Assessing the current state of medical education on cannabis in Canada: Preliminary findings from Quebec.
TL;DR: The preliminary findings of a survey conducted to understand the perceptions of Quebec's medical students regarding cannabis-related teachings in their current curriculum show very low to low levels of exposure to, knowledge of, and comfort levels with cannabis- related subjects.
About: This article is published in Paediatrics and Child Health.The article was published on 2020-06-15 and is currently open access. It has received 6 citations till now. The article focuses on the topics: Curriculum.
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TL;DR: In this paper, a comprehensive systematic literature review was performed using PubMed/MEDLINE, EMBASE, and Google Scholar databases, as well as PsychINFO to study healthcare professionals' knowledge level (HCP) and HCPs in-training regarding both medical uses and indications.
13 citations
TL;DR: In this article , the authors evaluated the knowledge, comfort, and practice of healthcare providers in medical and recreational cannabis using a questionnaire based on instruments developed in previous studies and found that the strongest barrier to recommending or authorizing medical cannabis was uncertainty in safe and effective dosage and routes of administration, and lack of research evidence demonstrating its safety and efficacy.
Abstract: Canadians seeking medical cannabis (MC) may encounter difficulties in finding a healthcare provider (HCP) who authorizes their access to it. Barriers that HCPs face in authorizing MC are unclear. The objectives of this study were to evaluate HCP opinions, knowledge, comfort, and practice in MC prescribing and counseling on recreational cannabis use, and whether the COVID-19 pandemic affected MC prescribing practices.Eligible participants included HCPs (e.g., attending physicians, nurses, pharmacists) in Canada. A questionnaire evaluating their knowledge, comfort, and practice in medical and recreational cannabis was designed based on instruments developed in previous studies. Between April 13th-December 13th 2021, ninety-one healthcare associations were asked to distribute the survey to their members, and an advertisement was placed in the online Canadian Medical Association Journal. Descriptive statistics were used to analyze the results.Twenty-four organizations agreed to disseminate the survey and 70 individuals completed it. Of respondents, 71% were attending physicians or medical residents, while the remainder were nurses, pharmacists or other HCPs. Almost none (6%) received training in MC in professional school but 60% did receive other training (e.g., workshops, conferences). Over half (57%) received more questions regarding MC since recreational cannabis was legalized, and 82% reported having patients who use MC. However, 56% felt uncomfortable or ambivalent regarding their knowledge of MC, and 27% were unfamiliar with the requirements for obtaining MC in Canada. The most common symptoms for recommending MC were pain and nausea, whereas the most common conditions for recommending it were cancer and intractable pain. The strongest barrier to authorizing MC was uncertainty in safe and effective dosage and routes of administration. The strongest barrier to recommending or authorizing MC was the lack of research evidence demonstrating its safety and efficacy. During the pandemic, many respondents reported that a greater number of their patients used cannabis to relieve anxiety and depression.Our results suggest that HCPs across Canada who responded to our survey are unfamiliar with topics related to MC. The strongest barriers appear to be lack of clinical research, and uncertainty in safe and effective MC administration. Increasing research, training, and knowledge may help HCPs feel more equipped to make informed treatment/prescribing decisions, which may help to improve access to MC.
2 citations
TL;DR: In this article, a review of the status of medical cannabis curriculum for medical and allied healthcare trainees worldwide was conducted, and the findings suggest that the implementation of competencies-based curricula on medical cannabis is essential for medical trainees to have the appropriate level of knowledge to counsel and educate their patients.
2 citations
TL;DR: In this article , the authors explore several of these barriers and provide recommendations to decision-makers to enable a family-centered and evidence-based approach to medical cannabis medicine and research for children.
Abstract:
Medical cannabis (MC) may offer therapeutic benefits for children with complex neurological conditions and chronic diseases. In Canada, parents, and caregivers frequently report encountering barriers when accessing MC for their children. These include negative preconceived notions about risks and benefits, challenges connecting with a knowledgeable healthcare provider (HCP), the high cost of MC products, and navigating MC product shortages. In this manuscript, we explore several of these barriers and provide recommendations to decision-makers to enable a family-centered and evidence-based approach to MC medicine and research for children.
TL;DR: This scoping review will synthesise the literature related to youth cannabis use in Canada and generate recommendations and gaps in the literature to inform policies, public education strategies and evidence-based programming.
Abstract: Introduction Canadian youth (aged 15–24) have the highest rates of cannabis use globally. There are increasing concerns about the adverse effects of cannabis use on youth physical and mental health. However, there are gaps in our understanding of risks and harms to youth. This scoping review will synthesise the literature related to youth cannabis use in Canada. We will examine the relationship between youth cannabis use and physical and mental health, and the relationship with use of other substances. We will also examine prevention strategies for youth cannabis use in Canada and how the literature addresses social determinants of health. Methods and analysis Using a scoping review framework developed by Arksey and O’Malley, we will conduct our search in five academic databases: MEDLINE, Embase, APA PsycInfo, CINAHL and Web of Science’s Core Collection. We will include articles published between 2000 and 2021, and articles meeting the inclusion criteria will be charted to extract relevant themes and analysed using a qualitative thematic analysis approach. Ethics and dissemination This review will provide relevant information about youth cannabis use and generate recommendations and gaps in the literature. Updated research will inform policies, public education strategies and evidence-based programming. Results will be disseminated through an infographic, peer-reviewed publication and presentation at a mental health and addiction conference. Ethics approval is not required for this scoping review.
