Perception of the risk of medicinal marijuana in postgraduate medical residents

Sandra Castillo-Guzmán; Dionicio Palacios Ríos; Teresa Adriana Nava Obregón; Daniela Alejandra Becerril Gaitàn; Keren  Daniela Juangorena García; Danya Carolina Domínguez  Romero; Misael Jerónimo Reyes Rodríguez

doi:10.12688/f1000research.17394.1

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Research Note

Perception of the risk of medicinal marijuana in postgraduate medical residents

[version 1; peer review: 1 approved with reservations, 1 not approved]

Sandra Castillo-Guzmán ¹, Dionicio Palacios Ríos¹, Teresa Adriana Nava Obregón¹, [...] Daniela Alejandra Becerril Gaitàn¹, Keren Daniela Juangorena García¹, Danya Carolina Domínguez Romero¹, Misael Jerónimo Reyes Rodríguez¹

Sandra Castillo-Guzmán ¹, Dionicio Palacios Ríos¹, [...] Teresa Adriana Nava Obregón¹, Daniela Alejandra Becerril Gaitàn¹, Keren Daniela Juangorena García¹, Danya Carolina Domínguez Romero¹, Misael Jerónimo Reyes Rodríguez¹

PUBLISHED 04 Apr 2019

Author details Author details

¹ Pain and Palliative Care Clinic, Anesthesiology Service, Hospital Universitario Dr.Jose Eleuterio González y Facultad de Medicina de la Universidad Autónoma de Nuevo León, Monterrey, Nuevo León, 66463, Mexico

Sandra Castillo-Guzmán
Roles: Conceptualization, Formal Analysis, Investigation, Methodology, Project Administration, Supervision, Writing – Original Draft Preparation, Writing – Review & Editing

Dionicio Palacios Ríos
Roles: Formal Analysis, Methodology

Teresa Adriana Nava Obregón
Roles: Formal Analysis, Methodology

Daniela Alejandra Becerril Gaitàn
Roles: Formal Analysis, Investigation, Methodology

Keren Daniela Juangorena García
Roles: Investigation

Danya Carolina Domínguez Romero
Roles: Conceptualization, Investigation

Misael Jerónimo Reyes Rodríguez
Roles: Conceptualization, Formal Analysis, Investigation

OPEN PEER REVIEW

REVIEWER STATUS

Abstract

Background: Drugs can often cause adverse reactions, and the perception of the risk of prescription drugs could influence prescription behaviour.
Methods: This was a prospective cross-sectional study of the perception of postgraduate physicians in training of the risk of using medical marijuana, comparing it with their perception of paracetamol and sedatives. A visual analogue scale with ranges from 0 (no risk) to 10 (totally risky) was used.
Results: A total of 197 postgraduate students were evaluated; 48 women and 149 men took part, with a mean age 27.8 years. Among the different specialties, there was a difference with regard to the perception of medical marijuana and paracetamol and all perceived a greater risk with sedatives. There was no evidence of a risk perception of marijuana in relation to factors such as alcohol consumption and smoking.
Conclusions: There is a difference in the perception of risk of medical marijuana and paracetamol with this perception being greater with sedatives. Regarding specialties, the perception of risk was greater for medical marijuana in general surgery than in urology.

Keywords

Risk perception,marijuana, méxico, postgraduate medical residents.

Corresponding author: Sandra Castillo-Guzmán

Competing interests: No competing interests were disclosed.

Grant information: The author(s) declared that no grants were involved in supporting this work.

Copyright: © 2019 Castillo-Guzmán S et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

How to cite: Castillo-Guzmán S, Palacios Ríos D, Nava Obregón TA et al. Perception of the risk of medicinal marijuana in postgraduate medical residents [version 1; peer review: 1 approved with reservations, 1 not approved]. F1000Research 2019, 8:381 (https://doi.org/10.12688/f1000research.17394.1) First published: 04 Apr 2019, 8:381 (https://doi.org/10.12688/f1000research.17394.1) Latest published: 04 Apr 2019, 8:381 (https://doi.org/10.12688/f1000research.17394.1)

Introduction

Multiple therapeutic uses have been proposed for marijuana; however, in Mexico, the legalization of its therapeutic and recreational use is currently in the process of being accepted¹. Cannabinoids have been used for the management of certain symptoms, such as nausea and vomiting induced by chemotherapy², appetite stimulation in patients with HIV/AIDS³, chronic pain², spasticity induced by paraplegia or multiple sclerosis, and anxiety, sleep, psychosis, glaucoma and Tourette syndrome⁴.

