Most general practitioners in Australia favor prescribing medical cannabis to treat spasticity in multiple sclerosis (MS) or pain in select other diseases, but are not allowed to under current laws and say they know little about its use, according to results of a national survey.
A study based on its findings, “Knowledge and attitudes of Australian general practitioners towards medicinal cannabis: a cross-sectional survey,” was published in British Medical Journal Open.
Public interest in cannabis for medical purposes is growing across Australia — as it is elsewhere — and policies allow companies to grown the cannabis plant although patient access remains restricted.
The survey looked at doctors’ perceptions of the therapeutic benefits and potential harms of medical cannabis, asked of their willingness to prescribe it, and of patient demands for its use.
A total of 640 doctors completed the survey, conducted between August and November 2017 by The University of Sydney.
Results showed a vast majority supported the use of medical cannabis in MS-related muscle spasticity or stiffness (61.2%), chronic cancer pain (80.2%), as palliative care (78.8%) to ease chemotherapy-induced nausea and vomiting, and to help people with epilepsy (70.3%).
It use by patients with anxiety and depression, however, had little support among doctors surveyed — 13% and 9.4%, respectively.
Among those who responded to questions of safety relative to other prescription treatments, a majority thought it less risky than chemotherapies (78.1%); opioid analgesics (75.6%), including morphine, codeine, hydrocodone and oxycodone; benzodiazepines (74.5%); antipsychotics (68.3%); and antidepressants and statins (more than 50% for both).
Most general practitioners (61.5%) had at least one patient in the three months that preceded the survey ask about medical cannabis, and 7.5% reported more than five enquiries.
But most also felt that their knowledge of medical cannabis was inadequate, and only 28.8% said they were comfortable discussing its use with patients.
Still, 56.5% support its availability via prescription, and favor an access model that includes both doctor training and allowing general practitioners to prescribe it independent of specialists. But few — 1 in 10 — understood or could navigate the rigid and extensive bureaucracy involved in such prescriptions.
“Our survey demonstrates many GPs [general practitioners] have fielded recent enquiries about medicinal cannabis from their patients — yet most feel poorly informed and inadequately trained around medicinal cannabis and its current regulation and uses,” Iain McGregor, the study’s senior author, said in a press release.
“Our results highlight the need for improved training of GPs around medicinal cannabis, and the discrepancy between GP-preferred models of access and the current specialist-led models,” the researchers wrote.
A major reason why less than 800 patients in Australia today have access to medical cannabis, McGregor said, is due to general practitioners being excluded from legally prescribing it.
“Most Australians know how hard it is to access specialist medical care, let alone a specialist with an interest in cannabis-based medicines,” he added. “This situation continues to frustrate patients, many of whom simply continue to access illicit cannabis to self-medicate.”
Medical cannabis as an MS treatment is the focus of increasing research. Recently, MMJ Bioscience filed a request with the U.S. Food and Drug Administration (FDA) to open Phase 2 trials assessing cannabis-based pharmaceutical compounds in the treatment of MS.
A recently published evidence overview reported finding medical cannabis to be a safe and effective way of relieving pain, and supported its inclusion in clinical practice. Reported benefits included easing spasticity in MS patients.
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