Mandatory pharmacist-led education session for patients seeking medical cannabis

Keywords: Patient Education as Topic, Educational Measurement, Medical Marijuana, Cannabis, Chronic Pain, Patient Preference, Pharmacists, Surveys and Questionnaires, Canada

Abstract

Objective: The primary objectives of this pre-post session study, was to evaluate the impact of a pharmacist-led education session on the perceived benefits and safety of cannabis among patients with chronic pain, as well as determine the influence of pharmacist education on the selection of safer cannabis products and dosage forms for medical use among patients.

Methods: A retrospective analysis of completed pre-post session questionnaires was conducted among chronic pain patients attending a mandatory education session led by a pharmacist, prior to being authorized cannabis in clinic. All questionnaire data was analyzed using SPSS v. 25. Demographic and sample characteristics were reviewed using univariate analyses. Chi-Square tests were employed to determine if the group-based education significantly affected knowledge, perception of efficacy and safety of cannabis.

Results: Of the 260 session participants, 203 completed pre-post session questionnaires. After the session, a majority of current cannabis users (33.8%) and cannabis naïve/past users (56.9%) reported they would use a low THC product in the future, and a majority of current users (54.5%) would use a high CBD product in the future. After education, participants were more likely to report cannabis as having the potential for addiction (chi-square =42.6, p <0.0001) and harm (chi-square =34.0, p <0.0001).

Conclusions: Pharmacist counselling and education has the potential to influence patient selection and use of cannabis, from more harmful to safer products, as well as moderate the potential perceived benefits of use.

Downloads

Download data is not yet available.

References

Hill KP, George TP. Cannabis legalisation in Canada: a crucial trial balloon. Lancet Psychiatry. 2019;6(1):5-6. https://doi.org/10.1016/s2215-0366(18)30460-7

Cox C. The Canadian Cannabis Act legalizes and regulates recreational cannabis use in 2018. Health Policy. 2018;122(3):205-209. https://doi.org/10.1016/j.healthpol.2018.01.009

Statistics Canada. Data on cannabis for medical purposes. Available at: https://www.canada.ca/en/health-canada/services/drugs-medication/cannabis/research-data/medical-purpose.html (accessed Jun 2, 2020).

Canadian Pharmacists Association. Available at: Pharmacists disappointed with proposed cannabis regulations, concerned with impact to medical cannabis patients. https://www.pharmacists.ca/news-events/news/pharmacists-disappointed-with-proposed-cannabis-regulations-concerned-with-impact-to-medical-cannabis-patients/ (accessed Jun 2, 2020).

Minister of Justice. Cannabis Act (S.C. 2018, c. 16). Available at: https://laws-lois.justice.gc.ca/eng/acts/c-24.5/ (accessed Jun 2, 2020).

Fearon J. Reasonable Doubt: the history of marijuana law in Canada. Now Magazine. Available at: https://nowtoronto.com/news/history-of-marijuana-law-in-canada-from-opium-dens-to-shoppe/ (accessed Jun 2, 2020).

Minister of Justice. Marihuana for medical purposes regulations, SOR/2013-119. Available at: https://laws-lois.justice.gc.ca/eng/regulations/sor-2013-119/20130607/P1TT3xt3.html (accessed Jun 2, 2020).

Balneaves LG, Alraja A, Ziemianski D, McCuaig F, Ware M. A National Needs Assessment of Canadian Nurse Practitioners Regarding Cannabis for Therapeutic Purposes. Cannabis Cannabinoid Res. 2018;3(1):66-73. https://doi.org/10.1089/can.2018.0002

Minister of Justice. Access to cannabis for medical purposes regulations. Available at: https://laws.justice.gc.ca/eng/regulations/sor-2016-230/20160805/P1TT3xt3.html (accessed Jun 2, 2020).

Health Canada. Medical document supporting the use of cannabis for medical purposes under the cannabis regulations. Available at: https://www.canada.ca/content/dam/hc-sc/migration/hc-sc/dhp-mps/alt_formats/pdf/marihuana/info/Medical-Document-EN.pdf (accessed Jun 2, 2020).

Lough S. Private cannabis clinics offer clients access. CMAJ. 2015;187(12):865-866. https://doi.org/10.1503/cmaj.109-5119

Grewal JK, Loh LC. Health considerations of the legalization of cannabis edibles. CMAJ. 2020;192(1):E1-E2. https://doi.org/10.1503/cmaj.191217

Mudan A, DeRoos F, Perrone J. Medical Marijuana Miscalculation. N Engl J Med. 2019;381(11):1086-1087. https://doi.org/10.1056/nejmc1907013

Institute of Safe Medical Practices. Labeling problems have led to errors. https://www.ismp.org/news/ismp-warns-medical-marijuana-product-labeling-problems-have-led-errors (accessed Jun 22, 2020).

