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Marijuana as antiemetic medicine: A survey of oncologists' experiences and attitudes

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Abstract

A random-sample, anonymous survey of the members of the American Society of Clinical Oncology (ASCO) was conducted in spring 1990 measuring the attitudes and experiences of American oncologists concerning the antiemetic use of marijuana in cancer chemotherapy patients. The survey was mailed to about one third (N = 2,430) of all United States-based ASCO members and yielded a response rate of 43% (1,035). More than 44% of the respondents report recommending the (illegal) use of marijuana for the control of emesis to at least one cancer chemotherapy patient. Almost one half (48%) would prescribe marijuana to some of their patients if it were legal. As a group, respondents considered smoked marijuana to be somewhat more effective than the legally available oral synthetic dronabinol ([THC] Marinol; Unimed, Somerville, NJ) and roughly as safe. Of the respondents who expressed an opinion, a majority (54%) thought marijuana should be available by prescription. These results bear on the question of whether marijuana has a "currently accepted medical use," at issue in an ongoing administrative and legal dispute concerning whether marijuana in smoked form should be available by prescription along with synthetic THC in oral form. This survey demonstrates that oncologists' experience with the medical use of marijuana is more extensive, and their opinions of it are more favorable, than the regulatory authorities appear to have believed.
Marijuana as Antiemetic Medicine: A
Survey of Oncologists' Experiences and
Attitudes
Marijuana as Antiemetic Medicine: A Survey of Oncologists' Experiences and Attitudes
Doblin, Richard and Kleiman, Mark A. R, "Marijuana as Antiemetic Medicine: A Survey of Oncologists'
Experiences and Attitudes."
Journal of Clinical Oncology. 1991; 9(7): pp. 1314-1319.
ABSTRACT
A random-sample, anonymous survey of the members of the American Society of Clinical Oncology
(ASCO) was conducted in spring 1990 measuring the attitudes and experiences of American oncologists
concerning the antiemetic use of marijuana in cancer chemotherapy patients. The survey was mailed to
about one third (N = 2,430) of all United States-based ASCO members and yielded a response rate of 43%
(1,035). More, than 44% of the respondents report recommending the (illegal) use of marijuana for the
control of emesis to at least one cancer chemotherapy patient. Almost one half (48%) would prescribe
marijuana to some of their patients if it were legal. As a group, respondents considered smoked marijuana to
be somewhat more effective than the legally available oral synthetic dronabinol [THC] Marinol; Unimed,
Somerville, NJ) and roughly as safe. Of the respondents who expressed an opinion, a majority (54%)
thought marijuana should be available by prescription. These results bear on the question of whether
marijuana has a "currently accepted medical use," at issue in an ongoing administrative and legal dispute
concerning whether marijuana in smoked form should be available by prescription along with synthetic
THC in oral form. This survey demonstrates that oncologists' experience with the medical use of marijuana
is more extensive, and their opinions of it are more favorable, than the regulatory authorities appear to have
believed.
INTRODUCTION
Marijuana (smoked) has been reported to be effective in treating emesis associated with cancer
chemotherapy (1-4), but its use is currently prohibited by law (5). The main psychoactive ingredient in
marijuana, tetrahydrocannabinol (THC; dronabinol), was approved in 1985 by the Food and Drug
Administration (FDA) for use in the treatment of emesis. As marketed under the trade name Marinol
(Unimed, Somerville, NJ) and synthetically formulated in sesame oil in gelatin capsules to be taken orally,
almost 100,000 doses were prescribed in 1989 (6).
Litigation concerning the rescheduling of marijuana to permit its medical use has been making its way
through the courts since 1972 (7). The central issue in the longstanding administrative and legal dispute,
argued before the United States Court of Appeals (DC Circuit) on March 4, 1991 (8), is whether or not
marijuana has a "currently accepted medical use in treatment in the United States.'' This is the standard for
rescheduling required by the Uniform Controlled Substances Act of 1970 (5), which created the current
system of drug scheduling. The Act does not further specify the standard.
