical Therapy: Pharmacists' Perspectives

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          Abstract

          Background

          Medicinal cannabis has recently attracted much media attention in Australia and across the world. With the exception of a few countries, cannabinoids remain illegal–known for their adverse effects rather than their medicinal application and therapeutic benefit. However, there is mounting evidence demonstrating the therapeutic benefits of cannabis in alleviating neuropathic pain, improving multiple sclerosis spasticity, reducing chemotherapy induced nausea and vomiting, and many other chronic conditions. Many are calling for the legalisation of medicinal cannabis including consumers, physicians and politicians. Pharmacists are the gatekeepers of medicines and future administrators/dispensers of cannabis to the public, however very little has been heard about pharmacists’ perspectives. Therefore the aim of this study was to explore pharmacists’ views about medicinal cannabis; its legalisation and supply in pharmacy.

          Methods

          Semi-structured interviews with 34 registered pharmacists in Australia were conducted. All interviews were audio-recorded, transcribed ad verbatim and thematically analysed using the NVivo software.

          Results

          Emergent themes included stigma, legislation, safety and collaboration. Overall the majority of pharmacists felt national legalisation of a standardised form of cannabis would be suitable, and indicated various factors and strategies to manage its supply. The majority of participants felt that the most suitable setting would be via a community pharmacy setting due to the importance of accessibility for patients.

          Discussion

          This study explored views of practicing pharmacists, revealing a number of previously undocumented views and barriers about medicinal cannabis from a supply perspective. There were several ethical and professional issues raised for consideration. These findings highlight the important role that pharmacists hold in the supply of medicinal cannabis. Additionally, this study identified important factors, which will help shape future policies for the successful implementation of medicinal cannabis in healthcare. We recommend that these views and strategies be incorporated in the development of policies and legislations.

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          Most cited references20

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          Colorado family physicians' attitudes toward medical marijuana.

          Over the last decade, the use of medical marijuana has expanded dramatically; it is now permitted in 16 states and the District of Columbia. Our study of family physicians in Colorado is the first to gather information about physician attitudes toward this evolving practice. We distributed an anonymous web-based electronic survey to the 1727 members of the Colorado Academy of Family Physicians' listserv. Items included individual and practice characteristics as well as experience with and attitudes toward medical marijuana. Five hundred twenty family physicians responded (30% response rate). Of these, 46% did not support physicians recommending medical marijuana; only 19% thought that physicians should recommend it. A minority thought that marijuana conferred significant benefits to physical (27%) and mental (15%) health. Most agreed that marijuana poses serious mental (64%) and physical (61%) health risks. Eighty-one percent agreed that physicians should have formal training before recommending medical marijuana, and 92% agreed that continuing medical education about medical marijuana should be available to family physicians. Despite a high prevalence of use in Colorado, most family physicians are not convinced of marijuana's health benefits and believe its use carries risks. Nearly all agreed on the need for further medical education about medical marijuana.
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            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.
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              Physician attitudes regarding the prescription of medical marijuana.

              Surveys of physicians' attitudes regarding the therapeutic value of marijuana are rare. Drawing on a national sample of family physicians, general internists, obstetrician-gynecologists, psychiatrists, and addiction specialists, 960 (adjusted response rate 66%) offered opinions about the legal prescription of marijuana as medical therapy. Thirty-six percent believed prescribed marijuana should be legal and 26% were neutral to the proposition. Non-moralistic attitudes toward substance use were significantly associated with support for physician prescription, as was internal medicine and obstetrics-gynecology specialization. Physicians are, in general, less supportive than the general American public regarding the use of medical marijuana.
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                Author and article information

                Contributors
                Role: Editor
                Journal
                PLoS One
                PLoS ONE
                plos
                plosone
                PLoS ONE
                Public Library of Science (San Francisco, CA USA )
                1932-6203
                12 May 2016
                2016
                : 11
                : 5
                : e0155113
                Affiliations
                [001]Faculty of Pharmacy, The University of Sydney, Sydney, New South Wales, Australia
                Penn State College of Medicine, UNITED STATES
                Author notes

                Competing Interests: The authors have declared that no competing interests exist.

                Conceived and designed the experiments: BC BS SI. Performed the experiments: BC BS SI. Analyzed the data: BC BS SI. Contributed reagents/materials/analysis tools: BC. Wrote the paper: BC BS SI.

                Article
                PONE-D-16-02268
                10.1371/journal.pone.0155113
                4865212
                27171490
                37e4128c-1fd7-4e15-86be-7e72cfc95e20
                © 2016 Isaac et al

                This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

                History
                : 18 January 2016
                : 25 April 2016
                Page count
                Figures: 1, Tables: 4, Pages: 17
                Funding
                The authors have no support or funding to report.
                Categories
                Research Article
                Medicine and Health Sciences
                Pharmacology
                Behavioral Pharmacology
                Recreational Drug Use
                Cannabis
                People and Places
                Population Groupings
                Professions
                Pharmacists
                Medicine and Health Sciences
                Pharmacology
                Drugs
                Cannabinoids
                Social Sciences
                Law and Legal Sciences
                Legislation
                Medicine and Health Sciences
                Health Care
                Health Care Providers
                Allied Health Care Professionals
                People and Places
                Population Groupings
                Professions
                Medicine and Health Sciences
                Health Care
                Health Care Policy
                Medicine and Health Sciences
                Health Care
                Health Education and Awareness
                Custom metadata
                All relevant data are within the paper and its Supporting Information files.

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