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Neurology Today Conference Reporter: AES Annual Meeting

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Thursday, December 6, 2018

Survey Finds Gaps in Training Among Health Care Providers in Cannabidiol Prescribing

BY THOMAS R. COLLINS

NEW ORLEANS—Medical providers including neurologists, pharmacists, and nurses are willing to prescribe cannabidiol (CBD) products but feel they lack adequate knowledge and training to do so, according to national survey findings presented here at the American Epilepsy Society annual meeting.

As CBD products become more widely available, the survey results point to training deficits that will need to be addressed for epilepsy patients to fully benefit from the products, according to researchers who conducted the survey for Greenwich Biosciences, a subsidiary of GW Pharmaceuticals, which manufactures the CBD product approved by the US Food and Drug Administration in June.

Magdalena Szaflarski, PhD, associate professor of sociology at the University of Alabama, who presented the findings, said that the results are not too surprising, given that CBD products have not been legal until recently and that laws on most products still vary by state.

"That's why we're seeing this gap between the willingness to prescribe it and their actually doing it," she said. "Providers do not have enough knowledge yet. Researchers don't even have enough knowledge about many of the cannabis-based therapies to be confident about prescribing it to patients. So there's a lot to be done."

A total of 451 health professionals — evenly divided among neurologists, pharmacists, and nurses and nurse practitioners — responded to the survey across the US. Forty percent of the respondents worked in community settings and a quarter in academic settings, and their responses typically didn't differ according to setting, researchers said.

Answers to questions on beliefs and attitudes reflected an openness to CBD products. More than 80 percent said they somewhat agree, agree, or strongly agree with the statement, "I believe that CBD is effective in reducing seizure frequency." Nearly 90 percent of the neurologists said they somewhat agree, agree, or strongly agree with the statement, "If legalized, I would be comfortable prescribing the FDA approved and regulated version of CBD for treatment of epilepsy."

Only about 60 percent of respondents said they felt they had enough knowledge to prescribe CBD products, and approximately 80 percent said they needed more education about CBD treatment for epilepsy.

On questions gauging knowledge — among neurologists, pharmacists, and nurses (which included nurse practitioners) — 75 percent, 81 percent and 67 percent, respectively, correctly answered whether cannabis is legal (it's not). But only 38 percent, 59 percent, and 46 percent, respectively correctly answered whether hemp is legal (it is).

"We were particularly surprised that among neurologists there was this larger gap," Dr. Szaflarski said. "Neurologists seemed to know more than the other two provider groups, but still the gaps were pretty large, considering all the development on this issue in the last two years, within neurology and also specifically in epilepsy."

Dr. Szaflarski said there appears to be more willingness to prescribe CBD products than was seen in previous surveys. "What these new results show," she said, is "that more and more providers are coming on board and accepting these therapies, and many think that they're helpful and they would be willing to use them in their practice."

Joseph I. Sirven, MD, FAAN, professor of neurology at Mayo Clinic in Phoenix, AZ, said the findings demonstrate the confusion that surrounds CBD use.

"I believe there is such stigma surrounding the medication from its connection to marijuana — that we know so little and the laws seem so dynamic — that no one can keep up with the regulations," he said. "In the US, each state has its own laws and then there is a federal law with so many conflicting answers, it's hard to know what is correct. Even with the good news of this version of CBD being approved, there is still considerable confusion between this product and products available in dispensaries."

Greenwich Biosciences, Inc. funded the study. Dr. Szaflarski received consulting fees and research support from GW Pharmaceuticals, Inc. and Greenwich Biosciences, Inc. Dr. Sirven reported no disclosures.

LINK UP FOR RELATED INFORMATION

AES Abstract 3.469: Szaflarski M, McGoldrick P, Currens L, et al. Cannabinoid knowledge and attitudes among US healthcare providers.