In September 1988, after 2 years of Drug Enforcement Administration (DEA) administrative hearings, DEA
Administrative Law Judge Francis Young issued a recommendation in favor of rescheduling marijuana. He
ruled that the appropriate standard for current acceptance is identical to the one established for a successful
defense in medical malpractice cases, which requires only that the medical practice at issue be accepted by
a "respectable minority" of physicians (9). Ironically, the 1955 medical malpractice case that established
this standard involved a lawsuit against an oncologist for the unsuccessful use of chemotherapy, which was
then new and did not have the approval of the American Medical Association. The court stated that as long
as there was no infallible cure and the doctor "did not engage in quackery by representing that he had one,''
the support of a respectable minority of peers would be sufficient to avoid malpractice liability. The court
remarked "We [the court] are not physicians and we have no light on the subject except such as is shed by
the testimony of physicians..." (10).
On December 29, 1989, the Administrator of DEA rejected Judge Young's recommendation and refused to
reschedule marijuana on the grounds that medical use of marijuana was not currently accepted. The
Administrator used an eight-part standard for determining current acceptance similar to the "safety and
efficacy" standard used by the FDA to approve the marketing of new drugs by pharmaceutical companies
(11). The DEA first articulated this standard in another rescheduling case in 1987, after the United States
Court of Appeals (1st Circuit 1987) rejected its contention that FDA new drug approval itself was the
appropriate standard (12). On April 26, 1991, the United States Court of Appeals (DC Circuit) (13) ruled
that DEA's standard was impossible to meet, and was therefore invalid. The court remanded to the DEA its
ruling rejecting Judge Young's recommendation in favor of the rescheduling of marijuana.
The extent of oncologists' acceptance of medical use of marijuana remains a disputed issue. Dr Ivan
Silverberg, an oncologist and witness in the DEA hearings, testified, "There has evolved an unwritten but
accepted standard of treatment within the oncologic community which readily accepts marijuana's use"
(14). On the other hand, the DEA characterized the medical use of marijuana as a "cruel and dangerous
hoax" (15). In a newspaper interview, DEA Associate Chief Counsel Steven Stone suggested that only a
fringe group of oncologists accepted marijuana as an antiemetic. Stone remarked, "The Judge seems to hang
his hat on what he calls a 'respectable minority of physicians.' What percent are you talking about? One half
of one percent? One quarter of one percent?" (16). This report of oncologists experiences with and attitudes
about marijuana as an antiemetic is based on a survey of these specialists conducted in the spring of 1990.
SUBJECTS AND METHODS
A random sample of the United States-based members of the American Society of Clinical Oncology
(ASCO) was surveyed. The membership of ASCO, the only formal association of clinical oncologists in the
United States, comprises about 80% of the approximately 5,000 board-certified oncologists and almost 60%
of the approximately 11,700 oncologists in the United States, including academic and research-oriented
oncologists as well as clinicians in private practice. The survey was conducted independently of ASCO
sponsorship.
The survey, responses to which were anonymous, was sent to about 35% (N = 2,430) of the total United
States-based ASCO 1989 membership (N = 6,830). The 1,035 surveys returned resulted in a response rate
of 43%, representing 15% of United States-based ASCO members and 9% of all oncologists in the United
States. Of the respondents, 57 (6%) returned the survey unanswered, indicating that they did not treat
patients. Other respondents did not answer every question. The data analysis is based on the total number of
respondents answering each particular question.
The survey initially elicited personal information about the oncologist's year of graduation from medical
school and size of practice. Oncologists were then asked to estimate the proportion of their cancer
chemotherapy patients for whom the currently available antiemetics provided adequate relief or caused
significant problems with side effects.
Respondents were asked how frequently they prescribed Marinol, whether any of their patients had used
marijuana as an antiemetic, whether they had directly observed or discussed marijuana's medical use with
patients, and whether they had ever recommended that a patient try marijuana.
