Medical Cannabis Plant and Agricultural Practices

Cannabis is an herbaceous flowering plant that was discovered in eastern Asia as an indigenous plant which later spread all over due to widespread agricultural practices. Cannabis sativa is a scientific word which means; “cannabis” which means cultivation and “Sativa” which means things that are cultivated. Cannabis sativa comprises of; marijuana, leaves, dried flowering tops and stems of the plant. Different parts of the plant are harvested differently depending on their different uses. 

There are two species of the cannabis plant which are cannabis Sativa and cannabis Indica. The first species of the plant which is cannabis Sativa was categorized by a scholar known as Carl Linnaeus in 1753. Cannabis was used medicinally until the early-20th century. It was period of time that opium, coca leaves and cannabis were prohibited due to its psychoactive properties. Over the time, generations of health professionals were educated in a system where cannabis was considered purely illicit.

The National Academies of Sciences, Engineering, and Medicine (NASEM) proceed and report a thorough review of the medical literature on the wellness impacts of cannabinoids and cannabis. NASEM infer that there is “conclusive and substantial evidence” that medical cannabis is potent to relieve chronic pain, spasticity related with multiple sclerosis and chemotherapy-induced nausea and vomiting. Medications containing natural or synthetic cannabinoids currently approved by FDA for medicinal use in chemotherapy cancer patients as an antiemetic, in AIDS patients as an appetite stimulant for weight loss, for neuropathic pain, epilepsy, overactive bladder, and spasticity and less frequently to augment analgesic treatment in several countries. 

Additionally, NASEM deduce that there is “substantial” proof for the relationship between cannabis smoking and airway disorders, and between cannabis use and motor vehicle accidents, lower birth weight offspring, and schizophrenia or other psychosis. Cannabis in general has affect in all body system. It has been shown to decrease pulmonary function, affect immunological system, it increases in mortality of HIV-positive cannabis users and abnormal cell growth that may precipitate the onset of cancer. 

In Cardiovascular system it causes direct stimulation of the cardiac pacemaker by marijuana leads to an increase in heart rate in cardiac patients. Daily cannabis use is a risk factor for liver fibrosis, thus, daily cannabis use in patients with liver disease is contraindicated. Pregnant women who smoke cannabis are more susceptible to have low birth weight infants possibly from a shorter gestation. The mental effects of smoked cannabis include mental slowness, “relaxation”, tiredness, euphoria, and some users report anxiety, paranoia and affective disorder. 

The latest study assessing patient opinions of the utilizing medical cannabis in the management of pain after musculoskeletal injury in Massachusetts revealed that most of patients accept that cannabis can be utilized to relieve pain, treat agitation and decrease use of narcotic drugs for pain therapy . In a recent survey indicates that there is a wide controversy in believe on the use of medical marijuana in the management of epilepsy, which differed significantly, with fewer specialists supporting its use compared with general medical practitioner and patients. In a survey of Colorado primary care providers, few support physical and mental benefits of medical cannabis to the patients.

In a large Minnesota, a recent survey demonstrated that majority of caregiver thought (“strongly agree” or “somewhat agree”) that medical cannabis was a legal medical treatment (58.1%) and 38.7% thought that medical cannabis should be given to patients for particular medical conditions. More than 50% of caregivers thought that medical cannabis was beneficial to treat specific medical conditions such as cancer, terminal illness, and chronic pain, where few support that medical cannabis improved patient's quality of life. Over one-third of caregivers believed that medical cannabis reacted with medical therapies. One-half of caregivers were not prepared to or did not want to answer patient questions about medical cannabis, and the majority of caregivers wanted to learn. 

In Washington, a Survey conducted Among health care providers revealed that more than 50% of the participants were lawfully permitted to write MC authorizations per Washington State law, and 27% of those had issued written MC authorizations. Overall, participants reported low knowledge and comfort level related to recommending MC. Participants ranked MC knowledge as essential and supported requirement of MC training in medical provider curriculum. Majority of providers in Washington State have not received education on scientific basis of MC or training on best clinical practices of MC. 

