Introduction: Acute and chronic pain are frequently managed by urologists with the goal of providing effective, cost-efficient, and non-addictive means of care. Non-steroidal anti-inflammatories (NSAIDs), acetaminophen, and opioids are the key agents utilized in managing acute post-procedural and chronic pain. However, medical marijuana (MM) is another agent in our armamentarium and can be an effective alternative to opioids. MM is legalized for use in cancer, multiple sclerosis, spasticity, and pain in 36 states in the USA, including New York (NY).
Methods: An anonymous questionnaire on MM (QAMM) was designed based on small group interviews to assess the attitudes, barriers, and fund of knowledge regarding MM. After IRB approval, the questionnaire was distributed via email to approximately 150 healthcare workers at an academic healthcare system in NY.
Results: 78 subjects (63% women) responded to the QAMM; 32 surgeons or physicians, 8 registered nurses, nurse practitioners, or physician's assistants, 20 administrative staff, 7 research staff, and 11 others. Nearly all responders (96%) would consider MM after failure of primary treatment but only half would consider MM as initial treatment (p < 0.01). More responders felt favorable or neutral about the use of MM for chronic (99%) compared to acute pain (81%) (p=0.05). Nearly a third of responders indicated a personal (29.5%) or family (33.3%) history of opioid abuse as factors that would negatively affect their comfort with MM. Main barriers to the use of MM were identified as inadequate education (35%), the potential for abuse (23%), lack of randomized clinical trials (19%), and negative perception among peers (16%). Most responders reported unfamiliarity with the therapeutic potentials and side effects of MM and only 60% were aware that MM was legal in NY. A history of alcohol or drug abuse among family and friends was reported in 40% of responders. None of the questions were considered intrusive. Post-study small group discussions identified a future need to inquire about the attitudes toward cannabinoid use in the next QAMM.
Conclusions: Our pilot project showed a higher than expected response rate among members of the healthcare system. There is a clear need for further education of prescribers, staff, and researchers about the potential role of MM in modern medicine. Both translational and clinical research are urgently needed to offer alternatives to opioids and reduce the prevalence of substance abuse. National deployment of an improved QAMM will be performed once funding is secured.
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.jpg "Leah Beland, MD photo")