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Concerns, beliefs and attitudes of pharmacists and pharmacy students on cannabis use in Canada

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Official websites use. Share sensitive information only on official, secure websites. Since cannabis has been legalized in Canada for medical and recreational use, there has been an increased demand on pharmacists for cannabis counselling. The objective of this study was to determine the concerns, beliefs and attitudes of Canadian pharmacists and pharmacy students towards using cannabis. An online survey was synthesized under 3 broad themes: concerns, beliefs and attitudes about cannabis, consisting of 27 questions capturing demographics and Likert scale responding to survey questions. We examined whether there were differences in responses by geographic location i. Across Canada, there were survey respondents, with in Ontario and 95 in Quebec. Relative to Quebec or the rest of Canada, respondents from Ontario were significantly more likely to be comfortable providing counselling to and answering questions of patients on the safety and efficacy of medical cannabis use. Examining sex differences across Canada, male respondents were more comfortable than female counselling patients on the safety and efficacy of medical cannabis. The current results reinforce the perceived need by pharmacists and pharmacy students for targeted education, and future research in cannabis education should consider potential gender differences in attitudes and beliefs surrounding cannabis therapy. In October , the Cannabis Act went into effect, whereby the Government of Canada legalized the possession, use, cultivation and purchase of cannabis for recreational use by individuals who are, depending on the province, 18, 19 or 21 years of age and older. This study provides an overview of the knowledge and confidence of pharmacists towards providing patient care as it relates to cannabis and demonstrates the importance of education in optimizing patient care under a backdrop of increasing cannabis legalization. Stronger education of pharmacists and students may enhance counselling abilities and confidence, which are determinants of quality patient care. Pharmacists play a frontline role in helping guide patients through their medical cannabis therapy and must uphold the principles of beneficence and nonmaleficence. Indeed, the lack of strong evidence for medical cannabis therapy ensures continued ethical and legal concern among practising pharmacists. Evidence of clinical efficacy does exist, however, and a recent systematic review of 79 randomized controlled trials showed that there was moderate-quality evidence to support the use of cannabinoids for the treatment of chronic pain and spasticity, whereas low-quality evidence suggested that cannabinoids were associated with improvements in nausea and vomiting due to chemotherapy, weight gain in HIV infection, sleep disorders and Tourette syndrome. Although cannabis research and training is still in its infancy, some professional associations have developed educational materials on cannabis. It is known that health care provider attitudes and beliefs can influence the care that they provide. Since pharmacists play a pivotal role in medication management and safety, as well as public education, it is imperative to understand their attitudes towards the consumption of cannabis. The objective of this study was to explore the attitudes of pharmacists and pharmacy students in Canada towards using cannabis for both medical and recreational purposes. More specifically, we wanted to identify their concerns over providing advice and on the legality of dispensing cannabis to patients. Secondary objectives were to examine potential differences in responses by geographic location i. It was hypothesized that due to the recent mandatory cannabis e-learning requirements by the Ontario College of Pharmacists, respondents from Ontario would have fewer concerns regarding providing advice on medical and recreational cannabis. The inclusion criteria for this study were to be either a pharmacy student or a pharmacist in Canada. For Quebec, the respondents needed to understand French and, for the rest of Canada, English. Participants were recruited from July 14, , to October 28, , by sharing the link to the survey on social media and with pharmacist associations and colleges across Canada to distribute to their respective members. Completion of the survey was taken as implied consent. A review of the literature on surveys assessing the knowledge and attitudes of pharmacists, pharmacy students and other health care professionals toward cannabis use was conducted through PubMed and Google Scholar. A item questionnaire was subsequently developed that focused on 3 key themes on cannabis use: 1 concerns, 2 beliefs and 3 attitudes. The questionnaire was written in English and was translated into French. Definitions for cannabis use were operationalized in the survey as follows: 1 medically supervised use of cannabis was defined as cannabis used under medical supervision Medical Cannabis ; 2 self-medicating cannabis use was defined as cannabis used for perceived medical purposes but without medical supervision Self-medicating Cannabis ; and 3 recreational cannabis use was defined as cannabis used for nonmedical purposes Recreational Cannabis. Comparisons were made by geographic location Ontario, Quebec and Canada and by sex male vs female. Pharmacists and pharmacy students from Ontario were compared with those from all other provinces i. This approach to grouping by geographic location was taken due to the relatively small numbers of those responding from provinces other than Ontario and Quebec. Standardized residuals were analyzed to determine which cells contributed significantly to the results. When a standardized residual is greater than 2, the