A systematic review and meta-analysis published by Whiting et al.⁴ in 2015 evaluated the benefits of using cannabinoids. They found moderate-quality evidence for the treatment of chronic pain and spasticity and low-quality evidence regarding nausea and vomiting due to chemotherapy, weight gain in HIV infection, sleep disorders and Tourette syndrome. However, cannabinoids were associated with an increased risk of adverse effects in the short term.

The risk perceived by doctors in training as specialists is important because they could be responsible for their prescription in the future. Their perception may be similar to the fear of prescribing morphine or underestimating the effect of anti-inflammatory drugs and paracetamol.

Continuing with the research on the risk perception toward drugs, the objective of this study was to assess the perception of risk to medicinal marijuana in postgraduate medical residents of an academic hospital and compare this with the risk perception of paracetamol and sedatives.

Methods

Subjects and recruitment

This was a cross-sectional study that was carried out during May 2017 in the Dr. Jose E. Gonzalez University Hospital in Monterrey, Mexico, an academic hospital that cares for uninsured patients from three north-eastern states in Mexico. The objective was to evaluate the perception of the use of medical marijuana in postgraduate medical residents. The study protocol was previously approved by the Ethics Committee of the Universidad Autonoma de Nuevo Leon, registration number PL17-00134. We used a convenience sample of residents in postgraduate training from diverse specialties in our institution. A total of 197 medical residents from 8 medical specialties were included (anesthesiology, 34; general surgery, 34; traumatology, 20; neurosurgery, 15; urology, 14; otorhinolaryngology, 11; gynecology, 29; and internal medicine, 40). Participants were recruited and assessed in-person in offices, operating room and halls of the hospital. Individuals were assessed to determine if they met the inclusion criteria (postgraduate students in training in a medical specialty of both sexes, regardless of age, who accepted to participate in the study). Only those who did not wish to participate were excluded. After accepting, information about the study was provided and informed consent was obtained. Verbal consent was used because of the low-risk of the study.

Survey

A survey consisting of two sections was applied (the Spanish and English versions of the survey are available on Figshare⁵). Section 1 included general data collection questions such as age, sex, marital status, city of residence, place of birth, and time living in the city. Also, current health problems, smoking and active alcohol consumption, level of education, name of the specialty they were training in, the current semester of study. Economic income and the participant’s name, as optional data, were asked. Section 2 consisted of a 10-centimeter long line that represented the level of risk that they felt a drug could have. The respondent had to mark with an X the level of risk, considering the left side as being completely safe and the right as completely unsafe. The drugs evaluated were paracetamol, medical marijuana and sedatives. Text regarding the three drugs was arranged in three different ways in each questionnaire to avoid influencing the respondent’s decision; afterwards, the median response in centimetres was considered.

Statistical analysis

Statistical analysis was performed with the SPSS statistical program, version 20. Descriptive statistics of the total sample were calculated. Risk perception was reported as median with interquartile ranges. The Kruskal-Wallis test followed by a Dunn post hoc test was used to determine the difference among the different medical services. The Mann-Witney U-test was used to compare the perception of the three drugs between smokers and non-smokers and between alcohol consumers and non-consumers.

Results

Sample characteristics

A total of 197 postgraduate medical students were evaluated; there were 48 women and 149 men with a mean age of 27.8 years (range 25 to 32). The percentage of surveyed participants according to the year of residence was 26.9% for the first year, 29.4% for the second year and 43.7% for >3 years of training. The frequency of self-reported smoking was 24.4% while for self-reported drinking it was 81.2%.

Risk perception of medicinal marijuana, paracetamol and sedatives

Overall, the risk perception of medical marijuana was 3 cm (IQ range = 1–5 cm) which we consider as risk perception of medium grade; for paracetamol it was 1 cm (IQ range = 1–2) which we consider as a risk of low grade, and for sedatives, 5 cm (IQ range= 4–8 cm) which we consider as a risk perception of high grade. There was a significant difference in the risk perception among the three drugs studied (p<0.01).