References
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TL;DR: These data support the continued value of PC expertise and need for specialized medical toxicology information to manage more serious exposures, despite a decrease in cases involving lessserious exposures, according to the near real-time status of NPDS.
Abstract: Introduction: This is the 35th Annual Report of the American Association of Poison Control Centers’ (AAPCC) National Poison Data System (NPDS). As of 1 January 2017, 55 of the nation’s poison cente...
286 citations
TL;DR: The present exploratory, descriptive study aimed to determine the designated time for mandatory pain content in curricula of major Canadian universities for students in health science and veterinary programs before being licensed.
Abstract: OBJECTIVE: The present exploratory, descriptive study aimed to determine the designated time for mandatory pain content in curricula of major Canadian universities for students in health science and veterinary programs before being licensed.
215 citations
TL;DR: Several key educational needs among Canadian physicians regarding CTP are identified and these data can be used to develop resources and educational programs to support clinicians in this area, as well as to guide further research to inform these gaps.
Abstract: There is increasing global awareness and interest in the use of cannabis for therapeutic purposes (CTP). It is clear that health care professionals need to be involved in these decisions, but often lack the education needed to engage in informed discussions with patients. This study was conducted to determine the educational needs of Canadian physicians regarding CTP. A national needs assessment survey was developed based on previous survey tools. The survey was approved by the Research Ethics Board of the McGill University Health Centre Research Institute and was provided online using LimeSurvey®. Several national physician organizations and medical education organizations informed their members of the survey. The target audience was Canadian physicians. We sought to identify and rank using 5-point Likert scales the most common factors involved in decision making about using CTP in the following categories: knowledge, experience, attitudes, and barriers. Preferred educational approaches and physician demographics were collected. Gap analysis was conducted to determine the magnitude and importance of differences between perceived and desired knowledge on all decision factors. Four hundred and twenty six responses were received, and physician responses were distributed across Canada consistent with national physician distribution. The most desired knowledge concerned “potential risks of using CTP” and “safety, warning signs and precautions for patients using CTP”. The largest gap between perceived current and desired knowledge levels was “dosing” and “the development of treatment plans”. We have identified several key educational needs among Canadian physicians regarding CTP. These data can be used to develop resources and educational programs to support clinicians in this area, as well as to guide further research to inform these gaps.
106 citations
TL;DR: A fundamental mismatch between the state-level legalization of medical marijuana and the lack of preparation of physicians-in-training to prescribe it is highlighted.
104 citations
TL;DR: Improved understanding of the neurobiology underlying addictive behaviors and the effects of psychoactive substances at the neuropeptide, neurotransmitter, and receptor levels has contributed to the development of medications that can significantly improve outcomes among individuals with substance use disorder.
Abstract: Substance use disorders contribute substantially to the global burden of disease,1 with hospitals and medical clinics often clogged with the primary and secondary sequelae of these conditions in the United States.2 Yet many in the medical community fail to diagnose and treat substance use disorders, in part because of the failure to educate physicians about addiction medicine.
The last several decades have advanced our understanding of the biology of addiction, which has led to the recognition that drug and alcohol addiction are chronic and relapsing diseases of the brain resulting from various drug effects on the brain’s reward and control circuitries. These effects involve neuroadaptations that follow chronic drug exposure and ultimately serve to impair the function of brain regions involved with motivation and self-control.3 Research has also delineated the dynamic interplay between drugs and their molecular targets, thereby helping to identify specific neuroadaptations that are unique to the individual drug types (eg, alcohol, nicotine, cocaine, heroin), and how the expression of the resultant maladaptive behaviors is altered by environmental factors. Advances in genetic research have also enabled the identification of gene variants that affect vulnerability to addictive disorders, and how some genes can influence the response to treatment, which introduces the possibility of applying personalized medicine principles to the treatment of addiction.4
A recent report highlighted that most individuals with addiction in the United States do not receive any treatment from a physician.
Improved understanding of the neurobiology underlying addictive behaviors and the effects of psychoactive substances at the neuropeptide, neurotransmitter, and receptor levels has contributed to the development of medications that can significantly improve outcomes among individuals with substance use disorder. Particularly effective among medications are those for treatment of opioid addiction (opioid agonist and antagonist medications). Effective medications also exist for treatment of nicotine and alcohol addiction. Although there are currently no approved medications for treatment of addiction to stimulant drugs (eg, cocaine and methamphetamines), marijuana, or sedative/hypnotic drugs (eg, benzodiazepine, barbiturates), behavioral interventions exist that have proven to be effective at reducing their use. These include interventions by health care professionals and psychosocial interventions that leverage specialized treatment programs.5
These advances make the traditional view of addiction primarily a moral issue—an outdated model. New therapies have the potential to create a momentous shift in society, whereby addiction is seen primarily as a health issue amenable to prevention and treatment, through the application of evidence-based tools. However, this shift has yet to be fully realized, with advances in this area often not implemented in the medical setting.
