Doctors call for more education when it comes to prescribing cannabis

Physician-reported knowledge gaps in cannabis education isn’t a new concept

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      by Alastair Spriggs

      In the fall of 2018, third-year medical student Yipeng Ge experienced a pot-related emergency-room consult at the Ottawa Hospital Civic Campus. 

      A patient was unable to tolerate food and fluid after vomiting excessively for several days prior to the visit, Ge told the Georgia Straight by phone.

      Her medical history included irritable-bowel syndrome (IBS), migraines, chronic pain…The list went on. Her remedy of choice was cannabis. It seemed to be the only medication that could control her pain and symptoms related to IBS.

      Ge’s first thought: the patient’s state was caused by excess consumption of cannabis. But due to limited education, Ge didn’t feel comfortable counselling her cannabis use or providing additional resources. He ended up simply telling her to smoke less pot.

      “On that night, she was the expert on cannabis use in that clinic room,” Ge said by phone. 

      Like Ge, medical professionals across Canada are dealing with the uncomfortable task of talking to patients about cannabis, even though they know very little about the substance. As a result, doctors and students alike are demanding more cannabis-related medical education to fill this long-standing knowledge gap.

      “It’s not just a few people with severe diseases that want cannabis for medicinal use,” Dr. Mark Ware, chief medical officer at Ontario-based Canopy Growth Corporation, told the Straight in a phone interview. “People come in and ask if they should try cannabis for pain and anxiety, or agitation and dementia…it’s now a national public policy and more people are open to trying it.”

      In late November, Ware spoke to more than 500 family doctors—at the annual Refresher Course for Family Physicians (hosted by McGill University's faculty of medicine)—about the controversies that challenge cannabis research today. He was bombarded with questions. 

      Doctors are feeling an increased pressure from patients to guide them through cannabis use, but they just don’t know what to say. As Ware put it: “Doctors are hungry for information.” 

      Dr. Eric Cadesky, president of Doctors of B.C., recognizes the need for more information around cannabis. “There is just too much unknown,” he says.

      Physician-reported knowledge gaps in cannabis education isn’t a new concept. A 2012–13 study published in the open-access journal BMC Medical Education on cannabis for therapeutic purposes found that 70 percent of respondents would be better able to treat patients using medical cannabis with more education. The lowest knowledge levels were found in dosing and creating effective treatment plans.

      Confusion around the medical profession led Ge and fellow Canadian Federation of Medical Students (CFMS) members to produce a cannabis position paper this past spring. It recommends that Canadian medical schools create a longitudinal evidence-based cannabis curriculum in undergraduate medical education, provide specialized cannabis training in continuing medical studies, and expand funding for medical education and research on cannabis.

      The position paper says a lack of comprehensive education on the history, biology, pharmacology, safety, efficacy, and patient approaches translates into poor clinical practice and negative patient outcomes.

      It also predicted that legalization of recreational cannabis will likely result in more cannabis-related consults from patients as consumption and access increases. Ge says this creates a lot of unease and uncertainty for medical students going into professional medical positions because more cannabis-related conversations might arise. 

      For the CFMS, a solution would introduce an undergraduate medical education curriculum that includes interactive small-group teaching, online modules, and instructional lectures. However, they are aware of their greatest obstacle: the scarcity and lack of diversity of experimental, observational, and clinical studies on cannabis use.

      According to Michael John Milloy, an epidemiologist and a research scientist at the B.C. Centre on Substance Use, the 95-year pot prohibition has limited clinical research and created this knowledge gap.

      “We haven’t been able to evaluate the extent to which cannabis should be a part of clinical guidelines because we haven’t been able to do the studies required to generate the evidence,” he noted by phone. 

      Prior to legalization, scientists and researchers had to obtain an exemption from criminal law to study cannabis for analytical, genetic, or clinical testing. Only a few researchers were able to overcome this “challenging proposition”. As a result, most medical knowledge around cannabis relies of patients’ anecdotes. 

      Legalization meant the introduction of the new Cannabis Act legislation. Now researchers and scientists must apply for a research licence from the Ministry of Health to conduct clinical trials. Ware says this process should be easier; he also says that cannabis is now a matter of “public health”, which should move clinical trials forward more aggressively.

      For Milloy, who was named professor of cannabis science at the University of British Columbia on November 23, the goal is to make cannabis “boring”. The inaugural position at the university will lead clinical trials to explore the potential role of cannabis in treating opioid addiction.

      “Instead of looking at cannabis as a demon weed or some great panacea, we need to investigate it with the best scientific tools to determine its risks and benefits,” he added. 

      “We’ve got a long way to go,” Ware said. “But I think there’s strong momentum building towards closing the knowledge gap.”

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