The risk perception according to specialty shows that all specialties studied have a greater risk perception to sedatives than to the other drugs studied (p<0.01). In this sense, the drug with the lowest risk perception was paracetamol (Table 1). Among the specialties, general surgery had the highest risk perception to medical marijuana while urology had the lowest risk perception (p<0.01). In the case of paracetamol, general surgery residents also had the highest risk perception (2 cm), while that rest of the specialties had lower risk perception (from 1 to 1.5 cm) (p= 0.04). In the case of sedatives, there no were a significant difference in risk perception between the residents of each specialty (Table 2).

Table 1. Kruskal-Wallis test comparing the medians of the different medical services.

Values are given as median (IQ range).

Medical service	Medical marijuana risk, cm	Paracetamol risk, cm	Sedatives risk, cm	P value
Anesthesiology (N=34)	3.50 (1.75–5.25)	1.5 (1–3.3)	5.0 (2–8)	<0.01
General Surgery (N=34)	5 (3–6)	2.0 (1–3)	6.5 (5–8)	<0.01
Traumatology (N=20)	2 (1–3)	1 (1–1.8)	6 (4.3–8)	<0.01
Neurosurgery (N=15)	3 (1–5)	1 (1–1)	4 (4–6)	<0.01
Urology (N=14)	1 (1–3.5)	1 (1–1.3)	5 (4–7.5)	<0.01
Otorhinolaryngology (N=11)	3 (1–3)	1 (1–2)	5 (5–8)	<0.01
Gynecology (N=29)	3 (1–6)	1 (1–1)	5 (4–8)	<0.01
Internal medicine (N=40)	4 (1.25–5)	1 (1–2)	5 (3–5.8)	<0.01
P value	<0.01	0.04	0.15

Table 2. Mann-Whitney U-test comparing the variables medicinal marijuana, paracetamol, and sedatives in alcohol users, non-alcohol users, smokers and non-smokers.

Drug	Alcohol user, median cm (Q1–Q3)	Non-alcohol user, median (Q1–Q3)	P value*	Smoker, median cm (Q1–Q3)	Non-smoker, median cm (Q1–Q3)	P value†
Medicinal marijuana	3 (1–5)	4 (2–5)	0.16	3 (1–5)	3 (2–5)	0.107
Paracetamol	1 (1–2)	1 (1–3)	0.08	1 (1–2)	1 (1–2)	0.367
Sedatives	5 (4–8)	5 (4–6)	0.27	5 (4–7)	5 (4–8)	0.591

*Alcohol user vs non-alcohol user. †Smoker vs non-smoker.

Risk perception by self-reported smokers and self-reported alcohol consumption

Both groups, smokers and non-smokers, had a greater risk perception of sedatives than other drugs. The risk perception of medical marijuana (p=0.11), paracetamol (p= 0.37) and sedatives (p= 0.59) was not statistically different between smokers and non-smokers (Table 2). In the case of self-reported alcohol consumption, sedatives also had the greatest risk perception in both alcohol users and non-alcohol users. There was no significant difference between groups in the risk perceived for medicinal marijuana, paracetamol and sedatives.

Discussion

In this study, we evaluated the risk perception of medical marijuana in medical residents of several specialties in Monterrey, Mexico. To our knowledge, this is the first study in medical residents. Overall, the risk perception of medical marijuana was 3 cm. We consider that the perceived risk to medical marijuana is medium, since medical marijuana, in reality, is still under study for the treatment of some diseases; therefore, its use should be cautious. The low risk perception may also suggest that medical residents have a favourable attitude towards medicinal marijuana and thus, a willingness to recommend it. The latter should be evaluated in other studies.

We previously evaluated the risk perception toward medicinal marijuana in undergraduate medical students⁶. The risk perception of the use of paracetamol, marijuana and sedatives is the same in graduate students and undergraduate students. However, in this previous study, the risk perception of medical marijuana in undergraduate students was different between smokers and non-smokers and between alcohol and non-alcohol users.

One of our limitations is that only the degree of risk perception was assessed; however, the degree of knowledge, which is an objective of future research, should be contemplated by other studies. It is worth mentioning that the lack of knowledge of drugs has been associated with a negative attitude to prescribing them, as in the case of opioids (opiophobia)^7,8.

