Canadian doctors ‘still reluctant’ to prescribe medical cannabis

Doctors in Ontario are still hesitant to prescribe medical cannabis to chronic pain patients, 20 years after it was first introduced.

Physicians surveyed by researchers at McMaster University, said their main concerns relate to possible ill-effects and a lack of understanding regarding their effectiveness as painkillers.

Of particular concern were potentially harmful effects on cognitive development, a possible worsening of existing mental illnesses in patients and the drug’s effects in older adults, which may include dizziness or drowsiness.

Meanwhile, the number of Canadians using medical cannabis has soared from just under 24,000 in June 2015 to 377,000 by September 2020.

“This paper is demonstrating that there is a real perceived need by family physicians that more evidence, education and guidance is needed, so they can better help patients who are asking about this treatment,” said Jason Busse, associate director of the Michael G. DeGroote Centre for Medicinal Cannabis Research at McMaster.

Six of the 11 physicians surveyed also raised the issue of how legal recreational cannabis affected its medical counterpart, but 10 said therapeutic variants should remain an option.

Recreational cannabis, which has a different formulation than medical cannabis, was legalised in Canada in October 2018.

The report states that: “Increased use of medical cannabis was likely the result of the easing of regulations, greater availability given the growing numbers of producers and cannabis clinics and reduced stigma around the use of cannabis for therapeutic purposes.”

However, doctors are still hampered by a lack of proper guidance, while medical cannabis products have not undergone the same rigorous trials as other pharmaceutical drugs on the market, said Busse, associate professor of anesthesia.

In 2019, the Canadian Medical Association said that although cannabis may offer patients relief when conventional therapies fail, a lack of evidence surrounding the risks and benefits of its use makes it difficult for physicians to advise patients properly.

“When you have such widespread recreational and medical cannabis use, there is a real challenge for healthcare providers who are not trained in prescribing it,” said Busse.

Researchers conducted telephone interviews with the doctors between January and October 2019 and published their findings in the Canadian Medical Association Journal Open.