Ward KE, Cohen LB. Promoting Safe Use of Medications: Providing Medication Education to Seniors Receiving Meals on Wheels. Consult Pharm. 2015;30(10):616-622. https://doi.org/10.4140/tcp.n.2015.616

El-Ibiary SY, Raney EC, Moos MK. The pharmacist's role in promoting preconception health. J Am Pharm Assoc (2003). 2014;54(5):e288-e303. https://doi.org/10.1331/japha.2014.14536

Koren DE, Zuckerman A, Teply R, Nabulsi NA, Lee TA, Martin MT. Expanding Hepatitis C Virus Care and Cure: National Experience Using a Clinical Pharmacist-Driven Model. Open Forum Infect Dis. 2019;6(7):ofz316. https://doi.org/10.1093/ofid/ofz316

Hyoguchi N, Kobayashi D, Kubota T, Shimazoe T. Effects on Deaf Patients of Medication Education by Pharmacists. J Deaf Stud Deaf Educ. 2016;21(4):416-421. https://doi.org/10.1093/deafed/enw037

Dunn SP, Birtcher KK, Beavers CJ, et al. The role of the clinical pharmacist in the care of patients with cardiovascular disease. J Am Coll Cardiol. 2015;66(19):2129-2139. https://doi.org/10.1016/j.jacc.2015.09.025

Dattani S, Mohr H. Pharmacists' role in cannabis dispensing and counselling. Can Pharm J (Ott). 2018;152(1):14-15. https://doi.org/10.1177/1715163518813314

Opitz BJ, Ostroff ML, Whitman AC. The Potential Clinical Implications and Importance of Drug Interactions Between Anticancer Agents and Cannabidiol in Patients With Cancer. J Pharm Pract. 2020;33(4):506-512. https://doi.org/10.1177/0897190019828920

Seamon MJ, Fass JA, Maniscalco-Feichtl M, Abu-Shraie NA. Medical marijuana and the developing role of the pharmacist. Am J Health Syst Pharm. 2007;64(10):1037-1044. https://doi.org/10.2146/ajhp060471

Parmar JR, Forrest BD, Freeman RA. Medical marijuana patient counseling points for health care professionals based on trends in the medical uses, efficacy, and adverse effects of cannabis-based pharmaceutical drugs. Res Social Adm Pharm. 2016;12(4):638-654. https://doi.org/10.1016/j.sapharm.2015.09.002

Canadian Institutes of Health Research; Natural Sciences and Engineering Research Council of Canada; Social Sciences and Humanities Research Council. Tri-council policy statement: ethical conduct for research involving humans. Available at: https://ethics.gc.ca/eng/policy-politique_tcps2-eptc2_2018.html (accessed May 11, 2020).

Ravi D, Ghasemiesfe M, Korenstein D, Cascino T, Keyhani S. Associations Between Marijuana Use and Cardiovascular Risk Factors and Outcomes: A Systematic Review. Ann Intern Med. 2018;168(3):187-194. https://doi.org/10.7326/m17-1548

Richards JR. Cannabinoid Hyperemesis Syndrome: Pathophysiology and Treatment in the Emergency Department. J Emerg Med. 2018;54(3):354-363. https://doi.org/10.1016/j.jemermed.2017.12.010

Zehra A, Burns J, Liu CK, Manza P, Wiers CE, Volkow ND, Wang GJ. Cannabis Addiction and the Brain: a Review. J Neuroimmune Pharmacol. 2018;13(4):438-452. https://doi.org/10.1007/s11481-018-9782-9

Hines LA, Freeman TP, Gage SH, Zammit S, Hickman M, Cannon M, Munafo M, MacLeod J, Heron J. Association of High-Potency Cannabis Use With Mental Health and Substance Use in Adolescence. JAMA Psychiatry. 2020;77(10):1044-1051. https://doi.org/10.1001/jamapsychiatry.2020.1035

