Moreover, several position papers and research reports highlight the fact that MC might not be appropriate for age-related conditions. For example, the Canadian Rheumatology Association concluded that there is insufficient beneficial evidence along with possible harm about the use of pharmaceutical cannabinoids in osteoarthritis, rheumatoid arthritis and back pain.The European Pain Federation asserted that cannabis-based medicines should be only considered as third-tier therapy for chronic neuropathic pain including older patients who may be more sensitive to the neuropsychiatric and postural hypotensive effects of cannabinoids.Meta-analysis results show a lack of sufficient evidence about the effectiveness of MC for reduction of chronic pain; questions remain about its effectiveness for people with chronic non-cancer pain prescribed opioids, and it was found linked to more significant pain and lower self-efficacy in managing pain.The lack of uniformity among such findings have resulted in repeated calls for further research,including that focused on short- and long-term effects, benefits, and risks linked to mental health, misuse and dependence, physical and cognitive impairment, and more.Many parts of a cannabis plant were once documented as a Thai traditional medicine in the 17th century, but international restrictions limited cannabis production, sale, possession and consumption in Thailand for decades. However, over the past few years, different groups, including traditional and alternative medical practitioners, have joined forces to advocate for MC legalization in the country. Such efforts led to the approval of MC bill in November 2018, and the allowance to possess cannabis vertical farming for medical and research purposes that was legally approved in February 2019.The aim of this study was to examine attitudes toward MC, and specifically about its application for pain management, across medical students in two universities, one in Israel and the other in Thailand.
Based on previous studies,we hypothesized that a cross-national comparison will reveal some differences in MC attitudes, but also that areas of agreement will be evidenced, providing support and direction for uniform MC curriculum that may be applicable across nations. This cross-sectional study was IRB-approved both at Ben Gurion University of the Negev and at Chiang Mai University Faculty of Medicine . The data collection instrument consisted of attitudes about MC, as described and detailed elsewhere,as well as the following demographic variables: age, gender, religion, religiosity level, civil and occupational status, and work experience. Participants were additionally asked to rate the perceived efficacy of MC for different medical conditions that are related to pain . Rating was on a 6-point Likert scale, from “very ineffective” to “very effective”. In addition, participants were asked if they think the medical cannabis should be included in the acadmic curriculum and in field training , and what are their sources of information about medical cannabis . Questions were developed in English, translated to Hebrew and Thai languages, and back-translated to English to ensure content and vocabulary were appropriate to the students surveyed. This process involved native Hebrew, Thai, and English-speaking faculty members of the university. All students enrolled in medical school at both universities were invited by email to participate in this survey by email. No exclusion criteria were applied. The email informed the students that their participation was voluntary, not a part of their academic activities and would not affect any academic standing. No compensation, monetary of other, was offered. The linked webpage provided the study objectives, a tick for giving informed consent and the online questionnaire. The sample characteristics are described using frequencies and percentages for categorical variables, and means and standard deviation for continuous variables. Attitude and belief scores were compared across the participating universities using Pearson’s Chi-squared test for dichotomous variables. All statistical analyses were conducted using SPSS, version 25. The aim of this study was to examine attitudes toward MC, and specifically about its application for pain management, across medical students in Israel and Thailand. Regardless of country, participants acknowledged that cannabis could be addictive . The majority of students additionally agreed that MC poses physical and/or mental health risks to patients; however, 79.1 % of them reported they believe the substance has physical and mental health benefits. Students reported relatively high levels of acceptance of MC for pain management, with the Israeli students tending to be more positive of its use than their Thai counterparts. Although Israeli students reported more favorable beliefs about the potential of MC and higher acceptance for recreational purposes, only 12.5 % felt prepared to answer patient questions about MC compared to 36.2 % of the Thai students. While MC was not included in the curriculum of both universities at the time of data collection, nearly all of the students, regardless of country, endorsed the need for training on MC both in academic curricula and in clinical training .
The current study findings suggest that Thai students tend to be more skeptical and cautious about the use of cannabis for medical conditions. In Thailand, cannabis has been used for traditional medical purposes up to 1937 when it was banned. For most of its recorded history, Thailand, as with many other nations, had no laws prohibiting cannabis use or possession. The legal situation began to change in the early 20th century. As one of the original signatories to the League of Nations International Opium Convention of 1912, Thailand then named Siam enacted anti-drug legislation that enabled it to receive international grants, loans, and benefits. Failing to do so would have prevented or placed these benefits in jeopardy. In complying with its foundation signatory status, Thailand introduced its first anti-drug laws in 1922 that laid the base for present day drug laws in the Kingdom. In 1937 Thailand’s second prime minister, General Phot Phahonyothin, criminalized cannabis in the country and its use remains constrained by social norms and harsh legislation.These conditions may explain the small number of Thai students who reported cannabis use and/or have family members and friends who have used the substance. Despite the lack of social acceptance and the legal repercussions related to recreational use of cannabis in Thailand, MC may in fact be somewhat accepted in this country given that cannabis has been an inherent part of Thai traditional medicine in ancient times. While the MC program in Thailand is relatively new, in Israel it is much more established. However, although MC has been legal in Israel for more than twenty years, the regulatory framework is constantly changing and developing. Currently, more than 80,000 patients are licensed to use MC for various indications. While a recent study showed that Israeli students of different health and social care professions hold relatively favorable attitudes towards MC, medical students reported attitutudes that are somewhat distinct from students of other professions. For example, compared to nursing and social work students, a lower proportion of medical students agreed that MC may be associated with physical or mental health benefits.Indeed, the lack of preparedness of the medical students and practitioners to discuss cannabis risks and benefits with patients is common. For example, a survey among oncologists recently reported on a lack of preparedness to make MC recommendations as well as perceived efficacy of MC for cancer-related symptoms.
