By Jessica Kindynis
Doctors around the country have been fielding enquiries from patients regarding medical cannabis at an increasing rate in recent years. Yet many of our primary healthcare providers admit poor personal knowledge of this age-old medicine.
A survey of more than 630 GPs across Australia was conducted in 2018. Doctors were asked to provide insights into their attitudes and clinical experience with medical cannabis.
56.5% believed that medical cannabis should be available for specific conditions. While 14.9% disagreed with this statement entirely, 28.6% felt neutral on the topic.
“A clear majority were in favour of having medicinal cannabis as an option that they could prescribe, but they did not feel comfortable talking to their patients about it, because they didn’t feel well educated … they want to have it in their doctor’s bag, if you will, but they feel uneducated.”
The Lambert Initiative’s Professor Iain McGregor on the 2018 survey
Only 28.8% of practitioners stated they would feel comfortable discussing medical cannabis with their patients, though this number was not correlated to the doctors who believed medical cannabis should be available.
Most strikingly the large majority of respondents rated their knowledge of medical cannabis as poor. This finding is reflected in an anecdote shared by industry expert and researcher Justin Sinclair:
“I gave a talk at a hospital in Queensland late last year where I asked everyone in attendance—some 130 nurses, doctors, et cetera—whether they had had any training in the endocannabinoid system during their undergraduate training, and not one hand was raised.”
Concerns around titration have been raised in the medical community. While many hypertensive and psychiatric medications require titration it is an art that is not regularly practised in conventional medicine, where standard doses are often applied to a wide demographic.
The response of each individual and the nature of their endocannabinoid system is unique, thus medical cannabis is often titrated up from a very low dose until a therapeutic response is achieved.
Having to manage an individual patient’s dose with such precision can be confronting, especially for GPs who lack confidence in their medical cannabis knowledge.
While some doctors are keen to be able to prescribe but choose not to until they’ve completed further education, other practitioners still believe there is no foundation for the use of medical cannabis at all – applying a blanketing opinion that there is not enough evidence for its safety and efficacy.
Arguably cannabis has a relatively positive safety profile, yet the RACGP’s advice continues to be that medical cannabis should only be prescribed as a last resort treatment.
The tension between doctor education on medical cannabis, their willingness to prescribe and the practicalities of prescribing an unauthorised medicine is particularly stark in the Australian landscape.
Even for those willing to consider prescribing, the current medical cannabis application pathways can be time-consuming. The application process has been simplified since its initial rollout, yet the additional workload on already overburdened medical doctors is prohibitive for many.
Unfortunately, no. Undergraduate education does not cover medical cannabis or the endocannabinoid system (ECS).
Despite what we know about the ECS’s influences over physiological processes including the immune and gastrointestinal systems, the ECS and cannabis as a whole are largely omitted from educational texts.
Practitioners can choose to partake in online courses or face-to-face seminars, and while the latter are few and far between, many do provide a strong foundational knowledge of the basics of medical cannabis phytotherapy and offer CPD points.
Currently, if medical staff are seeking further training in medical cannabis there are a few educational options outside of investing time in personal research, however the recent Senate Inquiry recommended the need for Australian medical colleges and associations to work together to develop training in this area.
The National Institute of Integrative Medicine (NIIM), the Australasian College of Nutritional and Environmental Medicine (ACNEM) and NICM Health Research Institute, Western Sydney University (NICM) have partnered together to create Medical Cannabis Education resources and regular continuing professional development (CPD) events for practitioners.
Other societies and guilds within the medical fraternity also provide short CPD courses and events at irregular intervals. While such events are occurring with greater frequency and offering high-quality training and information, within Australia there are no accredited educational pathways in the tertiary setting.
So regardless of how they are getting their information on medical cannabis, doctors are largely on their own. With no foundation laid in their medical training, it’s no wonder so many practitioners are hesitant to prescribe medical cannabis.
As de-stigmatisation continues to erode at old preconceptions surrounding cannabis and positive research outcomes validate the use of medicinal cannabis treatments, we can hope to see comprehensive and readily available education options for medical professionals in the future to ultimately give patients more choice.