Bhattacharyya S, Morrison PD, Fusar-Poli P, Martin-Santos R, Borgwardt S, Winton-Brown T, Nosarti C, O' Carroll CM, Seal M, Allen P, Mehta MA, Stone JM, Tunstall N, Giampietro V, Kapur S, Murray RM, Zuardi AW, Crippa JA, Atakan Z, McGuire PK. Opposite effects of delta-9-tetrahydrocannabinol and cannabidiol on human brain function and psychopathology. Neuropsychopharmacology. 2010;35(3):764-774. https://doi.org/10.1038/npp.2009.184

Carlini EA, Cunha JM. Hypnotic and antiepileptic effects of cannabidiol. J Clin Pharmacol. 1981;21(S1):417S-427S. https://doi.org/10.1002/j.1552-4604.1981.tb02622.x

Broyd SJ, van Hell HH, Beale C, Yücel M, Solowij N. Acute and Chronic Effects of Cannabinoids on Human Cognition-A Systematic Review. Biol Psychiatry. 2016;79(7):557-567. https://doi.org/10.1016/j.biopsych.2015.12.002

Russo EB. Taming THC: potential cannabis synergy and phytocannabinoid-terpenoid entourage effects. Br J Pharmacol. 2011;163(7):1344-1364. https://doi.org/10.1111/j.1476-5381.2011.01238.x

Crippa JA, Derenusson GN, Ferrari TB, Wichert-Ana L, Duran FL, Martin-Santos R, Simões MV, Bhattacharyya S, Fusar-Poli P, Atakan Z, Santos Filho A, Freitas-Ferrari MC, McGuire PK, Zuardi AW, Busatto GF, Hallak JE. Neural basis of anxiolytic effects of cannabidiol (CBD) in generalized social anxiety disorder: a preliminary report. J Psychopharmacol. 2011;25(1):121-130. https://doi.org/10.1177/0269881110379283

Naftali T, Mechulam R, Marii A, Gabay G, Stein A, Bronshtain M, Laish I, Benjaminov F, Konikoff FM. Low-Dose Cannabidiol Is Safe but Not Effective in the Treatment for Crohn's Disease, a Randomized Controlled Trial. Dig Dis Sci. 2017;62(6):1615-1620. https://doi.org/10.1007/s10620-017-4540-z

Zuardi AW, Crippa JA, Hallak JE, et al. Cannabidiol for the treatment of psychosis in Parkinson's disease. J Psychopharmacol. 2009;23(8):979-983. https://doi.org/10.1177/0269881108096519

Russo EB. Cannabidiol Claims and Misconceptions [published correction appears in Trends Pharmacol Sci. 2017 May;38(5):499]. Trends Pharmacol Sci. 2017;38(3):198-201. https://doi.org/10.1016/j.tips.2016.12.004

Wu TC, Tashkin DP, Djahed B, Rose JE. Pulmonary hazards of smoking marijuana as compared with tobacco. N Engl J Med. 1988;318(6):347-351. https://doi.org/10.1056/nejm198802113180603

Joshi M, Joshi A, Bartter T. Marijuana and lung diseases. Curr Opin Pulm Med. 2014;20(2):173-179. https://doi.org/10.1097/mcp.0000000000000026

Kempker JA, Honig EG, Martin GS. The effects of marijuana exposure on expiratory airflow. A study of adults who participated in the U.S. National Health and Nutrition Examination Study. Ann Am Thorac Soc. 2015;12(2):135-141. https://doi.org/10.1513/annalsats.201407-333oc

Zhang LR, Morgenstern H, Greenland S, Chang SC, Lazarus P, Teare MD, Woll PJ, Orlow I, Cox B; Cannabis and Respiratory Disease Research Group of New Zealand, Brhane Y, Liu G, Hung RJ. Cannabis smoking and lung cancer risk: Pooled analysis in the International Lung Cancer Consortium. Int J Cancer. 2015;136(4):894-903. https://doi.org/10.1002/ijc.29036

Grotenhermen F. Pharmacokinetics and pharmacodynamics of cannabinoids. Clin Pharmacokinet. 2003;42(4):327-360. https://doi.org/10.2165/00003088-200342040-00003

Hunault CC, van Eijkeren JC, Mensinga TT, de Vries I, Leenders ME, Meulenbelt J. Disposition of smoked cannabis with high Δ(9)-tetrahydrocannabinol content: a kinetic model. Toxicol Appl Pharmacol. 2010;246(3):148-153. https://doi.org/10.1016/j.taap.2010.04.019