There is evidence of knowledge of the potential risks of medical marijuana and recommendations have been made for medical marijuana use in patient care in the United States⁹. In Mexico there are no studies that have evaluated the knowledge and experience in the use of medical marijuana in patient care nor a legal basis for it.

Conclusions

Risk perception to medical marijuana in medical residents of Monterrey, Mexico is 3 cm (IQ range = 1-5 cm) which we consider as a risk perception of medium grade. Among the different specialties, there was a difference with regard to the perception of risk of medical marijuana. There was no difference between smokers and alcohol users in risk perception. The degree of knowledge toward medicinal marijuana is an objective of future research in medical students and postgraduate medical residents.

Data availability

Underlying data

Figshare: Raw data and survey of risk perception to medical marijuana of medical residents. https://doi.org/10.6084/m9.figshare.7742723.v1⁵.

Underlying data for this study are available in file “Raw date Risk perception of medical marijuana in Postgraduate medical residents.xlsx”.

Extended data

Figshare: Raw data and survey of risk perception to medical marijuana of medical residents. https://doi.org/10.6084/m9.figshare.7742723.v1⁵.

The following extended data are available:

Survey Risk perception of Medicinal marijuana Mexico.pdf (English translation of questionnaire).
Survey Risk perception of Medicinal marijuana Mexico.pdf (Original Spanish-language questionnaire).

Data are available under the terms of the Creative Commons Attribution 4.0 International license (CC-BY 4.0).

Grant information

The author(s) declared that no grants were involved in supporting this work.

The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Acknowledgments

We thank Sergio Lozano-Rodriguez, M.D. for his help in translating and editing the manuscript, and Braulio H. Velasco-Sepulveda and Omar González Santiago for their help with statistical analysis.

F1000 recommended

References

1. Arellanes FJV, Mendívil EAS: La mariguana en México: implicaciones biológicas y sociales en su legalización y regulación [Marijuana in Mexico: biological and social implications in its legalization and regulation]. RIIAD. 2018; 4(1): 36–52. Publisher Full Text
2. Wilkie G, Sakr B, Rizack T: Medical Marijuana Use in Oncology: A Review. JAMA Oncol. 2016; 2(5): 670–675. PubMed Abstract | Publisher Full Text
3. Fride E, Bregman T, Kirkham TC: Endocannabinoids and food intake: newborn suckling and appetite regulation in adulthood. Exp Biol Med (Maywood). 2005; 230(4): 225–34. PubMed Abstract | Publisher Full Text
4. Whiting PF, Wolff RF, Deshpande S, et al.: Cannabinoids for Medical Use: A Systematic Review and Meta-analysis. JAMA. 2015; 313(24): 2456–2473. PubMed Abstract | Publisher Full Text
5. Castillo-Guzman S: Raw data and survey of risk perception to medical marijuana of medical residents. figshare. Fileset. 2019. http://www.doi.org/10.6084/m9.figshare.7742723.v1
6. Castillo-Guzmán S, Palacios-Ríos D, Nava-Obregón TA, et al.: Risk perception of medicinal marijuana in medical students from northeast Mexico [version 1; peer review: 1 not approved]. F1000Research. 2017; 6: 1802. Publisher Full Text
7. Ger LP, Ho ST, Wang JJ: Physicians' knowledge and attitudes toward the use of analgesics for cancer pain management: a survey of two medical centers in Taiwan. J Pain Symptom Manage. 2000; 20(5): 335–44. PubMed Abstract | Publisher Full Text
8. Weinstein SM, Laux LF, Thornby JI, et al.: Physicians' attitudes toward pain and the use of opioid analgesics: results of a survey from the Texas Cancer Pain Initiative. South Med J. 2000; 93(5): 479–87. PubMed Abstract
9. Chaudhry HJ, Hengerer AS, Snyder GB: Medical Board Expectations for Physicians Recommending Marijuana. JAMA. 2016; 316(6): 577–578. PubMed Abstract | Publisher Full Text

Comments on this article Comments (0)