Oncologists were also asked to estimate the proportion of their patients who reported effective emetic
control or negative side effects from using marijuana or Marinol, to directly compare the safety and efficacy
of marijuana and Marinol, and to estimate what proportion of their patients experienced net benefits from
their use of marijuana.
Oncologists were further asked to respond to the statements "Marijuana can be effective in the control of
emesis," "Marijuana can be used safely in the control of emesis," 'Marijuana should be given an accepted
place in the antiemetic armamentarium," and "I find the use of Marinol in the control of emesis to be a
legitimate, currently acceptable medical practice" by indicating strong agreement, agreement, strong
disagreement, disagreement, or no opinion. Oncologists were also asked, if marijuana were legal, whether
they would prescribe it to "many," "few," or "none" of their patients or if they needed more information.
RESULTS
Ten percent of the respondents graduated from medical school in the 1980s; almost one half (48%) of the
respondents graduated from medical school in the 1970s; almost one third (31%) in the 1960s; 9% in the
1950s; and 2% in the 1940s. In 1989, almost one half (49%) of the respondents had an annual patient
population of more than 225; almost one quarter (24%) treated between 150 and 225 patients; 18% treated
between 75 and 150 patients; and 9% treated 75 or fewer patients.
Two hundred nine (21%) of oncologists reported that the available medicines provided inadequate relief to
half or more of their patients (Fig 1). More than half (520, 54%) of the respondents reported that the
available antiemetics caused significant problems with side effects in more than a "few" of their patients
( Fig 1).
Slightly more than 70% (686) of respondents reported that at least one of their patients had used marijuana
as an antiemetic and that they had directly observed or discussed marijuana's medical use with that
patient(s). Marinol had been prescribed by 557 respondents (57%).
A surprising proportion of respondents (432, 44%) said they had recommended marijuana to at least one
patient. Only six respondents noted that they did so as part of a legally authorized research protocol. Not
surprisingly, respondents who treated more than 150 patients per year were more likely to have
recommended marijuana than respondents treating fewer than 150 patients (46% v 34%, P < .05).
Respondents who graduated from medical school in the 1950s, the 1960s, or the 1970s had statistically
similar rates of recommending marijuana (1950s, 46%; 1960s, 44%; 1970s, 44%). However, those who
graduated during the 1980s had a significantly lower rate (30%. P < .05).
EFFICACY OF MARIJUANA AND MARINOL
Three hundred eighty-five respondents (64%) stated that marijuana was effective in 50% or more of their
patients, and 266 (56%) reported the same of Marinol (Fig 2). The difference is statistically significant (P
= .008).
Of the 277 respondents (28%) who felt they had sufficient information to compare marijuana directly with
Marinol in terms of efficacy, 44% believed marijuana to be more effective, 13% believed Marinol to be
more effective, and 43% thought they were about equally effective. Of those who reported a preference (N
= 157), 121 (77%) thought marijuana was more effective than Marinol. The difference between 77% and
50% (the null hypothesis) is statistically significant below the .0001 level.
Six hundred eight respondents (63%) agreed with the statement affirming the efficacy of marijuana in the
treatment of emesis (9% "strongly agreed" and 54% "agreed"), and 77 respondents (8%) disagreed (2%
"strongly disagreed" and 6% "disagreed"). Two hundred eighty-three (29%) had no opinion. Of the
respondents with opinions (N = 685), 89% believed marijuana to be effective in the control of emesis. Of
respondents to a question concerning net benefits (N = 644), 409 (64%) reported that 50% or more of their
patients experienced net benefits from marijuana. Only 15 (2%) reported that none of their patients
experienced net benefits from marijuana.
SAFETY OF MARIJUANA AND MARINOL
Two hundred twenty-four respondents (47%) stated that the use of Marinol caused negative side effects in
50% or more of their patients, and 235 (40%) reported the same about marijuana (Fig 3). The difference is
statistically significant (P = .018).
Of the 288 respondents (29%) who felt they had sufficient information to compare marijuana with Marinol
in terms of side effects, 20% believed marijuana to cause fewer problems with side effects, 23% believed
Marinol to cause fewer problems, and 57% thought they were equal. Slightly more than half, 52% (65), of
those who reported a preference (124) reported Marinol to cause fewer problems with side effects. The
difference between 52% and 50% is not statistically significant (P = .596).
