Ukaegbu Obioha, Smith Jared, Hall David, Frain Thomas, Abbasian Cyrus
East Wandsworth Community Mental Health Team, Springfield Hospital, South West London and St George's Mental Health NHS Trust, 61 Glenburnie Road, London, SW17 7DJ, UK.
Population Health Research Institute, St George's, University of London, Cranmer Terrace, Tooting, London, SW17 0RE, UK.
J Cannabis Res. 2021 Dec 15;3(1):51. doi: 10.1186/s42238-021-00104-x.
Cannabidiol (CBD) is now a legal substance in Europe and is available in 'high street shops', usually as CBD oil. However, in the United Kingdom (UK), there is no clear consensus among healthcare professionals and organisations over how to manage CBD use in their patients. This is an important issue as CBD is a constituent of 'medicinal and recreational cannabis' and is gaining support in the scientific literature and lay media for use in physical and mental health problems. Given the aforementioned, this study is an exploration of healthcare professionals' beliefs and attitudes with regard to CBD.
In July 2018, we sent requests by email to approximately 2000 clinical staff (including 319 physicians) at a mental health trust in South West London to answer 8 questions in a single survey using Surveyplanet.com , about their beliefs regarding CBD. There was no specific method of choosing the staff, and the aim was to get the email request sent to as many staff as possible on each service line. We did an analysis to see how the attitudes and beliefs of different staff member groups compared. We also gave them space to offer free text responses to illustrate their ideas and concerns. We used chi-squared tests for comparison across groups and used odds ratio for pairwise group comparisons.
One hundred ninety surveys were received in response, and of these, 180 were included in the final sample. The physician response rate was 17.2% (55/319); the response rate for non-physicians could not be estimated as their total number was not known at outset. 32.2% of the responders had the right to prescribe (58/180) and 52.8% had an experience of working in addiction services (95/180). We found that staff members who can prescribe were 1.99 times as likely to believe CBD has potential therapeutic properties compared to those who do not (OR = 1.99, CI = 1.03, 3.82; p = 0.038) and 2.94 times less likely to think it had dangerous side effects (OR = 0.34, CI = 0.15, 0.75; p = 0.006). Prescribing healthcare professionals were 2.3 times as likely to believe that CBD reduces the likelihood of psychosis (OR = 2.30, CI = 1.10, 4.78; p = 0.024). However, prescribing healthcare professionals with the ability to prescribe were 2.12 times as likely to believe that CBD should be prescription only (OR = 2.12, CI = 1.12, 4.01; p = 0.02). Individuals experienced in addiction services were 2.22 times as likely to be associated with a belief that CBD has therapeutic properties (OR = 2.22, CI = 1.22, 4.04; p = 0.009). Staff in general reported a lack of knowledge about CBD in their free text responses.
With almost 95% of prescribers being physicians, they appear to demonstrate awareness of potential therapeutic benefit, reduced likelihood of psychosis and seeming lack of dangerous side effects with CBD. However, their higher stringency about the need for prescription implies an attitude of caution. There was also a suggestion that biases about cannabis were influencing responses to questions as well. The external validity of this study could be diminished by sampling bias and limitation to a single mental health trust. Nonetheless, some of the results drew a reasonable comparison with similar studies.
大麻二酚（CBD）目前在欧洲是一种合法物质，在“商业街店铺”中可以买到，通常是以CBD油的形式。然而，在英国，医疗保健专业人员和组织对于如何管理患者使用CBD尚未达成明确共识。这是一个重要问题，因为CBD是“药用和娱乐用大麻”的一种成分，并且在科学文献和大众媒体中，其在身心健康问题上的应用正获得越来越多的支持。鉴于上述情况，本研究旨在探索医疗保健专业人员对CBD的看法和态度。
2018年7月，我们通过电子邮件向伦敦西南部一家心理健康信托机构的约2000名临床工作人员（包括319名医生）发送请求，让他们使用Surveyplanet.com在一项单一调查中回答8个问题，内容涉及他们对CBD的看法。选择工作人员没有特定方法，目的是将电子邮件请求发送到每个服务线上尽可能多的工作人员。我们进行了分析，以比较不同工作人员群体的态度和看法。我们还留出空间让他们提供自由文本回复，以阐明他们的想法和担忧。我们使用卡方检验进行组间比较，并使用优势比进行两两组比较。
共收到190份回复，其中180份被纳入最终样本。医生的回复率为17.2%（55/319）；非医生的回复率因一开始不知道其总数而无法估计。32.2%的回复者有权开处方（58/180），52.8%的回复者有在成瘾服务领域工作的经验（95/180）。我们发现，与无权开处方的人员相比，有权开处方的工作人员认为CBD具有潜在治疗特性的可能性高1.99倍（优势比=1.99，置信区间=1.03，3.82；p=0.038），认为其有危险副作用的可能性低2.94倍（优势比=0.34，置信区间=0.15，0.75；p=0.006）。开处方的医疗保健专业人员认为CBD降低精神病发生可能性的可能性高2.3倍（优势比=2.30，置信区间=1.10，4.78；p=0.024）。然而，有权开处方的医疗保健专业人员认为CBD应仅凭处方使用的可能性高2.12倍（优势比=2.12，置信区间=1.12，4.01；p=0.02）。有成瘾服务工作经验的人员认为CBD具有治疗特性的可能性高2.22倍（优势比=2.22，置信区间=1.22，4.04；p=0.009）。工作人员在自由文本回复中普遍表示对CBD缺乏了解。
由于近95%的开处方者是医生，他们似乎意识到了CBD潜在的治疗益处、降低精神病发生的可能性以及似乎不存在危险副作用。然而，他们对处方必要性的更高严格要求意味着一种谨慎的态度。还有迹象表明，对大麻的偏见也在影响对问题的回答。本研究的外部效度可能因抽样偏差和仅局限于一家心理健康信托机构而降低。尽管如此，一些结果与类似研究进行了合理比较。