Version 1

VERSION 1 PUBLISHED 04 Apr 2019

Author details Author details

¹ Pain and Palliative Care Clinic, Anesthesiology Service, Hospital Universitario Dr.Jose Eleuterio González y Facultad de Medicina de la Universidad Autónoma de Nuevo León, Monterrey, Nuevo León, 66463, Mexico

Sandra Castillo-Guzmán
Roles: Conceptualization, Formal Analysis, Investigation, Methodology, Project Administration, Supervision, Writing – Original Draft Preparation, Writing – Review & Editing

Dionicio Palacios Ríos
Roles: Formal Analysis, Methodology

Teresa Adriana Nava Obregón
Roles: Formal Analysis, Methodology

Daniela Alejandra Becerril Gaitàn
Roles: Formal Analysis, Investigation, Methodology

Keren Daniela Juangorena García
Roles: Investigation

Danya Carolina Domínguez Romero
Roles: Conceptualization, Investigation

Misael Jerónimo Reyes Rodríguez
Roles: Conceptualization, Formal Analysis, Investigation

Competing interests

No competing interests were disclosed.

Grant information

The author(s) declared that no grants were involved in supporting this work.

Article Versions (1)

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Published: 04 Apr 2019, 8:381

https://doi.org/10.12688/f1000research.17394.1

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© 2019 Castillo-Guzmán S et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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Castillo-Guzmán S, Palacios Ríos D, Nava Obregón TA et al. Perception of the risk of medicinal marijuana in postgraduate medical residents [version 1; peer review: 1 approved with reservations, 1 not approved] F1000Research 2019, 8:381 (https://doi.org/10.12688/f1000research.17394.1)

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ApprovedThe paper is scientifically sound in its current form and only minor, if any, improvements are suggested

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Version 1

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Reviewer Report 23 Mar 2022

Wangjun Qin, Department of Pharmacy, China-Japan Friendship Hospital, Beijing, China

Approved with Reservations

https://doi.org/10.5256/f1000research.19020.r126852

This article tells us a risk perception of medium grade for medical marijuana in medical residents in one hospital of Monterrey, which is interesting for researchers from other counties. Marijuana is used in Europe and America more than that in ... Continue reading

This article tells us a risk perception of medium grade for medical marijuana in medical residents in one hospital of Monterrey, which is interesting for researchers from other counties. Marijuana is used in Europe and America more than that in Asia. Thus, it is supposed there are significant variations among medical residents from these countries. Even so, the present study provides a baseline in Monterrey and a reference for other countries and regions.

There are some limits for the present version. First, the authors did not describe the way to select the participants recruited and readers may wonder whether a random sample was used. Second, the risk perception for medical marijuana may associated with the medical knowledge. However, the difference in risk perception among yeas of residence is not analyzed. Third, the face-to-face questionnaires may influence the results of the participants.

Overall the article is useful in providing an understanding the risk perception for medical marijuana in medical residents and its influence factors.

Is the work clearly and accurately presented and does it cite the current literature?

Yes
Is the study design appropriate and is the work technically sound?

Partly
Are sufficient details of methods and analysis provided to allow replication by others?

Partly
If applicable, is the statistical analysis and its interpretation appropriate?

Partly
Are all the source data underlying the results available to ensure full reproducibility?

Yes
Are the conclusions drawn adequately supported by the results?

Yes

Competing Interests: No competing interests were disclosed.

Reviewer Expertise: Clinical pharmacy in pain management

I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard, however I have significant reservations, as outlined above.

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Reviewer Report 09 Feb 2022

Julie Dupouy, University Department of General Medicine, Faculty of Medicine, University of Toulouse, Toulouse, France

Not Approved

https://doi.org/10.5256/f1000research.19020.r115460

This paper by Castillo-Guzman et al., reports the perception of the risk of medicinal marijuana in postgraduate medical residents in training in one hospital. My first comment is that the need to investigate this topic is not clearly indicated in ... Continue reading

This paper by Castillo-Guzman et al., reports the perception of the risk of medicinal marijuana in postgraduate medical residents in training in one hospital. My first comment is that the need to investigate this topic is not clearly indicated in the introduction. I think that if the authors want to consider medical cannabis as one analgesic drug they have to discuss deeply the efficacy of medical cannabis and cannabinoids. In the meta analysis in the BMJ about chronic pain¹, medical cannabis had small effect on pain, and some could argue, as the authors of this meta-analysis, that the clinical significance of some positive results found in this meta-analysis was not achieved. Adverse drug reactions were important in the a recent Cochrane review². Data are even more difficult to synthesize in psychiatric disorders (Black et al., 2019³ and McKee et al., 2019⁴) and are prone to be discussed.