In addition, a recent review of the existing literature recently pointed to the lack of MC education across all health-related disciplines.Consistently, the participants of this study supported medical cannabis use for medical conditions despite the lack of evidence-based information and the lack of knowledge and training. Unlike alcohol or tobacco, the provision of MC education is complicated by the lack of definitive evidence on the health implications of the substance.Progress toward necessary evidence has been impacted by the lack of consistent legal acceptance across countries impeding researchers from conducting large well-designed studies on the effectiveness of MC.Indeed, the perceived efficacy of MC for different pain indications are not in line with the current state of evidence, similar to findings reported in previous studies.However, this study points to a growing demand for high quality MC education among medical trainees. In some medical schools, residents and fellows have received information to help them be better prepared about MC use with patients; and, that education and training are needed to prepare future physicians for the reality of the clinical world they will be facing.The finding that students use informal sources for information on MC, such as blogs, websites, and other types of electronic sources was interesting but not surprising. For nearly a decade, it has been found that a vast majority of Internet users seek health care information online. Indeed, it is troubling that medical students like those in our study access a considerable amount of informal information that shapes their knowledge about MC and, possibly, future clinical decisions affecting patient care. Israeli students reported a considerable amount of informal information sources, more than their Thai counterparts . These differences may be attributed to the openness of Israeli society dealing with the issue for years, including an Internet filled with patient testimonials and other information, some of which may not be reliable or safe.However, it brings important information that can contribute to medical education and to clinical training. Notwithstanding the unique cultural and social characteristics of the two sub-samples, we aimed to assess common ground that could be utilized to design inclusive educational interventions. In conclusion, the findings of this study evidence the need for curriculum designed around MC use to promote students’ preparedness to serve patients in pain or with other medical conditions and allow for safe and effective use of MC. Although significant differences seem to exist among Israeli and Thai medical students regarding their knowledge, attitudes, and beliefs regarding MC for pain management. However, such differences do not mitigate the opportunity of developing a generic MC curriculum and an “international training trainers” initiative that can be evaluated for impact effectiveness to promote student learning and practice. Despite the limited evidence-base around the risks and benefits of MC, students should be exposed to information about MC to promote their ability, in the future, to counsel patients on its potential benefits and risks. Cannabis as a treatment for epilepsy dates to the 1800s in the published literature, with increasing interest over the last decade in its use as a treatment for pediatric drug-resistant epilepsy, driven partly by media reports of children whose seizures have responded to grow cannabis in containers.
Until recently, there was little clinical evidence to support its use in this population, and there were wide differences between the beliefs of health care professionals and the public with respect to effectiveness and safety . A 2015 survey by Epilepsia reported a “wide diversity of opinion on the use of medical marijuana in treating people with epilepsy” depending on whether the respondent was a neurologist or a member of the public. At that time, more than two-thirds of neurologists felt that data were insufficient to support its use, although 48 % would recommend it to patients whose “severe, catastrophic epilepsy” had not responded to approved therapy.The clinical landscape surrounding medical cannabis has undergone important transformations since 2015. At the time of the Epilepsia survey, there had been no randomized controlled trials involving children with epilepsy.As of May 2019, the evidence-base had grown to include 4 RCTs and 31 non-randomized studies involving children, with the findings largely supporting a positive effect for purified cannabidiol in reducing seizures associated with drug-resistant epilepsy. Epidiolex is not available in Canada at this time, despite recently receiving approval by the US Food and Drug Administration and theEuropean Medicines Agency . In Canada, patients with authorization from a health care provider have access to cannabis products including fresh or dried cannabis or cannabis oil. As of December 31, 2019, Health Canada had issued licenses to 165 cannabis producers to sell cannabis products to authorized medical patients, including 61 authorized to sell CBD-THC oils. Notably, these products are not subject to pre-market safety and efficacy review by Health Canada and are not issued a notice of compliance or a drug identification number. While two small cohort studies have recently evaluated the efficacy of two CBD-THC oils, most have not been evaluated in clinical studies, and it is unknown how Canadian neurologists perceive medical cannabis as a treatment for children with drug-resistant epilepsy.This qualitative study used an interpretive description approach and was undertaken as part of a health technology assessment of the use of cannabis as a treatment for pediatric drug-resistant epilepsy, and the findings are reported following SRQR checklist.