Four hundred seventy-eight respondents (49%) agreed with the statement affirming that marijuana could be
safely used in the treatment of emesis (6% "strongly agreed" and 43% ''agreed"), and 131 (14%) disagreed
(4% "strongly disagreed" and 10% "disagreed"). Three hundred sixty-one (37%) had no opinion. Of the
respondents with opinions (N = 609), almost four fifths (79%) believed that marijuana could be safely used
to control emesis.
Almost half (423, 44%) of the respondents reported that they believe marijuana to be both safe and
efficacious. Of respondents with opinions on both safety and efficacy (N = 577), 73% believe marijuana to
be both safe and efficacious. There were no significant differences in positive opinions of marijuana's safety
and efficacy between respondents who treated 150 patients or fewer annually and those who treated more
than 150 patients annually, or among respondents who graduated in different decades.
Three hundred twenty respondents (33% of all respondents) stated that marijuana should be accepted (5O%
"strongly agreed" and 28% "agreed") and 279 (29%) felt that it should not (7% "strongly disagreed" and
22% "disagreed"); 364 (38%) expressed no opinion. Of the 599 respondents with opinions, 53% favored
making marijuana available by prescription. The surplus of positive over negative opinions is within the
bounds of sampling error (P = .092). There were no significant differences in rate of acceptance by size of
patient population. However, respondents who graduated in the 1950s were significantly less likely to
accept the medical use of marijuana (22%) than respondents who graduated in the 1960s (35% ), the 1970s
(34%), or the 1980s (39%) (P < .05).
When asked whether Marinol should be accepted, 705 respondents (73%) agreed (20% "strongly agreed"
and 53% "agreed") and 83 (9%) disagreed (2% "strongly disagreed" and 7% "disagreed"); 177 (18%) had
no opinion. Of the 788 respondents with opinions, 89% accept the medical use of synthetic THC.
Almost half of the respondents (440, 48%) would prescribe marijuana to at least a few patients (4% to
"many," 44% to "few'') if it were legal; 200 (22%) would not prescribe it; and 274 (30%) said they would
need more information. The 48% who would prescribe marijuana if it were legal is only slightly less than
the 54% who have prescribed Marinol, which is legally available. Of those oncologists who had previously
recommended marijuana to at least one patient (N = 432), 279 (65%) would prescribe marijuana to at least a
few patients if it were legally available. Of those oncologists who had not recommended marijuana to at
least one patient (N = 550), 161 (29%) report that they would prescribe marijuana to at least a few patients
if it were legally available.
DISCUSSION
Although substantial, the response rate of 43% makes it difficult to determine precisely the views of the
entire ASCO membership. The views of the sample who returned the survey may differ significantly from
the views of those who did not. Since ASCO itself does not compile membership statistics for age, year of
graduation from medical school, or patient population size, respondents cannot be compared with the full
membership in these respects. However, no obvious anomalies in their characteristics were observed.
Furthermore, the distribution of postmarks by state on the returned surveys - the main information available
with which to evaluate response bias - very closely matched the geographic distribution of the survey forms
mailed. Although there is nothing specific to suggest the presence of response bias, it cannot be ruled out.
Therefore, all reported statistics should be considered indications of the general range of support for various
propositions, rather than precise determinations.
The central empirical question the survey was designed to answer was whether a significant minority of the
members of the ASCO supported the rescheduling of marijuana to permit its use in the treatment of nausea
associated with cancer chemotherapy. The response rate is sufficiently large to resolve that question
conclusively.