Vandrey R, Herrmann ES, Mitchell JM, Bigelow GE, Flegel R, LoDico C, Cone EJ. Pharmacokinetic Profile of Oral Cannabis in Humans: Blood and Oral Fluid Disposition and Relation to Pharmacodynamic Outcomes. J Anal Toxicol. 2017;41(2):83-99. https://doi.org/10.1093/jat/bkx012

Hartman RL, Brown TL, Milavetz G, Spurgin A, Gorelick DA, Gaffney G, Huestis MA. Controlled Cannabis Vaporizer Administration: Blood and Plasma Cannabinoids with and without Alcohol. Clin Chem. 2015;61(6):850-869. https://doi.org/10.1373/clinchem.2015.238287

Heckman CJ, Egleston BL, Hofmann MT. Efficacy of motivational interviewing for smoking cessation: a systematic review and meta-analysis. Tob Control. 2010;19(5):410-416. https://doi.org/10.1136/tc.2009.033175

Blevins CE, Walker DD, Stephens RS, Banes KE, Roffman RA. Changing social norms: The impact of normative feedback included in motivational enhancement therapy on cannabis outcomes among heavy-using adolescents. Addict Behav. 2018;76:270-274. https://doi.org/10.1016/j.addbeh.2017.08.030

Kolodny A, Courtwright DT, Hwang CS, Kreiner P, Eadie JL, Clark TW, Alexander GC.The prescription opioid and heroin crisis: a public health approach to an epidemic of addiction. Annu Rev Public Health. 2015;36:559-574. https://doi.org/10.1146/annurev-publhealth-031914-122957

Lucas P. Rationale for cannabis-based interventions in the opioid overdose crisis. Harm Reduct J. 2017;14(1):58. https://doi.org/10.1186/s12954-017-0183-9

Vyas MB, LeBaron VT, Gilson AM. The use of cannabis in response to the opioid crisis: A review of the literature. Nurs Outlook. 2018;66(1):56-65. https://doi.org/10.1016/j.outlook.2017.08.012

Piper BJ, DeKeuster RM, Beals ML, Cobb CM, Burchman CA, Perkinson L, Lynn ST, Nichols SD, Abess AT. Substitution of medical cannabis for pharmaceutical agents for pain, anxiety, and sleep. J Psychopharmacol. 2017;31(5):569-575. https://doi.org/10.1177/0269881117699616

Fitzcharles MA, Shir Y, Häuser W. Medical cannabis: strengthening evidence in the face of hype and public pressure. CMAJ. 2019;191(33):E907-E908. https://doi.org/10.1503/cmaj.190509

Zvonarev V, Fatuki TA, Tregubenko P. The Public Health Concerns of Marijuana Legalization: An Overview of Current Trends. Cureus. 2019;11(9):e5806. https://doi.org/10.7759/cureus.5806

Hawley P, Gobbo M, Afghari N. The impact of legalization of access to recreational Cannabis on Canadian medical users with Cancer. BMC Health Serv Res. 2020;20(1):977. https://doi.org/10.1186/s12913-020-05756-8

Walus AN, Woloschuk DMM. Impact of Pharmacists in a Community-Based Home Care Service: A Pilot Program. Can J Hosp Pharm. 2017;70(6):435-442. https://doi.org/10.4212/cjhp.v70i6.1718

Goldstone LW, Saldaña SN, Werremeyer A. Pharmacist provision of patient medication education groups. Am J Health Syst Pharm. 2015;72(6):487-492. https://doi.org/10.2146/ajhp140182

Kritikos V, Armour CL, Bosnic-Anticevich SZ. Interactive small-group asthma education in the community pharmacy setting: a pilot study. J Asthma. 2007;44(1):57-64. https://doi.org/10.1080/02770900601125755

Sarkadi A, Rosenqvist U. Experience-based group education in Type 2 diabetes: a randomised controlled trial. Patient Educ Couns. 2004;53(3):291-298. https://doi.org/10.1016/j.pec.2003.10.009

Sarkadi A, Vég A, Rosenqvist U. The influence of participant's self-perceived role on metabolic outcomes in a diabetes group education program. Patient Educ Couns. 2005;58(2):137-145. https://doi.org/10.1016/j.pec.2004.08.002

Published
2020-11-29
How to Cite
1.
Parihar V, Katz L, Siyam MA, Rogers A, Patterson L, Zacharias R. Mandatory pharmacist-led education session for patients seeking medical cannabis. Pharm Pract (Granada) [Internet]. 2020Nov.29 [cited 2021Jan.24];18(4):2088. Available from: https://pharmacypractice.org/journal/index.php/pp/article/view/2088
Section
Original Research