cell is contributing significantly to the differences between groups. This is an appropriate test to use after the chi-square statistic is found to be significant. The results regarding the legality of cannabis use are seen in Figure 1. There were no significant differences in response by sex. The percentage of responses from pharmacists and pharmacy students on their worries and concerns regarding potential repercussions associated with dispensing cannabis and providing advice is seen in Table 2. Percentage of responses from pharmacists and pharmacy students on their worries and concerns regarding potential repercussions associated with dispensing cannabis and providing advice. There was no significant difference between Ontario and Canada in concern over legal repercussions associated with providing advice on medical cannabis. No significant difference was noted for males. There was no significant difference between Ontario and Canada or between Ontario and Quebec in concern over legal repercussions associated with providing advice on recreational cannabis. No significant differences were noted in the role of therapy of children or according to sex. The results regarding how often advice is provided to patients on recreational and medicinal cannabis can be seen in Table 3. Percentage of responses by geographic location regarding how often advice is provided to patients on medicinal and recreational cannabis. There were no significant associations in how often advice is provided to patients on medicinal or recreational cannabis. Compared to the rest of Canada, those from Quebec were less likely to be comfortable providing advice on the safety of medical cannabis. A significant difference was identified by geographic location. The percentage of survey responses regarding personal beliefs on the role of pharmacy in dispensing medical cannabis and comfort in discussing medical and recreational cannabis use with patients can be seen in Table 4. Percentage of survey responses regarding personal beliefs of the role of pharmacy in dispensing medical cannabis and comfort in discussing medical and recreational cannabis use with patients. Since legalization, across Canada, For Ontario, There were no significant differences in responses between Ontario and the rest of Canada. No significant differences were noted for males. There were no significant differences in worry that patients who request medical cannabis may actually want it for recreational purposes, neither by geographic location, sex, nor practice setting. There were no significant differences in responses between Ontario and Canada on the worry that medical cannabis use may lead to the use of other drugs for recreational purposes. Figure 2 shows the frequency of response by geographic location to the question of whether perception of cannabis has changed since legalization. There were no significant differences between Ontario and Canada on the perception of cannabis since legalization. The percentage of responses from pharmacists and pharmacy students across all of Canada who believe medical cannabis has a place in medical therapy by various prespecified indications can be seen in Figure 3. There were no significant differences for whether medical cannabis has a place in medical therapy of adults or of children, neither by geographic location, sex, nor practice setting. For all other indications, there were no significant differences on responses between indications for adult and child therapy. Notably for all other indications beside seizures, respondents were less likely to consider cannabis as a therapy for children than for adults. The objective of the current study was to determine the attitudes of pharmacists and pharmacy students in Canada towards the use of cannabis for both medical and recreational purposes, as well as to identify their concerns regarding providing advice and on the legality of dispensing cannabis to patients. Interestingly, when compared with the rest of Canada, fewer females from Quebec indicated they had used cannabis since legalization. This disproportionately larger number of female respondents from Ontario who had used cannabis since legalization could have affected perceptions on the safety and efficacy of medical cannabis and could have played a role in the increased comfort in providing this advice when compared with Quebec and the rest of Canada. The fact that respondents from Quebec were more conservative in their beliefs about the legality of cannabis use is contrasted by their being less concerned over the legal repercussions of dispensing it, as well as being less concerned about the potential legal repercussions of providing advice on medicinal and recreational cannabis. This effect seems to be driven by differences in response by sex. Specifically, females from Quebec were less concerned about potential legal repercussions to dispensing medical cannabis to patients when compared with females from Ontario and from Canada. The current findings suggest that respondents from Ontario were more liberal in their views about the legality of cannabis use compared to Quebec and to the rest of Canada. In all of Canada, It was found that significantly fewer respondents from Quebec indicated that their perceptions of cannabis were more negative when compared to Ontario and to the rest of Canada. This is interesting in the context that fewer from Quebec indicated that they had tried cannabis since legalization, while at the same time, those from Quebec were more likely to be worried that medical or recreational cannabis use may lead to the use of other drugs i. When examining how often advice is provided to patients on medical and recreational cannabis, there were no significant associations by geographic location. It was found that relative to the rest of Canada, those from Ontario were significantly more likely to be comfortable discussing the safety and