Of all oncologists with opinions responding to our survey, 54% supported rescheduling. Possible response
bias makes it impossible to determine precisely whether a majority of the population with opinions actually
holds that view. Ascertaining whether a significant minority of the population supports rescheduling is
much simpler. A sensitivity analysis varying the degree of acceptance of the medical use of marijuana by
nonrespondents to the survey suggests that support for rescheduling marijuana is indeed present in at least a
significant minority of our population. In the hypothetical event that all nonrespondents and all respondents
without opinions were actually opposed to rescheduling, 13% of oncologists would remain in favor of
rescheduling. If all nonrespondents and respondents without opinions were actually for rescheduling, 85%
would support prescription availability of marijuana.
The survey data suggest that adding marijuana to the existing armamentarium of antiemetic agents would
result in substantial benefits to patients. Oncologists believe smoked marijuana to be roughly as safe as
legally available, oral synthetic THC (Marinol) and somewhat more effective. Of the oncologists
responding to our survey, 44% - 73% of those with opinions - consider marijuana both safe and efficacious.
Oncologists may prefer to prescribe smoked marijuana over oral THC for several reasons. The
bioavailability of THC absorbed through the lungs has been shown to be more reliable than that of THC
absorbed through the gastrointestinal tract (17-18), smoking offers patients the opportunity to self-titrate
dosages to realize therapeutic levels with a minimum of side effects, and there are active agents in the crude
marijuana that are absent from the pure synthetic THC.
Although the survey did not ask whether marijuana or Marinol might be safer or more effective when used
with specific patient groups, in space set aside for comments, 42 oncologists mentioned either that older
patients had more problems with side effects from both Marinol and marijuana or that patients who had side
effects tended to be inexperienced with marijuana. The increased prevalence of side effects in older patients
may be a cohort effect and not an age effect. Marijuana and Marinol may be most useful in younger or
marijuana-experienced patients.
More than four in 10 respondents (44%) report that they have recommended the (illegal) use of marijuana
to control emesis to at least one cancer chemotherapy patient. The fact that so many physicians have
advised patients to commit an illegal act to obtain marijuana suggests a substantial discrepancy between
clinical and regulatory opinions. Almost half (48%) would prescribe it to some of their patients if it were
legal.
The survey reported here of the opinions and experiences of clinicians is not a controlled clinical study of
the use of marijuana as an antiemetic. Nevertheless, this survey demonstrates that oncologists' experience
with the medical use of marijuana is more extensive, and their opinions of it are more favorable, than the
regulatory authorities appear to have believed. It appears that current regulations create the somewhat
anomalous situation that a substantial fraction of all practicing oncologists at least occasionally commit an
act - ie, counseling a patient to acquire and use a controlled substance - that constitutes a crime and that at
least in principle could lead to the revocation of their license.
REFERENCES
1. Evidence in Drug Enforcement Administration (DEA) Administrative Hearings, Judge Francis
Young, Jr. presiding: Alliance for Cannabis Therapeutics Exhibits: Official State Reports, vol 2,
1988 (GA-Tab 8, MI-Tab 9, NJ-Tab 10, NM-Tab 15, NY-Tab l6, TN-Tab 17)
2. Randall RC (ed): Cancer Treatment and Marijuana Therapy. Washington, DC, Galen Press. 1990.
3. Vinciguerra V, Moore-Terry MSW, Brennan E: Inhalation marijuana as an antiemetic for cancer
chemotherapy. NY State J Med 88:525-527. 1988
4. American Medical Association (AMA) Council on Scientific Affairs: Marijuana: Its health hazards
and therapeutic potentials. JAMA 246:1823-1827, 1981
5. Uniform Controlled Substances Act of 1970, 21 USC§800
6. Unimed Pharmaceuticals: Annual Report, December 1989. Somerville, NJ, Unimed
Pharmaceuticals, 1989
7. 37 Federal Register 18093, September 1, 1972
8. Alliance for Cannabis Therapeutics (ACT) v Drug Enforcement Administration (DEA), US Court
of Appeals 90-1019 (DC 2nd Circuit, filed January 19, 1990)
9. Ruling of DEA Administrative Law Judge Francis Young, Jr, DEA Administrative Hearings,
September 6, 1988
10. Baldor v Roberts, 81 So2d 658. (Florida Supreme Court, 1955)
11. 54 Federal Register 53767-53785, December 29, 1989
12. Grinspoon v DEA. 828 F2d 881 (1st Circuit 1987)
13. Alliance for Cannabis Therapeutics (ACT) v Drug Enforcement Administration (DEA), 90-1019
(DC Circuit, April 26, 1991)
