Article, Emergency Medicine

The practical knowledge, experience and beliefs of US emergency medicine physicians regarding medical Cannabis: A national survey

Journal logoUnlabelled imageAmerican Journal of Emergency Medicine 38 (2020) 1952-1954

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The practical knowledge, experience and beliefs of US emergency medicine physicians regarding medical Cannabis: A national survey

Keywords:

Medical cannabis Marijuana

National physician survey Knowledge

Experience Beliefs

Emergency medicine

Medical cannabis is legal in 33 US states [1] but remains federally il- legal. The majority of legal states require physicians to provide cannabis recommendations in order for patients to have access to it. Our primary study objective was to assess the knowledge, experience and beliefs re- garding medical cannabis in US emergency medicine (EM) physicians. A secondary objective was to determine any effects based on demo- graphic variables.

We performed an anonymous in-person survey questionnaire at the largest EM conference (American College of Emergency Physicians an- nual meeting) that was held in Washington DC October 29-November 1, 2017 utilizing a 14-question survey with the following elements: de- mographics (age, race, gender, medical practice setting, US state of prac- tice) and cannabis questions on knowledge, physician experience, and beliefs.

A total of 871 conference participants were approached near regis- tration over the first three days of the conference from mid-morning to late afternoon, 387 people filled out the questionnaire and 16 were excluded, leaving 371 completed surveys by US EM physicians, which represented 11.3% of US physicians attending the conference. The sur- vey was a quality improvement initiative of the ACEP ethics committee. Institutional Board Review approval was obtained from the University of Central Florida.

Frequency and percentage, mean and standard deviations were reported for survey responses. To compare demographic variables, age, gender, race, cannabis users for medical or non-medical rea- sons, and cannabis legality in state of practice, to four knowledge questions, two physician experience questions, and three physician

Pennsylvania, Texas, Ohio and Illinois (Table 2). Compiled responses to the questionnaire are reported on Table 3.

There were no differences by age, race, gender, medical practice set- ting, or personal use of cannabis with the following exceptions. For knowledge questions, physicians who had taken cannabis personally for medical reasons were significantly more likely to know what the endocannabinoid system does (62.5% (5/8) vs. 29.9% (108/361), p b .05) and were significantly more likely to know how to choose a starting dose for medical cannabis (25.0% vs. 2.5%, p b .05). For experi- ence questions, physicians who had taken cannabis personally for both medical reasons and for non-medical reasons were significantly more likely to have recommended cannabis to their patients (37.5% vs. 10.5%, p b .05, and 16.9% vs. 5.7%, p b .001).

For belief questions, physicians who had taken cannabis for non- medical reasons were significantly more likely to believe cannabis has medical value (75.3% (125/166) vs. 62.1% (121/195), p b .05), and should be legal for medical usage (82.5% (137/166) vs. 67.2% (131/195), p b .005) and for non-medical usage (68.7% (114/166) vs. 33.3% (65/195), p b .0001). And, younger physicians compared to older (54.4% (100/ 184) vs. 45.1% (83/184), p b .05) and academic physicians compared to those in private practice (52.7% vs. 42.2%, p b .001) were significantly more likely to believe it should be legal for non-medical usage.

Table 1

Demographic characteristics of study participants

Demographic N %

Gender

Male 250 67.4

Female 121 32.6

Age (mean +- SD) 43.4 +- 12.2

Race

White 258 70.9

Asian 46 12.6

Black/African American 24 6.6

Chicano/Latino 18 5.0

Mixed 8 2.2

Native American 2 0.5

Other 8 2.2

Medical degree type

MD 325 87.6

DO 46 12.4

Primary Medical specialty

Emergency medicine 361 97.3

beliefs questions, Fisher’s exact test were performed. Continuous variables such as age were dichotomized (age: <=40, N40 years).

Family Medicine Internal medicine

5 1.3

5 1.3

All analyses were performed using SAS statistical software (Version 9.4, SAS Institute, Cary NC). A p b .05 was considered statistically significant.

The mean age was 43.4 +- 12.2 years old, men comprised 67.4% of participants and whites made up 70.9% of respondents (Table 1). There were 42 of 50 US states represented as well as the District of Co- lumbia and Puerto Rico. Only eight states did not have representation (Arkansas, Delaware, Hawaii, Idaho, Montana, Oklahoma, Rhode Island, Vermont). The highest respondents practiced in New York, California,

Years of practice (mean +- SD) 11.3 +- 11.2

Practice setting

Academic 203 56.1

Private 137 37.8

Military 9 2.5

Retired 3 0.8

Other 10 2.8

State cannabis work law

Legal state (medical or adult use) 266 73.9

Illegal state 94 26.1

* Percentages may not total 100% due to missing data or rounding.

https://doi.org/10.1016/j.ajem.2020.01.059 0735-6757/(C) 2020

The practical knowledge, experience and beliefs of US emergency medicine physicians regarding medical Cannabis: A national survey 1953

Table 2

Respondents by state legality as of October 2017.

Legality States of practice N % N (%)

Schedule I drugs as having no medicinal value [2] and may reflect that physicians have a contemporary understanding of the value of cannabis, particularly in light of the comprehensive report by the National Acade- mies of Science finding conclusive or substantial evidence in three con- ditions [3].

The personal experience of physicians using cannabis closely mimics national data that shows 45.2% of US adults have used cannabis [4]. That physicians who had taken cannabis for both medical and non-medical reasons were more likely to recommended it is consistent with a study showing higher prescribing practices with personal experience [5].

As a national survey of US EM physicians, this study does not rep- resent all medical specialties and cannot be generalizable to all phy- sicians. We acknowledge our survey is limited for the same reasons all surveys are limited: there is a participation bias, self-selection bias, low response rate and potential for incomplete data collection, to name a few.

