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There is a persistent disconnect between patients and clinicians on what role medicinal cannabis (MC) should play in palliative medicine.1 Last century, the lack of options for symptom management in advanced cancer coupled with the HIV epidemic led to strong popular support for prescribing MC.2 Though it was occasionally difficult to differentiate narrow efforts to permit medical use from a broader decriminalisation movement, much of the public effort was in good faith. Clinicians were less enthusiastic, pointing to evidence that other already legal agents were demonstrably superior for symptom management.3 Even so, they recognised the legitimacy of the patient perspective and debated the issue vigorously.4
This century, both public enthusiasm and clinician hesitancy for the medical use of cannabinoids are still present although the context is advanced cancer, not AIDS. This article considers a framework for considering why patients are so optimistic about MC and yet clinicians are not. By considering the debate from both perspectives, a two-pronged research agenda—patient and clinician centred—naturally emerges.
The clinician–patient divide
The clinician–patient divide may in part be explained by the disruptive journey MC has taken into the clinical armamentarium. Most medications are conceived in the laboratory or discovered in nature without any strong prior expectations. As such, they are unencumbered by emotional baggage. In contrast, cannabis has been consumed for thousands of years across many cultures. Like any enduring cross-cultural phenomenon, individuals within the culture will have been exposed to it and have formed an opinion of it. Strong prior expectations of clinical utility—positive or negative—inevitably produce some degree of cognitive dissonance when these expectations are juxtaposed with the ambiguous literature.
The traditional research mechanism is functional when the public has no prior expectation. Clinicians are free to set the agenda and the public largely accept their conclusions. This fails in the …
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests Professor Phillip Good and Professor Janet Hardy are recipients of two grants from The Commonwealth of Australia for clinical research into medical cannabis (MRF2006191; APP1152232). Dr Taylan Gurgenci is the recipient of a PhD scholarship for medical cannabis research in palliative care.
Provenance and peer review Not commissioned; internally peer reviewed.