A substantial literature describes the implementation gaps in addiction medicine. For instance, a recent audit of health care among US adults found that quality of care varied substantially according to medical condition and that, in the case of alcohol addiction, the percentage of recommended care received was approximately 10%. Interventions for smoking cessation were similarly low.6 Collectively, the underutilization of proven interventions contributes to major human and social costs that manifest in the form of disease, lost productivity, and crime, as well as substantial healthcare expenditures resulting directly from the health effects of substance use (eg, lung cancer) or indirectly from behaviors associated with substance use (eg, syringe sharing with subsequent human immunodeficiency virus [HIV] or hepatitis infections). For instance, many clinical trials have proven the benefits of opioid agonist treatment in reducing heroin use and HIV-risk behavior, resulting in methadone being placed on the World Health Organization’s list of essential medicines. Despite this evidence, methodone is underused by some treatment programs in the United States and, in some countries, this drug is unavailable or illegal, thus contributing to major missed opportunities to reduce heroin use and HIV epidemics.7
Moreover, failure of the health care system to effectively address substance abuse interferes with the medical outcomes of many other frequent comorbid diseases (eg, chronic obstructive pulmonary disease, HIV, hepatitis, chronic pain). An example of how an inadequate understanding of addiction negatively affects medical practice is illustrated by the improper use of opioid medications, both underprescribing and overprescribing. This deficiency in medical training contributes to improper management of pain and to the epidemic of opioid analgesic addiction in the United States.
The failure to effectively respond to a health issue—with enormous health and social costs—brings about the question of “Why.” One key explanation, which remains poorly understood even among individuals in the medical community, is failure of medical education systems to train physicians in addiction medicine. Despite the enormous burden of disease attributable to addiction in North America, there have traditionally been exceptionally few opportunities for physicians to obtain advanced skills in this area outside of addiction psychiatry.
The result has been predictable. A recent report8 highlighted that most individuals with addiction in the United States do not receive any treatment from a physician. Rather, much as in Canada, US addiction care is often provided by unskilled laypersons—that is, individuals without the mental health or medical training required to effectively deliver evidence-based interventions. The report’s toughest criticism is saved for the medical community, stating that “most medical professionals who should be providing addiction treatment are not sufficiently trained to diagnose or treat it.”8 Research by this same group has also reported that 94% of US physicians “failed to include substance abuse among the five diagnoses they offered” when presented with symptoms of alcohol abuse. Calling the lack of physician training a “monumental lost opportunity,” the report describes a “failure of the medical profession at every level—in medical school, residency training, continuing education and in practice—to confront the nation’s number one disease.”9
With the burden of disease contributed by substance use disorders, and with major taxpayer investments in criminal justice approaches (eg, incarceration for nonviolent drug offenses) that fail to acknowledge that addiction is a disease of the brain, the onus is on the medical community to take steps to better treat patients and protect public health. In this context, the American Board of Addiction Medicine (ABAM) and the ABAM Foundation have been established. ABAM has created guidelines and standards for the development of addiction medicine fellowship programs to enable US and international institutions to develop addiction medicine training programs that are eligible for accreditation by the ABAM Foundation. To date, 19 programs at academic centers in North America have been accredited by ABAM. The goal is for ABAM-accredited programs to grow in number and quality and, in time, this discipline will gain recognition from the American Board of Medical Specialties. The process will enable physicians completing their specialty training in a spectrum of disciplines (eg, internal medicine, family medicine, pediatrics) to pursue further standardized training to gain expertise to treat and prevent the spectrum of medical problems associated with substance use disorders.
The development of a new medical specialty is not without challenges and potential consequences. Because most patients with addiction will continue to receive care from primary care physicians, efforts must be made to avoid a degree of subspecialization that makes the use of existing and new addiction treatments less accessible to individuals working in primary care. Since they likely will provide care in primary care settings, newly trained addiction medicine specialists are perfectly positioned to join together with addiction psychiatrists to press for important curricular space for addiction medicine training in medical schools and residency training, and to create continuing medical education opportunities for generalist physicians.
Ultimately, through the greater in corporation of addiction medicine into the spectrum of medical training, patients will be better served by narrowing the health care quality chasm in addressing substance use disorders. The development of addiction medicine as a formal medical subspecialty also has the potential to begin the slow process of public education required to treat those who are alcohol- or drug-addicted with compassion and care, and to move away from over reliance on punitive approaches that have not served the interests of patients, public health, or taxpayers.7
89 citations