This survey was approved by an Ethic Committee. Nevertheless, I was surprised that data about name (even if optional), income, city of residence, marital status, medical illness, etc. were asked in the questionnaire. This seems to be an ethical concern if questionnaires were not anonymous and were answered face-to-face. In addition, completing the questionnaires face-to-face may influence the results, even more if the person in charge of administering the questionnaire was a physician known by the resident.

I did not find any explanation in the paper of what hypothesis sustain the comparison between specialties? Another question I had was why not to ask students about marijuana self-use in addition to alcohol and tobacco self-use?

There are other limits to discuss in this paper: the monocentric aspect of the survey, the low response rate, the fact that few specialties were represented and not medical ones (except internal medicine). These limits should be discussed.

Is the work clearly and accurately presented and does it cite the current literature?

Partly
Is the study design appropriate and is the work technically sound?

No
Are sufficient details of methods and analysis provided to allow replication by others?

Yes
If applicable, is the statistical analysis and its interpretation appropriate?

Partly
Are all the source data underlying the results available to ensure full reproducibility?

Yes
Are the conclusions drawn adequately supported by the results?

Partly

References

1. Wang L, Hong P, May C, Rehman Y, et al.: Medical cannabis or cannabinoids for chronic non-cancer and cancer related pain: a systematic review and meta-analysis of randomised clinical trials. BMJ. 2021. Publisher Full Text
2. Mücke M, Phillips T, Radbruch L, Petzke F, et al.: Cannabis-based medicines for chronic neuropathic pain in adults. Cochrane Database of Systematic Reviews. 2018; 2020 (7). Publisher Full Text
3. Black N, Stockings E, Campbell G, Tran L, et al.: Cannabinoids for the treatment of mental disorders and symptoms of mental disorders: a systematic review and meta-analysis. The Lancet Psychiatry. 2019; 6 (12): 995-1010 Publisher Full Text
4. McKee KA, Hmidan A, Crocker CE, Lam RW, et al.: Potential therapeutic benefits of cannabinoid products in adult psychiatric disorders: A systematic review and meta-analysis of randomised controlled trials.J Psychiatr Res. 140: 267-281 PubMed Abstract | Publisher Full Text

Competing Interests: No competing interests were disclosed.

Reviewer Expertise: Primary care, substance use disorders

I confirm that I have read this submission and believe that I have an appropriate level of expertise to state that I do not consider it to be of an acceptable scientific standard, for reasons outlined above.

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Version 1 04 Apr 19	read	read

Julie Dupouy, University of Toulouse, Toulouse, France
Wangjun Qin, China-Japan Friendship Hospital, Beijing, China

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23 Mar 2022 | for Version 1

Wangjun Qin, Department of Pharmacy, China-Japan Friendship Hospital, Beijing, China

5 Views Cite this report Responses(0)

Approved With Reservations

This article tells us a risk perception of medium grade for medical marijuana in medical residents in one hospital of Monterrey, which is interesting for researchers from other counties. Marijuana is used in Europe and America more than that in Asia. Thus, it is supposed there are significant variations among medical residents from these countries. Even so, the present study provides a baseline in Monterrey and a reference for other countries and regions.

There are some limits for the present version. First, the authors did not describe the way to select the participants recruited and readers may wonder whether a random sample was used. Second, the risk perception for medical marijuana may associated with the medical knowledge. However, the difference in risk perception among yeas of residence is not analyzed. Third, the face-to-face questionnaires may influence the results of the participants.

Overall the article is useful in providing an understanding the risk perception for medical marijuana in medical residents and its influence factors.

Is the work clearly and accurately presented and does it cite the current literature?

Yes
Is the study design appropriate and is the work technically sound?

Partly
Are sufficient details of methods and analysis provided to allow replication by others?

Partly
If applicable, is the statistical analysis and its interpretation appropriate?

Partly
Are all the source data underlying the results available to ensure full reproducibility?

