CF Survey: Educational Info About Cannabis, CBD Lacking

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Assessment, documentation, and education regarding cannabis and cannabidiol (CBD) use among cystic fibrosis (CF) patients varies across centers in the U.S., according to a survey of nearly 300 CF healthcare providers.

This variability may be related partially to the different laws between U.S. states regarding these controversial substances, the researchers noted.

The data also highlighted the need for more educational materials about cannabis-based products and CF to allow care teams to have knowledgeable conversations with patients.

These findings suggest that development of evidence-based and peer-reviewed educational materials about cannabis/CBD and CF should be among future CF care team initiatives, the researchers added.

CBD, the major non-psychoactive component in the cannabis plant, is suggested to have anti-inflammatory, immunomodulatory, antioxidant, and neuroprotective properties. As such, cannabidiol has gained increasing interest as a potential treatment for several health conditions.

However, the role of cannabis and CBD in healthcare “remains relatively controversial with complicated legal statuses and lack of safety and efficacy data in specific chronic diseases, such as cystic fibrosis,” the researchers wrote.

Still, due to their increasing availability and commercialization, people living with CF may use these products for easing many CF symptoms, such as appetite, pain, or mental health concerns.

Notably, while smoked, inhaled, or vaporized cannabis is likely the most readily available and inexpensive, these forms of consumption are not recommended in this patient population, due to their potential to cause even further lung damage.

Currently, only three U.S. states maintain illegal status to all forms of cannabis, with others having legalized the use of cannabis/cannabis-based products for medical and/or recreational purposes. In addition, the U.S. Food and Drug Administration approved the first CBD-based treatment in 2018 for two resistant seizure-related rare conditions.

“As research interest in cannabis and its chemical components continues to advance and as accessibility of cannabis and CBD widens, it is prudent to include CF in the conversation,” the scientists wrote.

A team in the U.S. now evaluated whether CF healthcare providers in the country are assessing and documenting cannabis use among their patients, and whether — and why — they prescribe it, or would prescribe it if were legal in their state.

An online, anonymous survey was distributed by the CF Foundation to 627 CF directors and coordinators and to the foundations’ listservs of nurse, pharmacist, dietitian, social worker, and psychology care team members.

The survey included 31 multiple choice, scaled, and open-ended items, which assessed awareness of current state laws, screening and documentation practices, prescribing practices for medical marijuana, knowledge of which indications cannabis and CBD could be beneficial, and the perceived need for educational materials.

A total of 282 healthcare professionals, representing all U.S. regions and working with children and adults with CF, responded to the survey. Most were social workers (29%) and physicians/advanced practice providers (28%).

More than half the respondents reported it was legal in their state to use cannabis (59.5%) and CBD (55.6%) for medical purposes, while 79.4% stated that recreational cannabis use was illegal in their state.

Nearly half (48.4%) assessed CF patients’ cannabis use on occasion, with 41% rarely or never asking about it, and 15.4% always assessing its use.

Most stated their team documented patients’ medical (62.5%) and recreational (55.4%) cannabis use, with physicians reporting the highest documentation rates. For those who did not document such use, main reasons included uncertainty of where it should be documented and concerns for patients’ future transplant candidacy.

Notably, when a patient reported using cannabis, most healthcare professionals asked about the reasons, methods, and frequency of use (68–85%), and talked about risks and adverse events (67%).

Notably, most participants did not feel very or fully prepared to answer patient/family questions about cannabis/CBD and CF, with 63.5% reporting they were slightly to moderately prepared to talk about cannabis, and 72% feeling slightly or not at all prepared to answer questions about CBD.

They also felt less knowledgeable about the differences between CBD and tetrahydrocanabinol (THC), cannabis’ main psychoactive component, and the majority never discussed these components with patients.

In agreement with signs of lack of appropriate information, particularly on CBD, appetite and pain were the main reported indications for use of both, even though CBD was shown previously to be associated with reduced appetite.

Moreover, a third of the healthcare providers were not sure which indications they would support for CBD use.

Importantly, most participants wanted some kind of educational material on cannabis/CBD, particularly regarding indications of use, risk and side effects, and THC versus CBD effects.

Also, concern over future exclusion from lung transplant lists was the main reported reason not to support cannabis use in CF patients, followed by legal status, and concern for addiction.

“Due to variability in state laws regarding cannabis and CBD, we expected differences in views and knowledge about these controversial substances,” the team wrote, adding that the survey’s findings “align with research in other populations, in that they demonstrate a need for increased cannabis education among health-care professionals.”

This information may help “inform and encourage development of education materials for medical providers and people with CF,” which may “facilitate the CF care team members to include cannabis and CBD into care discussions,” the investigators wrote.

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