Discussion
A majority of pharmacy students in this study lacked accurate knowledge about the approved therapeutic indications and adverse effects of medical marijuana. The only approved medical indications correctly identified by more than 50% of pharmacy students were for the treatment of cancer and glaucoma (91% and 57%, respectively). In contrast, notably more students correctly identified common adverse effects of marijuana, particularly those affecting the central nervous system. Perhaps not surprisingly, previous users of marijuana were more knowledgeable than students who reported never using marijuana regarding indications and adverse effects. No consistent trends were found between year of study and knowledge.
Despite an apparent lack of accurate knowledge about marijuana, the majority of pharmacy students favored legalizing marijuana for medical purposes, but did not support its legalization for recreational use. These results contrast markedly from student attitudes described by Burke and Marx in a study conducted more than 40 years ago. In that study, only a small percent of pharmacy students supported the use of medical or recreational use of marijuana (16% and 14%, respectively) compared with 58% and 35% in our study. Changes in state legalization, cultural acceptance, personal use, news and social media coverage, and decreased perception of risk have undoubtedly combined to shift opinions over the past 4 decades.
More recent studies have examined temporal changes in attitudes and perceived risks of marijuana over time. Schuermeyer et al used data from the National Survey on Drug Use and Health (2003–2011) to assess trends in marijuana attitudes and use in Colorado (approved medical marijuana state) and compared them to states without medical marijuana laws. The authors correlated a downward decline since 2009 in Coloradans' attitudes toward perceived risk of using marijuana and concluded that commercialization of marijuana in Colorado was associated with a decrease perception of risk.
Attitudes of pharmacy students toward the use of medical marijuana also contrasted with attitudes expressed by physicians. In a recent study administered to family physicians in Colorado, 46% felt physicians should never recommend marijuana as a medical treatment in contrast to 19% who felt physicians should recommend medical marijuana. Additionally, more than 60% of physicians surveyed agreed that marijuana possesses significant physical and mental health risks. An earlier study by Charuvastra et al looked at physicians from multiple specialties and found 36% of physicians were in favor of legalization of medical marijuana. Similarly, Schwartz et al's survey of oncologists found 30% of respondents were in favor of legalization of medical marijuana. In comparison to our study, physicians were less in favor of medical marijuana than pharmacy students. The notable difference in attitudes between physicians and pharmacy students may be partly a result of greater physician knowledge informed by years of clinical experience, but also may reflect added physician responsibility of prescribing marijuana and monitoring patients for possible adverse effects.
Students in our study indicated they had received little to no education regarding the use of medical marijuana in the pharmacy curriculum. However, 90% indicated they should receive some formal education. The low confidence and comfort levels pharmacy students expressed about their ability to answer patients' marijuana questions may reflect this lack of formal education. Likewise, physicians in the Colorado survey indicated a strong desire for more formal education regarding medical marijuana. Most physicians reported learning about medical marijuana from the news, other physicians, and/or patients rather than from a formal educational setting, such as continuing medical education. Our study did not ask pharmacy students how they learned about medical marijuana. Pharmacy school curricular standards as published in the new Accreditation Council for Pharmacy Education (ACPE) Standards and Guidelines do not specifically mention the topic of medical marijuana, although it may be assumed to be covered under the topic of drug abuse.
A major limitation of our study was that it was conducted at only one institution in a state where use of medical marijuana is not legal. Schools of pharmacy in states where medical marijuana is approved may cover this topic in more detail and, thus, potentially produce different results. Because of the sensitive nature of asking pharmacy students to self-report an illegal behavior, classifying students as previous users and those who had never used could be flawed. Only 36% of students indicated past use of marijuana. That is significantly lower than McAuliffe et al's survey, conducted in 1987, that showed 52% of pharmacy students had used marijuana. Baldwin et al found a difference in geographical areas in terms of pharmacy students past use of marijuana, with a higher percentage of students in a southwestern state having used marijuana compared with students in the Midwest.
Student confusion about terminology used in our survey may be another study limitation. We included the treatment of Huntington's disease as an approved indication for medical marijuana based on treatment of spasticity-related disorders. Students not familiar with the symptoms of Huntington's disease likely would not have selected it as an approved indication.
As the legal status of marijuana use changes, and clinical research proliferates, the list of approved and nonapproved uses for medical marijuana will change. For example, Lotan et al reported potential benefits of medical marijuana for the treatment of Parkinson's disease, although they concluded that more research needed to be conducted. Consequently, future versions of our survey would require the list of approved and nonapproved indications to be revised accordingly. This survey did not query pharmacy students on their knowledge of legal risks and their views about recommending the use of marijuana to consumers for medical purposes. A future survey should be developed to evaluate student and pharmacist knowledge of legal implications of recommending marijuana to patients.