In Canada, survey assessing knowledge of medical cannabis among Canadian physicians show that lack of knowledge for dosing and initiating potent treatment plans for patients using medical cannabis and prescribing cannabinoid medications. Good knowledge was found among Canadian physicians for safety, warning signs and risks of medical cannabis. The survey concludes that 87.5% and 87.3% of Canadian physicians have good or very good level of medical knowledge of cannabis. The need for education on cannabis in medicine was reported as strong or very strong by 64% of Canadian physicians, compared to 19% who were neutral, and 17% not very strongly or not at all. 

In Australia, study evaluate Knowledge and attitudes of Australian general practitioners towards medicinal cannabis found that most of GPs (61.5%) reported one or more patient asks about medicinal cannabis in the previous months. Majority of Australian GPs believe their own knowledge was incompetent and only 28.8% agreeable discussing medicinal cannabis with patients. Over half (56.5%) of Australian GPs accepted availability on prescription, with the preferred access model involving trained GPs prescribing independently of specialists. They reinforce use of medicinal cannabis for certain case, with strong reinforce for use in cancer, pain, palliative care and epilepsy, and much lower reinforce for use in grief and anxiety. 

In Israel, the perceptions of medical cannabis among Israeli Physicians did not have a unified opinion to whether cannabis is a medicine or not, but rather struggled with this query. This could indicate obstacle to the implementation of medical cannabis policies. An awareness of physicians’ perspective and the different levels of their willingness to implement medical cannabis policies is requirement for policy formulating in this promoting field.

The legal status of cannabis continues to be highly controversial. Cannabis can be used as medical or recreational use. (18)Cannabis has been legalized medically in many country such as Argentina ,Australia ,Austria ,Bermuda ,Canada, Chile, Colombia, Croatia, Cyprus ,Czech ,Republic ,Denmark, Finland ,Georgia ,Germany, Greece, Ireland ,Israel ,Italy, Jamaica ,South Korea , Lithuania ,Luxembourg, Malta, Netherlands ,New Zealand ,North Macedonia ,Norway, Peru, Philippines , Poland, Portugal ,Romania, San Marino, Slovenia, South Africa, Spain, Sri, Lank, Switzerland ,Thailand, Turkey, United Kingdom ,United states, Uruguay ,Vanuatu , Zimbabwe where middle east and the rest of the world are illegal. In countries like USA legal medical cannabis use is spreading in many states and recreational use is already allowed in seven of them.

29 US states and the District of Columbia have thorough programs allowing use of cannabis in particular status. All states with the exception of the District of Columbia determine which medical conditions cannabis can be utilized, and most states demand caregivers to be registered Cannabis is given to patients through state designated medical cannabis dispensaries. Routes of medical cannabis self-administration vary widely by state with many providing such as capsules, oil, and vaporizing liquid. 

In Hawaii, beneficial treatment of medical cannabis survey conducted among patients recorded 64%of participants who used medical cannabis experience decrease of chronic pain, 50% decrease of stress ,45% decrease of insomnia ,12% improved of appetite ,10% decreased of nausea,9% improved of attention, and 7% notice relief of depression. Multiple patients said that cannabis helped them to reduce or discontinue narcotics and benzodiazepines drugs for pain, anxiety, and insomnia. Most of patients 71% recorded no side effects, while 6% recorded a cough or throat irritation and 5% reported a fear of arrest. 

All other side effects were lower than 5%, no serious side effects were recorded. In Michigan, a survey comparing use of medical cannabis and opioids in chronic pain patients reported 64% decrease use of opioid drug in chronic pain patients, more relief of pain from medical cannabis than opioid drug, greatest increase in quality of life. Patients reported remarkable reduce in drugs side effects that affected their daily activity, and decreases in total number of medications use. 

To examine the knowledge of Saudi Physician's at KAMC towards medicinal cannabis, including patient demand, physician's perceptions of therapeutic effects and potential harms, perceived knowledge and willingness to prescribe, this study is important to see if Saudi physician are well prepared and educated in medical cannabis before legalization of marijuana for medical purposes due to the predictable increase in use, no available study in Saudi Arabia or Arab world ,we therefore conducted an educational needs assessment among Saudi physicians at KAMC .This survey was also designed to explore Saudi physicians believes and perceptions towards cannabis, and to make recommendations for the preferred format of physician education on medical cannabis in medical curriculum and implementation of certified training.