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Home > Irish GP attitudes towards decriminalisation and medical use of cannabis.

Guiney, Ciara (2017) Irish GP attitudes towards decriminalisation and medical use of cannabis. Drugnet Ireland , Issue 62, Summer 2017 , pp. 15-16.

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The debate on the decriminalisation of cannabis and legalising cannabis for medicinal use has been ongoing in Ireland and abroad. Despite this, the topic has received scant attention in the research literature. A ‘unique’ and recent study carried out in Ireland aimed to build on existing interest in this area by examining the attitudes of Irish general practitioners (GPs) towards decriminalisation and the medicinal use of cannabis (n=565).1,2

 

Methodology

All GPs whose details were recorded on the Irish College of General Practitioner’s database were invited to participate in an online survey. The response rate was 15% (n=565). The survey contained three sections:

  1. Closed questions were related to age, practice location, specialist level 1 or 2 registration3, and experience in treating opioid users.
  2. To assess GP attitudes, participants were asked to agree to a series of statements using a five-point Likert scale; for example, ‘cannabis should be decriminalised’, ‘cannabis should be legalised for medical use’, ‘decriminalisation of cannabis use would lead to its increased use’ (p. 4).
  3. A series of open-ended questions that enabled participants to expand on the responses given in section 2.2 

Results

The quantitative analysis, which examined responses by gender, age and training level, indicated that:1

  • 56.8% of Irish GPs (n=320) in this study did not agree with decriminalisation of cannabis.
  • Male GPs were more likely than female GPs to agree with the decriminalisation and legalisation of cannabis for medical use (p<0.0001 and p=0.002, respectively).
  • GPs who were younger (<50 years) were more likely to agree with the legalisation of cannabis for medical use (p=0.044).
  • GPs agreed that cannabis use has a negative impact on individuals with mental and physical health problems, 82.7% and 60%, respectively.
  • GPS agreed that cannabis use can leave young people at risk of developing schizophrenia (77.3%).
  • However, more than two-thirds agreed that cannabis had a role to play in pain management (63.5%), treatment of multiple sclerosis (62.3%), and palliative care (68.5%).
  • GPs with level 1 training for managing opioid users (n=86) agreed or strongly agreed that cannabis should be legalised for medical use (65%) and had a role to play in pain management (80%) and in multiple sclerosis (86%).
  • GPs with level 2 training for managing opioid users (n=13) strongly agreed or agreed that cannabis should be decriminalised. 

The qualitative analysis, which utilised a content analysis to examine the open-ended responses to the statements in section 2 resulted in five themes:2 decriminalisation and legislation debates; cannabis for therapeutic purposes; young people and family impacts; adverse health consequences; and legal status and comparisons to legal substances.

 

Decriminalisation and legalisation debates

These terms were often used interchangeably by GPs. The legalisation of drugs was seen as necessary by some, given that prohibition was perceived as not working. Decriminalising/legalising cannabis was viewed as a way to regulate and standardise the sale and production of cannabis, which would safeguard those that took cannabis. Decriminalisation was viewed as a way to reduce contact with dealers and reduce illegal income being generated from the sale of cannabis. Many GPs acknowledged the impact of using cannabis on mental health and the need to draw an evidence-based approach when trying to regulate the product.

 

Cannabis for therapeutic purposes (CTP)

GP comments on prescribing cannabis for medical use were mixed. Concerns were raised over prescribing and patient misuse. Many commented on the lack of research evidence to support CTP and queried how comparable it was to other therapies. Although GPs acknowledged its potential for palliative and chronic illnesses and pain management, some argued that the risks of using it far outweighed the benefits.

 

Young people and family impacts

The majority of GPs noted that using cannabis at a young age not only influenced the health and well-being of the young person but also influenced how well they did at school and their future career aspirations. Their families and the communities in which they lived also suffered. Concerns were raised over the level of mental illnesses, suicide attempts, and lack of engagement evident in this population. Drug education programmes were identified as a necessity to inform youth people of the harms associated with cannabis use with the aim of preventing onset and progression to more risky drug-related behaviour. The potency of cannabis sold on the street troubled GPs, as it was a stepping stone towards using more potent illicit drugs, such as cocaine or heroin.

 

Adverse health consequences

Many GPs emphasised that long-term cannabis use can lead to negative outcomes, such as dependence and mental health problems. GPs were conscious that some individuals were more susceptible to drug-induced psychosis or developing schizophrenia. Comments also centred on the challenges of treating cannabis use in mentally ill patients, particularly those that presented with suicidal ideation and self-harm. GPs stressed that better psychiatric services to support treatment were required.

 

Legal status and comparisons to legal substances

GPs compared the after-effects of using cannabis with nicotine, alcohol and opioid pain relief, and purported that cannabis was less harmful but only if taken in moderation.

 

Limitations

As acknowledged by the authors, the response rate for this study was low (15%). This would suggest that the final sample may not be representative of the total GP population that were invited to participate in the survey.

 

Conclusion

The majority of GPs in this study are not in favour of decriminalisation of cannabis drug policy, yet are in favour of legalising the use of cannabis for medicinal purposes. Due to the poor response rate, it could be argued that the results of this study should be interpreted with caution. However, despite this limitation, the study makes a unique contribution and builds on existing knowledge, while also providing insight into the attitudes of GPs from an Irish context. One of the study authors, Dr Des Crowley, hopes that this study ‘will be considered within the ongoing debate on substance misuse in Ireland’.4

 

1    Crowley D, Collins C, Delargy I, Laird E and Van Hout MC (2017) Irish general practitioner attitudes toward decriminalisation and medical use of cannabis: results from a national survey. Harm Reduction Journal, 14(4): 4. https://www.drugsandalcohol.ie/26675/

2    Van Hout MC, Collins C, Delargy I and Crowley D (2016) Irish general practitioner (GP) perspectives toward decriminalisation, legalisation and cannabis for therapeutic purposes. International Journal of Mental Health and Addiction: 1‒14. doi:10.1007/s11469-016-9710-2. https://www.drugsandalcohol.ie/27072/

4    Level 1 registration refers to GPs trained in addiction treatment but not to an advanced level. Level 2 registration refers to GPs with advanced addiction specialist training.

3    Irish College of General Practitioners (2017) Irish family doctors support legalisation of cannabis for therapeutic use. Available online at http://www.icgp.ie/go/about/policies_statements/2017/51D12BC8-E89A-0F29-4D05611C1C784A5F.html

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