Attitudes and Knowledge of Australian Gastroenterologists Around the Use of Medicinal Cannabis for Inflammatory Bowel Disease

Melissa J Benson; Sarah V Abelev; Crispin J Corte; Susan J Connor; Iain S McGregor

doi:10.1093/crocol/otaa045

Attitudes and Knowledge of Australian Gastroenterologists Around the Use of Medicinal Cannabis for Inflammatory Bowel Disease

Crohns Colitis 360. 2020 Jun 8;2(2):otaa045. doi: 10.1093/crocol/otaa045. eCollection 2020 Apr.

Authors

Melissa J Benson^{1

2

3}, Sarah V Abelev^{1

2

3}, Crispin J Corte^{4

5}, Susan J Connor^{6

7

8}, Iain S McGregor^{1

2

3}

Affiliations

¹ Lambert Initiative for Cannabinoid Therapeutics, The University of Sydney, Sydney, NSW, Australia.
² Faculty of Science, School of Psychology, The University of Sydney, Sydney, NSW, Australia.
³ Brain and Mind Centre, The University of Sydney, Sydney, NSW, Australia.
⁴ Department of Gastroenterology, Royal Prince Alfred Hospital, Sydney, NSW, Australia.
⁵ Faculty of Medicine and Health, Central Clinical School, The University of Sydney, NSW, Australia.
⁶ Department of Gastroenterology, Liverpool Hospital, Sydney, NSW, Australia.
⁷ Ingham Institute of Applied Medical Research, Sydney, NSW, Australia.
⁸ The University of New South Wales, Sydney, NSW, Australia.

Abstract

Background: Medicinal cannabis (MC) is being used for symptomatic relief by many patients with inflammatory bowel disease (IBD), often independently of clinical guidance. Such use presents challenges for supporting clinicians. The aim of this study was to determine the current attitudes, knowledge, and experience of gastroenterologists toward patient use of MC for symptom management in IBD.

Methods: Australian gastroenterologists (n = 70) and trainees (n = 23) completed an anonymous, 30-item questionnaire, probing their knowledge, attitudes, and experience with MC in managing IBD. Survey data were collected between April and August 2019.

Results: Thirty-nine percent of survey respondents reported having patients using MC; however, only a minority supported use of MC in IBD (21%) or expressed a desire to prescribe (28%). Only 6% claimed good understanding of current patient access pathways and only 31% felt comfortable discussing MC with their patients. Some respondents (20%) cited adverse side effects as a reason for not wanting to prescribe, with driving impairment (64%) and impacts on the developing brain (56%) cited as significant concerns. Nonetheless, MC was ranked as less hazardous than corticosteroids, immunomodulators, and biologics by most respondents, and many (53%) were encouraging of patient participation in future clinical trials.

Conclusions: Specialist support for the use of MC in IBD patients is relatively low, potentially reflecting the lack of experience and knowledge with MC, uncertain evidence for efficacy, and the often-unorthodox nature of current MC use in patients. This situation may change rapidly with increased familiarity, evidence development, and education around MC prescribing.

Keywords: gastroenterology; inflammatory bowel diseases; medicinal cannabis; surveys and questionnaires.