A new survey suggests that almost half of all oncologists recommend medical marijuana clinically, but less than 30% actually feel equipped with enough knowledge to make such recommendations.
Researchers at the Dana-Farber Cancer Institute (DFCI) surveyed oncologists from across the United States in order to examine their attitudes, knowledge, and practices regarding the use of medical marijuana in a clinical setting. Medical marijuana largely refers to whole-plant marijuana, which can contain hundreds of active compounds with complex synergistic interactions, rather than pharmaceutical cannabis, which refers to isolated cannabis compounds such as CBD or other cannabinoids.
Cannabinoid pharmaceuticals, which are available with a prescription, have been the object of considerable research. The same cannot be said about medical marijuana, however, whose medical utility in cancer and other diseases is still understudied. At the same time, medical marijuana is legal in over half of the states in the country, with cancer being one of the main conditions under which cannabis can be prescribed.
This discrepancy between evidence of marijuana's viability in oncology and its wide dispensation around the country seems to be mirrored by specialists as well. According to Ilana Braun and colleagues at DFCI's Division of Adult Psychosocial Oncology, 80% of the oncologists they surveyed discussed medical marijuana with patients and nearly half recommended the use of the agent clinically, despite the fact that less than 30% of all respondents actually consider themselves knowledgeable enough to make such recommendations.
There are very few other instances where a doctor would offer clinical advice about a topic on which the specialist is not knowledgeable enough. So what's going on? Although the survey wasn't designed to investigate the rationale behind the oncologists' answers, researchers believe an almost unique climate of marijuana prevalence may be responsible for the results. "Non-medical variables affect how oncologists approach medical marijuana: these include region of practice, practice setting, and the volume of patients they see," Braun said.
"Unfortunately, our survey wasn’t designed to drill down into the rationale behind oncologists’ decision-making regarding medical marijuana. For that, future surveys are clearly in order! Our survey did yield a few clues though. For instance: when asked about the comparative risks of medical marijuana and opioid pain medication, 75% of the oncologists we surveyed believed that medical marijuana was safer than opioids with regard to overdose risks, and 52% believed it to be safer than opioids with regard to risk for addiction," Braun told ZME Science.
"I think the results of this survey invite comparative effectiveness trials comparing medical marijuana to standard of care for certain cancer-related symptoms; also, research into how best to inform oncologists about this salient topic," she added.
The relatively large gap between the physicians' knowledge on the topic and their recommendations shows there is a lot of room for improvement when it comes to medical marijuana. This does not mean that medical marijuana might not work for some patients suffering from cancer; it's just that many doctors around the country, according to this survey, seem to be making decisions based on limited studies that are either small or poorly designed. To date, there has been no randomized clinical trial that examines whole-plant medical marijuana's effects in cancer patients.