14. Testimony of Dr. Ivan Silverberg, in Randall RC (ed): Marijuana. Medicine and the Law, vol 1.
Washington, DC, Galen Press, 1988, p 149
15. 54 Federal Register 53767-53785, December 29, 1989, p 53784
16. Slater L: Marijuana: Medicine or menace? Spinal Network, Winter, p 44, 1990
17. Chang A, Shiling D, Stillman R. et al: Delta-9-tetrahydrocannabinol as an antiemetic in cancer
patients receiving high-dose methotrexate. Ann Intern Med 91:819-824, 1979
18. Ohisson A, Lindgren J-E, Wahlen A, et al: Plasma delta-9-tetrahydrocannibinol concentrations and
clinical effects after oral and intravenous administration and smoking. Clin Pharmacol Ther
28:409-416, 1980
ACKNOWLEDGEMENT
Joseph P. Newhouse, of the Kennedy School, reviewed both the survey instrument and this report and
suggested several important improvements. Dr Jerome Jaffe, Director of the Addiction Research Center of
the National Institute on Drug Abuse, also offered constructive suggestions.
Copyrighted material. Reprinted by permission.
... Surveys regarding medical cannabis were conducted worldwide among certified medical doctors, pharmacists, and medical faculty students [12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30]. Most of these studies reveal problems with the lack of local clinical standards or knowledge about the legal status of medical cannabis [12,13]. ...
... Studies also show that views vary by medical specialty, gender, age, and religiosity [12,13]. Oncologists and palliative care specialists usually advocate strongly for the use of medical cannabis, family medicine, and neurology specialists are more conservative [12,13,[22][23][24][25][26][27][28]. There are also slight differences in the acceptance of incorporating cannabinoids in clinical practice between doctors and medical students living in different geographical locations [12]. ...
... Over 71% of physicians declared that their knowledge level about cannabinoids is "not" or "rather not" sufficient for patient counseling. Our finding that MDs self-evaluated knowledge about cannabinoids is not sufficient is repeatedly found in studies from other countries [12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28]. In Norway, 71% of surveyed physicians declared that they would like to be more knowledgeable about this topic [22]. ...
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... anxiety and depression) as the most prominent adverse effects associated with the consumption of cannabis. Similar findings were reported in Ireland, the USA, Canada, and Israel (Adler & Colbert, 2013;Ananth et al., 2018;Brooks et al., 2017;Carlini et al., 2017;Charuvastra et al., 2005;Crowley et al., 2017;Doblin & Kleiman, 1991;Ebert et al., 2015;Kondrad & Reid, 2013;Kweskin, 2013;Uritsky et al., 2011). ...
... The majority of physicians in the current study tended to agree with the notion that MC is a legitimate treatment option. This finding is mirrored in most of the previous research on provider perspectives towards MC (Ablin et al., 2016;Adler & Colbert, 2013;Ananth et al., 2018;Carlini et al., 2017;Crowley et al., 2017;Doblin & Kleiman, 1991;Ebert et al., 2015;Uritsky et al., 2011). However, two studies reported that physicians did not recommend cannabis as a legitimate treatment option due to concerns that it is harmful to both physical and mental health (Kondrad & Reid, 2013;Kweskin, 2013). ...