Both

California

29

8.1

63 (17.5)**

Massachusetts

11

3.1

Colorado

10

2.8

Nevada

4

1.1

Washington

3

0.8

Alaska

3

0.8

Oregon

2

0.6

District of Columbia

1

0.3

Medical

New York

38

10.6

203 (56.4)

Pennsylvania

27

7.5

Ohio

21

5.8

Illinois*

20

5.6

New Jersey

17

4.7

Florida

16

4.4

Michigan*

15

4.2

Maryland

13

3.6

Arizona

8

2.2

Connecticut

6

1.7

West Virginia

5

1.4

Alaska

3

0.8

Louisiana

3

0.8

Minnesota

3

0.8

Puerto Rico

3

0.8

New Mexico

2

0.6

North Dakota

2

0.6

New Hampshire

Arkansas, Delaware, Hawaii, Montana,

1

0.3

Oklahoma, Rhode Island, Vermont*

0

0.0

Not legal

Texas

26

7.2

94 (26.1)

Virginia

16

4.4

North Carolina

10

2.8

Georgia

7

1.9

Tennessee

6

1.7

Wisconsin

6

1.7

Alabama

4

1.1

Missouri

4

1.1

Indiana

3

0.8

Iowa

2

0.6

Kansas

2

0.6

Utah

Kentucky, Mississippi, Nebraska, South Carolina, South Dakota, Wyoming (1 each)

2

6

0.6

1.7

Idaho

0

0.0

In conclusion, public demand, state legalization and widespread so- cietal use have forced the medical community to have to deal with the impact of medical and non-medical cannabis, despite its ongoing feder- ally illegal status. Physicians must become more knowledgeable about the use and effects of cannabis in order to care for their patients.

Acknowledgments

We are indebted to the Society of Cannabis Clinicians who paid for statistical work on this paper. FSS was paid as a statistical consultant.

Author disclosures

KMT has a financial interest in MGC LLC, a California cannabis com- pany. A subset finding of this paper is published in letter format (Takakuwa KM, Shofer FS, Schears RM. A national survey of US emer- gency medicine physicians on their knowledge regarding state and fed- eral cannabis laws. Cannabis Cannabinoid Res. [in press]).

* Michigan, Vermont and Illinois were medical use states in 2017. Michigan and Vermont passed adult use in 2018 and Illinois passed adult use in 2019. ** Percentages may not total 100% due to missing data or rounding.

To our knowledge, this is the first comprehensive national survey of EM physicians about their knowledge, experience and beliefs regarding medical cannabis. The high level of support for medical cannabis seen in our study is incongruous with the federal designation that defines

References

  1. Source: National Conference of state legislatures. Accessed May 4, 2019 at http:// www.ncsl.org/research/health/state-medical-marijuana-laws. aspx.
  2. US Drug Enforcement Agency (DEA). Office of Diversion Control. Controlled substance schedules and list of controlled substances. Accessed September 12, 2018 at https:// www.deadiversion.usdoj.gov/schedules/
  3. National Academies of Sciences, Engineering, and Medicine. The health effects of Can- nabis and cannabinoids: The current state of evidence and recommendations for re- search. Washington, DC: The National Academies Press; 2017. https://doi.org/10. 17226/24625.
  4. Substance Abuse and Mental Health Services Administration. Accessed on Sep- tember 7, 2018 https://www.samhsa.gov/data/sites/default/files/cbhsq-reports/ NSDUHDetailedTabs2017/NSDUHDetailedTabs2017.pdf.

    Table 3

    Responses to knowledge, experience and beliefs questions

    Question Yes No Unsure/Don’t know

    N

    %

    N

    %

    N

    %

    Knowledge

    Knew what the endocannabinoid system does

    114

    (30.8)

    150

    (40.5)

    106

    (28.6)

    Knew how to choose a starting dose for medical cannabis

    11

    (3.0)

    360

    (97.0)

    Knew how to determine a maintenance dose

    7

    (1.9)

    363

    (98.1)

    Experience

    Personally taken cannabis for medical reasons

    8

    (2.2)

    363

    (97.8)

    Personally taken cannabis for non-medical purposes

    166

    (45.9)

    196

    (54.1)

    Taken b 10 times in life

    77

    (48.7)

    Taken between 10 and 100 times in life

    55

    (34.8)

    Taken N 100 times in life

    26

    (16.5)

    Has recommended medical cannabis to a patient

    41

    (11.1)

    329

    (88.9)

    Beliefs

    Believes cannabis has medical value

    252

    (68.3)

    30

    (8.1)

    87

    (23.6)

    Believes cannabis should be legal for medical usage

    275

    (74.3)

    28

    (7.6)

    67

    (18.1)

    Believes cannabis should be legal for non-medical usage

    183

    (49.5)

    117

    (31.6)

    70

    (18.9)

    1954 The practical knowledge, experience and beliefs of US emergency medicine physicians regarding medical Cannabis: A national survey

    Schumock GT, Walton SM, Park HY, et al. Factors that influence prescribing decisions.

    Frances S. Shofer

    Annals of Pharmacotherapy 2004;38(4):557-62. https://doi.org/10.1345/aph.1d390.

    Kevin M. Takakuwa

    Society of Cannabis Clinicians, Sebastopol, CA, United States of America

    ?Corresponding author: Kevin M. Takakuwa, PO Box 27574, San

    Francisco, CA 94127.

    E-mail address: [email protected]

    University of Pennsylvania, Philadelphia, PA, United States of America

    Raquel M. Schears

    University of Central Florida, Orlando, FL, United States of America

    4 December 2019

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