How do pharmacists feel about medicinal cannabis?

Health professionals generally support the use of medicinal cannabis in practice, but say they lack knowledge around all aspects of the medicine, new research has found

The data was published shortly after the RACGP updated its position statement on the matter.

The researchers, from schools of pharmacy at Queensland University of Technology and the University of Auckland, found that when it came to knowledge about medicinal cannabis, doctors, nurses and pharmacists all said their own knowledge was poor for both the legislative and clinical aspects of medicinal cannabis.

They searched PubMed, EMBASE, PsycINFO, CINAHL and Scopus databases for studies indexed up to 1 August 2018, using a predetermined study protocol.

Of the 15,775 studies retrieved, 106 were subjected to full text review, and of these, 26 were included in the analysis.

Of these 26 studies, 18 sampled medical practitioners and three sampled pharmacists; one covered nurse practitioners; and another four a mixed cohort of medical and allied health professionals, including pharmacists, of which nurses were the predominant population.

Of the three studies sampling pharmacists, only one captured pharmacists’ beliefs: it showed that 55% of Canadian pharmacists agreed that overall, medicinal cannabis was effective.

“Overall, pharmacists’ self-reported knowledge was quite low,” the authors observe.

One study showed that pharmacists “considered themselves to be lacking knowledge surrounding the pharmacology, pharmacokinetics and pharmacodynamics of medicinal cannabis”.

“Additionally, legislative and procedural knowledge around prescribing, cultivation and distribution was also lacking for many pharmacists,” the authors wrote.

“With respect to education, 66% and 65% of Canadian hospital pharmacists reported receiving no undergraduate or professional development respectively on medicinal cannabis.

“There was a self-reported desire from sampled Minnesotan and Australian pharmacists for further education.

“Finally, pharmacists stated that a lack of accessible and robust literature was a major limitation such that when faced with a clinical question, the majority of pharmacists used self-directed online learning to inform practice.”

The authors also observed that pharmacists reported concerns around lack of quality-controlled formulations, the potential for recreational misuse of the drug, the potential for diversion into illicit channels, and psychiatric co-morbidities – as well as the risk of drug-drug interactions. Of Canadian hospital pharmacists, 55% said they either disagreed or said they were unsure about whwether medicinal cannabis was safe.

Overall, the “general impression” was that health professionals support the use of medicinal cannabis in practice; however there was a “unanimous” lack of self-perceived knowledge around all aspects of the medicine, the authors wrote.

The authors wrote that the results are limited by the implicit common-sense models of behaviour used by the 26 included studies.

“Before strategies can be developed and implemented to change health professional behaviour, a more thorough understanding of the factors that underpin the delivery of medicinal cannabis is necessary.”

Late last month the RACGP updated its position statement on medicinal cannabis, in which it highlighted the need for more high quality research into the drug’s efficacy and said the current evidence is “limited and inconclusive”.

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