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Background: Recently, the renewed global interest in cannabis' therapeutic properties has resulted in shifting attitudes and legislative policies worldwide. The aim of this systematic review is to explore the existing literature on medical professionals' and students' attitudes and knowledge regarding medicinal cannabis (MC) to assess any relevant and significant trends. Methods: This systematic review was conducted in accordance with PRISMA guidelines. Using PubMed and Google Scholar, a literature search was performed to identify studies pertaining to healthcare professionals' and medical students' knowledge and attitudes regarding MC. There were no search limits on the year of publication; however, studies without primary data (e.g., abstracts, systematic reviews, meta-analyses) and non-English language papers were excluded. Studies were coded according to the following research questions: (1) Do respondents believe that cannabis should be legalized (for medicinal and/or recreational purposes)? (2) Are respondents confident in their level of knowledge regarding cannabis' clinical applications? (3) Are respondents convinced of cannabis' therapeutic potential? 4) What current gaps in knowledge exist, and how can the medical community become better informed about cannabis' therapeutic uses? and (5) Are there significant differences between the knowledge and opinions of healthcare students versus healthcare professionals with respect to any of the aforementioned queries? Chi-square tests were used to assess differences between medical students and medical professionals, and Pearson's bivariate correlations were used to analyze associations between survey responses and year of publication-as a proxy measurement to assess change over time. Results: Out of the 741 items retrieved, 40 studies published between 1971 and 2019 were included in the final analyses. In an evaluation of 21 qualified studies (8016 respondents), 49.9% of all respondents favored legalization (SD = 25.7, range: 16-97%). A correlational analysis between the percentage of survey respondents who support MC legalization and year of publication suggests that both medical students' and professionals' support for MC legalization has increased from 1991 to 2019 (r(19) = .44, p = .045). Moreover, medical professionals favor the legalization of MC at a significantly higher rate than students (52% vs. 42%, respectively; χ2 (1, N = 9019) = 50.72 p < .001). Also, respondents consistently report a strong desire for more education about MC and a substantial concern regarding MC's potential to cause dependence and addiction. Pearson's correlations between year of publication and survey responses for both of these queried variables suggest minimal changes within the last decade (2011-2019 for addiction and dependence, 2012-2019 for additional education; r(13) = - .10, p = .713 and r(12) = - .12, p = .678, respectively). Conclusion: The finding that both medical students' and professionals' acceptance of MC has significantly increased in recent decades-in conjunction with their consistent, strong desire for more educational material-suggests that the medical community should prioritize the development of MC educational programs. MC is far more likely to succeed as a safe and viable therapy if the medical professionals who administer it are well-trained and confident regarding its clinical effects. Limitations include a lack of covariate-based analyses and the exclusion of studies published after the literature search was performed (June 2019). Future research should analyze studies published post-2019 to draw temporal comparisons and should investigate the effect of numerous covariates (e.g., gender, religiosity, prior cannabis use) as newer studies gather data on these factors [PROSPERO Registration: CRD42020204382].
... oncologists had recommended to at least one patient that they use cannabis illegally to control chemotherapy-related vomiting (Doblin & Kleinman, 1991). That means their patients who complied with their doctor's advice (behavior the medical system always seeks to enforce) were simultaneously making themselves vulnerable to legal trouble and, consequently, a mental disorder diagnosis. ...
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Claims about mental health risks are one of the last remnants of the cannabis harm paradigm, but the evidence is paradoxical. This chapter explores from a sociological perspective how and why medical cannabis use in the context of mental health is marked by contradictions in both research findings and the views of clinicians and laypersons. The chapter considers differing logics and standards of evidence for interpreting evidence of efficacy in a realm of considerable scientific uncertainty, with close looks at the diagnostic problems with Cannabis Use Disorder in the context of medicinal use, as well as the complex relationship between cannabis use and schizophrenia diagnoses.
... While researchers and professional medical associations are warming to the therapeutic potential of cannabis, members of the practicing medical community are much more divided over using the plant in its current form as a therapy (Kondrad andReid 2013, Vettor et al. 2008 Doctors in specialties such as oncology, anesthesiology, and neurology are more likely to be aware of research on the efficacy of cannabis and endorse its use by their patients, and acceptance is increasing. Even before any state had passed a medical cannabis law, Harvard researchers found in 1991 that more than 44 percent of oncologists were encouraging their patients to try cannabis, despite its illegality (Doblin and Kleinman 1991). to medicate every American adult around the clock for a month" (44). ...
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