efficacy of medical cannabis with patients. When compared with Ontario or the rest of Canada, those from Quebec were significantly less likely to be comfortable discussing safety and efficacy of medical cannabis. Examining sex differences, it was found that across all of Canada, males were more comfortable counselling patients on the efficacy of medical cannabis. There were also sex differences by geographic location, where females from Quebec were less comfortable than females from the rest of Canada providing counselling on the safety of medical cannabis. Similarly, females from Quebec were less comfortable counselling on efficacy than females from Ontario. In this sense, the online training could be said to have helped Ontario pharmacists with their knowledge of safety and efficacy, but the current findings suggest that they are still wary about providing this advice on medicinal cannabis due to potential litigation. When comparing the indications for whether medical cannabis has a place in adult therapy and child therapy, respondents were more likely to choose that cannabis has a place in child therapy only for seizures. A plausible explanation for this is that there are data on the effectiveness and safety of medical cannabis for seizures, more particularly for drug-refractory childhood epilepsy. Indeed, there is less evidence to support cannabis for pediatric use, but this is also a broad theme that applies to many pharmacotherapies. This is consistent with the indications in other studies cancer, pain, nausea. For children and adolescents, the clinical and ethical trade-offs are more complex than those for adults; the younger the individual, the higher the risk for cannabis dependence or adverse outcomes. This suggests that pharmacists and pharmacy students recognize the differential clinical effects and adverse risks of cannabis on various subpopulations and the need for more evidence-based research. This study had some limitations. The survey was exploratory in nature and was not powered to specifically examine differences across all geographic locations or by sex. Therefore, it is important to consider that there were significantly more females than males who responded to the survey for all of Canada The aim of the current study was to examine the demographics of responses for pharmacists as well as pharmacy students, but the study was not powered to examine differences between these 2 groups, or other subgroup analyses that could have been performed e. We chose to create a preselected list of clinical indications for medical cannabis therapy for adults and children, which could have influenced our results. Insomnia and anxiety disorders excluding posttraumatic stress disorder , which are common reasons for self-medicating cannabis use, should be included in further studies that explore our topic. The current findings suggest that those from Ontario are more liberal in their views about the legality of cannabis use compared with Quebec and to the rest of Canada. Furthermore, relative to Quebec or the rest of Canada, respondents from Ontario were significantly more likely to be comfortable providing counselling and answering questions on medical cannabis use from patients about safety adverse effects, drug interaction, contraindication and efficacy indications, doses, types, routes of administration, medication regimen, monitoring. Overall, males were more comfortable than females counselling patients on the safety and efficacy of medical cannabis. Pharmacists base their practice on a strong body of evidence and may be more worried about cannabis because of their lack of education and practice on the topic. The current results reinforced the perceived need by pharmacists and pharmacy students for targeted education, and future research in education should consider potential gender differences in concerns, beliefs and attitudes surrounding cannabis therapy. Author Contributions: R. All authors approved the final version of the article. Our group was interested in assessing the attitude of pharmacists towards cannabis, since it has now been legalized in Canada. As a library, NLM provides access to scientific literature. Can Pharm J Ott. Find articles by Rahim Dhalla. Find articles by Piotr Merks. Find articles by Taylor Lougheed. Find articles by Gary Goldfield. Find articles by Holly Mansell. Find articles by Jameason Cameron. Collection date Jul-Aug. Characteristics of pharmacists and pharmacy students who participated in the survey. Open in a new tab. Ontario For each geographic location, the sum of responses to each survey question is in brackets. Similar articles. Add to Collections. Create a new collection. Add to an existing collection. Choose a collection Unable to load your collection due to an error Please try again. Add Cancel. I worry that patients who request medical cannabis may actually want it for recreational purposes. I worry that medical cannabis use may lead to the use of other drugs for recreational purposes. I am concerned there may be legal repercussions to providing advice on medical cannabis. I am concerned there may be legal repercussions to providing advice on recreational cannabis. I am concerned there may be legal repercussions to dispensing medical cannabis to patients. How often do you provide advice to patients on medical cannabis? How often do you provide advice to patients on recreational cannabis? I would be willing to dispense medicinal cannabis in my pharmacy if it were legal to do so. I feel medical cannabis should be dispensed only by a licensed pharmacy. I think most medical cannabis users need the intervention of pharmacists. I think most recreational cannabis users need the intervention of pharmacists. I feel comfortable discussing medical cannabis use with patients. I feel comfortable discussing recreational cannabis use with patients.

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