Table 2:

Participant quotes supporting thematic analysis

Theme/subthemeRepresentative quote(s)
Reluctance to authorize medical cannabis
 Lack of evidenceI don’t think most of the results of studies are that strong, they’re not really well-designed studies for the most part … . (MC001)
… some studies show that it’s really effective and some studies show that it’s not very effective. I suspect we’ve reached the point where we’re probably a little too liberal for the conditions we prescribe it for. (MC009)
 Indications for therapeutic useIt’s an okay adjunct, but it wouldn’t be my first line for pain control at all. (MC002)
… it’s more of a second- or third-line treatment … certain patients will find it helpful. (MC004)
There’s very few things, if any, that I would go to medical cannabis as my first medication to treat. (MC008)
 Discomfort with therapeutic use of cannabisI’m not 100% comfortable prescribing it, I do feel it might be helpful for some conditions, but I’m just not sure of the entire process of how to go about prescribing it and monitoring its use. (MC001)
I don’t prescribe it at all, I usually refer it out to clinics who are specialized in that. (MC002)
I would be happy if it went away, in terms of [the] physician’s responsibility toward it. I do not want to be prescribing marijuana. (MC006)
 Openness to emerging evidenceI think you have to keep an open mind, and you have to be attuned to what your patients are telling you … if you’re not willing to listen to what patients are telling you about what they’re using, and you don’t present an unbiased front, then people aren’t going to tell you what they’re doing. (MC009)
I think that we need to make sure we are providing our patients with access to evidence-based treatment and addressing any financial barriers and any stigma that may exist around particular treatments. I think we need to be careful of that when we are thinking about prescribing medical marijuana. (MC011)
Harms associated with the use of cannabis
 Effect on neurocognitive developmentThere is so much research saying that the brain is still changing and the reality is we don’t know what happens to kids’ brains when they take marijuana at the age of 15. And you know, I have so many patients who are young, who are like, “oh well now that is legalized for the age of 18, [and] I’m 14 and I’m so close, I’m sure it is fine.” And I think the fact that legalization, especially at such a young age, gives the message to a lot of people that it’s safe. (MC010)
 Harms for older adultsMaybe sort of looking at long-term effects on older people. All the medications we prescribe, there are certain geriatric populations that take various medications so I just want to know if there’s anything in particular or things to watch for. (MC002)
What is the effect of adding a cannabis product into a geriatric population that tends to be already medically more complex and already on lots of other medications and have multiple comorbidities? So, what impact does that have potentially, on their quality of life, ability to continue to drive a car, ability to continue to take care of themselves, and maybe dependence issues. (MC009)
 Exacerbation of mental illnessOur patients have mental health issues, ranging from depression to anxiety to schizophrenia, and you know, you worry about harms for people especially for people who have [mental] illnesses. (MC006)
So some of the [symptoms] I’ve noticed so far have been an increase in anxiety, difficulty with sleep, even cases of potential psychosis. (MC007)
 Concerns regarding cannabis clinicsCannabis clinics are fairly easy to access for most of these [patients]. (MC004)
I would, for the most part, send patients to marijuana [clinics]; there are a couple in Hamilton. Everyone wound up getting it. Most people that did had addiction issues and mental health issues. (MC006)
I’ve had patients who’ve come in and were prescribed medical cannabis and I would be like “oh you are so young, did the people go through the risks with you?” and they were like “no not really” and so I think that concerns me because it seems like even depending on which cannabis clinic certain people are referred to, they are not necessarily being presented with both the pros and the cons. (MC010)
Lack of knowledge surrounding medical cannabis
 Inadequate trainingI’d say my knowledge of [medical cannabis] is pretty average … average enough to know that I would refer someone else to [authorize] medical cannabis if I thought it would help. And also enough to say that it won’t help with your kind of pain or your set of conditions. So, I would know enough about that, but in terms of dosing and things like that I am not as comfortable, but it’s not something I sought to really train in. (MC002)
I went to medical school 35 years ago, there was zero training about cannabis and anything I learned about cannabis has been through continuing education that consists of online courses and information, position statements and summaries, sessions at conferences... So, the training has been whatever I chose to participate in, there’s nothing required of me. (MC005)
We did have some lectures from physicians in residency, [and] we also read a few articles during that time as well. I definitely don’t know all of the up-to-date research that’s ongoing in marijuana, it’s just the things that I’m coming across. (MC007)
 Continuing educationI just don’t know what the regulations are in terms of how that’s monitored, so my [further] education would hopefully help me figure out where I can direct patients to, sort of more, reputable sources of marijuana once it’s been prescribed. (MC002)
Something that comes out from time to time, that would actually be very helpful to get updates about what’s [new] with medical cannabis. (MC007)
 Physician’s role regarding cannabis[Regarding medical cannabis], it is still not a prescription. A prescription includes the name of a substance, exactly what is in it, it includes a dosage, frequency, and duration. And it is dispensed by a pharmacist. None of those criteria are being fulfilled by cannabis. I am a little bit lost right now about what my form actually does for anyone. I think anyone and his dog can walk into a drug store and get whatever they want without approval from a physician. (MC004)
Pretending that marijuana/cannabis is a prescription has been a joke … There is nothing about dosing or actual content; the traditional approach to making cannabis accessible really has just been to say this person has a medical condition and I believe this person may benefit from medical cannabis … Right now, it’s very confusing why I have any role in making cannabis accessible to anyone. Whatever I write or say on a form does not decrease the cost of it. It does not make it funded, and it still does not provide any instructions that have to be followed … I would love to see [the] medical profession removed from the transaction completely and to make [cannabis] more like alcohol. (MC005)
 Recreational v. medicinal cannabisI’m not sure how [recreational] products are regulated and if they know how much THC or CBD is in it, so I am not sure if [using recreational cannabis for therapeutic purposes] would be a good idea. (MC003)
I think it’s still helpful … being prescribed medical cannabis because a lot of people are not sure what’s the best time to take it for medical reasons. I still think there’s a role for medical cannabis even if recreational cannabis is approved for use now. (MC004)
  • Note: CBD = cannabidiol, THC = tetrahydrocannabinol.