Both nationally and internationally there is ongoing debate about the medical use of cannabis for a range of conditions. The attitudes to medicinal cannabis of a sample of Irish patients experiencing chronic pain are the subject of a new study.1 In a 2017 review on the topic by the Health Products Regulatory Authority (HPRA), the medical use of cannabis is defined as ‘a situation where a doctor prescribes or recommends the use of cannabis for treatment of a medical condition in a patient under his/her care’ (p. 9).2 The review found three medical conditions for which there was ‘some scientific evidence to support the use of cannabis or cannabinoids as a medical treatment in patients who have failed available treatments’ (p. 16).2

These were spasticity associated with multiple sclerosis; intractable nausea and vomiting associated with chemotherapy; and severe, refractory (treatment-resistant) epilepsy. Based on these findings, the Minister for Health established an access programme for cannabis-based treatments for people with any of the three approved medical conditions. However, the review found insufficient evidence to support the use of medicinal cannabis for other conditions, including chronic pain.3 Therefore, patients experiencing chronic pain fall outside the access criteria for the access programme. It is within this context that Rochford et al. carried out their study.1

Methods

The aim of the study was to explore the attitudes of patients experiencing chronic pain towards medicinal cannabis. The research team used a questionnaire that gathered basic sociodemographic information, had 12 statements on the topic, and used a five-point Likert scale to assess the extent to which they agreed with each statement.4 Data were collected from patients attending chronic pain clinics in University Hospital Limerick. While 96 surveys were completed, the overall response rate is not reported. Therefore, while the authors generalise their findings to ‘Irish patients experiencing chronic pain’, it is unclear whether the sample is representative of this population.

Findings

Descriptive analysis was carried out on the data. The key findings were as follows.

Cannabis use

• 22.92% had tried cannabis before.
• 68.75% would try cannabis if it were prescribed for them. 

Legal status of cannabis

• 86.46% agreed that cannabis should be legalised for medicinal purposes, and 88.54% agreed that it should be legalised for chronic pain. If legalised, 87.5% agreed that it should only be available through a consultant’s prescription.
• A more general statement about the legal status of cannabis suggests that there is not as much support for a change in the law when it comes to the broader use of cannabis. Some 58.33% agreed that ‘the criminal status of cannabis should be abolished’. However, this statement is unclear as to whether it refers to the decriminalisation of the use of cannabis or the legalisation of cannabis itself. 

Perceived health benefits

• 80.21% agreed with the broad statement ‘cannabis has health benefits when used appropriately’.

Social acceptability of cannabis

• 73.96% agreed that it would be socially acceptable to use cannabis for medicinal purposes.

Safety of cannabis

• 43.75% agreed with the statement that cannabis was a safe drug, with 42.71% responding ‘neutral’.
• 51.04% agreed with the statement ‘cannabis is safer than morphine’, with 43.75% responding ‘neutral’.
• 33.33% agreed that cannabis was addictive, with 43.75% responding ‘neutral’. 

In their discussion on the findings, the authors argue that while their study suggests that patients are in favour of the use of medicinal cannabis and that a majority believe it has health benefits, this is contrary to that found in studies of physicians. To support this, they cite a study of physicians from Colorado, USA that showed ‘the opposite with a lack of support for medicinal cannabis and only a minority believing it confers a health benefit’.5

However, they do not refer to the findings of a study of Irish GPs’ attitudes to cannabis, which found that 58.6% agreed that ‘cannabis should be legalised for medical use’ and that 63.5% agreed that ‘cannabis has a role to play in pain management’.6 The authors conclude by saying that it is their opinion that patients with chronic pain should be included in the Government’s access programme for medicinal cannabis.

1 Rochford C, Edgeworth D, Hashim M and Harmon D (2018) Attitudes of Irish patients with chronic pain towards medicinal cannabis, Ir J Med Sci. [Early online] https://www.drugsandalcohol.ie/28551/

2 Health Products Regulatory Authority (2017) Cannabis for medical use: a scientific review. Dublin: Department of Health. http://www.drugsandalcohol.ie/26784/

3 Dillon L (2017) Cannabis for medical use: a scientific review, Drugnet Ireland, 62: 9–10. https://www.drugsandalcohol.ie/27735/.

4 The choices given were strongly disagree, disagree, neutral, agree, and strongly agree.

5 Kondrad E and Reid A (2013) Colorado family physicians’ attitudes toward medical marijuana, J Am Board Fam Med, 26(1): 52–60.

6 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 Reduct J, 14(1): https://www.drugsandalcohol.ie/26675/