Yes
Are the conclusions drawn adequately supported by the results?

Yes

Competing Interests

No competing interests were disclosed.

Reviewer Expertise

Clinical pharmacy in pain management

I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard, however I have significant reservations, as outlined above.

Respond to this report

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Reviewer Report

6 Views

09 Feb 2022 | for Version 1

Julie Dupouy, University Department of General Medicine, Faculty of Medicine, University of Toulouse, Toulouse, France

6 Views Cite this report Responses(0)

Not Approved

This paper by Castillo-Guzman et al., reports the perception of the risk of medicinal marijuana in postgraduate medical residents in training in one hospital. My first comment is that the need to investigate this topic is not clearly indicated in the introduction. I think that if the authors want to consider medical cannabis as one analgesic drug they have to discuss deeply the efficacy of medical cannabis and cannabinoids. In the meta analysis in the BMJ about chronic pain¹, medical cannabis had small effect on pain, and some could argue, as the authors of this meta-analysis, that the clinical significance of some positive results found in this meta-analysis was not achieved. Adverse drug reactions were important in the a recent Cochrane review². Data are even more difficult to synthesize in psychiatric disorders (Black et al., 2019³ and McKee et al., 2019⁴) and are prone to be discussed.

This survey was approved by an Ethic Committee. Nevertheless, I was surprised that data about name (even if optional), income, city of residence, marital status, medical illness, etc. were asked in the questionnaire. This seems to be an ethical concern if questionnaires were not anonymous and were answered face-to-face. In addition, completing the questionnaires face-to-face may influence the results, even more if the person in charge of administering the questionnaire was a physician known by the resident.

I did not find any explanation in the paper of what hypothesis sustain the comparison between specialties? Another question I had was why not to ask students about marijuana self-use in addition to alcohol and tobacco self-use?

There are other limits to discuss in this paper: the monocentric aspect of the survey, the low response rate, the fact that few specialties were represented and not medical ones (except internal medicine). These limits should be discussed.

Is the work clearly and accurately presented and does it cite the current literature?

Partly
Is the study design appropriate and is the work technically sound?

No
Are sufficient details of methods and analysis provided to allow replication by others?

Yes
If applicable, is the statistical analysis and its interpretation appropriate?

Partly
Are all the source data underlying the results available to ensure full reproducibility?

Yes
Are the conclusions drawn adequately supported by the results?

Partly

References

1. Wang L, Hong P, May C, Rehman Y, et al.: Medical cannabis or cannabinoids for chronic non-cancer and cancer related pain: a systematic review and meta-analysis of randomised clinical trials. BMJ. 2021. Publisher Full Text
2. Mücke M, Phillips T, Radbruch L, Petzke F, et al.: Cannabis-based medicines for chronic neuropathic pain in adults. Cochrane Database of Systematic Reviews. 2018; 2020 (7). Publisher Full Text
3. Black N, Stockings E, Campbell G, Tran L, et al.: Cannabinoids for the treatment of mental disorders and symptoms of mental disorders: a systematic review and meta-analysis. The Lancet Psychiatry. 2019; 6 (12): 995-1010 Publisher Full Text
4. McKee KA, Hmidan A, Crocker CE, Lam RW, et al.: Potential therapeutic benefits of cannabinoid products in adult psychiatric disorders: A systematic review and meta-analysis of randomised controlled trials.J Psychiatr Res. 140: 267-281 PubMed Abstract | Publisher Full Text

Competing Interests

No competing interests were disclosed.

Reviewer Expertise

Primary care, substance use disorders

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Perception of the risk of medicinal marijuana in postgraduate medical residents

Abstract

Keywords

Introduction

Methods

Subjects and recruitment

Survey

Statistical analysis

Results

Sample characteristics

Risk perception of medicinal marijuana, paracetamol and sedatives

Table 1. Kruskal-Wallis test comparing the medians of the different medical services.

Table 2. Mann-Whitney U-test comparing the variables medicinal marijuana, paracetamol, and sedatives in alcohol users, non-alcohol users, smokers and non-smokers.

Risk perception by self-reported smokers and self-reported alcohol consumption

Discussion

Conclusions

Data availability

Underlying data

Extended data

Grant information

Acknowledgments

References

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