Australian physicians feel they have been overlooked and left to manage the uncertainties of bringing medical cannabis into clinical practice without adequate support or leadership, a new study shows.
While most feel there may be a place for medical cannabis in practice, feedback from a range of specialists shows the rollout is perceived to have been rushed, politically driven and with physicians feeling isolated, unsupported and sometimes coerced into prescribing a product for which they continue have doubts about.
“The horse has bolted” was a recurring theme about the medical cannabis rollout expressed by 23 physicians in specialities such as oncology and pain medicine, interviewed by Melbourne University researchers.
Physicians said they accepted there may be a role for medical cannabis in indications such as chemotherapy-related nausea and vomiting and chronic pain. However the unprecedented situation of having an unlicensed drug being rushed into practice meant they were left with unaddressed concerns about the efficacy, safety and quality of products being brought to market and demanded by patients.
After medical cannabis was decriminalised in 2016, physicians said there had been a lack of leadership from government and professional groups on how to bring it into practice, especially in terms of education.
In the study published in BMJ Open, physicians said difficulties arose because medical cannabis did not fit into current science-based models of care. Many said they had tried to meet patient requests for prescribing cannabis, but had faced many challenges, such as the cumbersome regulatory system around prescribing.
Physicians said they would like good quality education on prescribing medical cannabis but had been left in the dark on issues such as dosages, active ingredients, indications, as well as reliable information on efficacy and safety.
Many said they had effectively had to become self taught in the prescribing of medical cannabis, and had achieved mixed results when using it in what were effectively open trials.
“It doesn’t work for everybody and for some people it has no benefits whatsoever,” said one respondent.
“For some people, it has terrible side effects, but I believe that users are best able to work with their doctors if they think it is a benefit to them. It is one of those things that you kind of have to try.”
Physicians also expressed concerns about the lack of assessment of efficacy and safety monitoring of medical cannabis in real world use, with particular concern about effects on brain function in young people and cognitive effects and driving.
“There is a dearth of knowledge. We need to have a prospective arrangement in order to supply pharmacovigilance that are also about outcomes – the profiles of people who are benefiting and not benefiting. So I think there’s a bit of a direction of duty there,” said one respondent.
“The way we make advances in medicine is through research. If it just falls down to anecdotal stories and claims, then we’re not going to know the right doses, another added.
The study investigators said the feedback from physicians showed that healthcare system readiness “had largely been deficient in the rollout of medicinal cannabis” in Australia.
They said there were important lessons for rollout of other novel and innovative therapies when it came to consultation, communication and education with physisians and other stakeholders.
“To work through the issues highlighted by the informants in this study, ongoing dialogue between regulatory authorities, health professionals, and the community, both at the outset and throughout the process of the rollout was and is, vital,” they said
“Of importance, is the acknowledgement from patients and prescribers that there remains a paucity of knowledge around the side effects and adverse events of medicinal cannabinoids. This understanding will provide an impetus for both patients and prescribers to contribute real world data to pharmacovigilance systems.”
“Addressing these factors is essential for safe and effective prescribing in contemporary medical practice,” they concluded.