In a representative survey conducted in September 2017, knowledge and attitudes of the population towards medicinal cannabis were investigated for the first time. Conclusion: There is broad support for the legalization of medicinal cannabis if distribution and prescription are integrated into the healthcare system.
Key Findings Overview:
- There is a very good level of knowledge among the population, but there is a need for improvement in information exchange between patients and doctors as well as pharmacists.
- Above all, the pain-relieving and antispasmodic effects are well known, followed by cannabis as a treatment for depression, as well as its anti-inflammatory and appetite-stimulating effects.
- The willingness to allow medicinal cannabis is high – provided that doctors and pharmacies maintain control.
- General legalization of cannabis, personal cultivation for medical purposes, and purchase without a prescription in hemp shops are strictly rejected by the population.
Media interest during the study presentation on September 26, 2017, was enormous and demonstrates that the topic of medicinal cannabis has not only resonated with the population but has also generated broad media interest. Kurier, Der Standard, Die Presse, Wiener Zeitung, heute, Krone TV, Puls 4; Hanf Magazin and the ORF program “Mittag in Österreich” extensively covered the topic.
“Surprisingly, the population is well informed about the topic of medicinal cannabis – although only four percent of respondents received information from doctors or pharmacists. There is a need for dialogue here because the population clearly supports the idea that medical cannabis should only be available with a doctor’s prescription and through pharmacies,”says study author Peter Hajek at the beginning of the presentation.
The researcher has now presented one of the few representative studies on the knowledge and attitudes of the population towards medicinal cannabis. 1,000 respondents aged 16 and older were surveyed using a mixed methods approach (telephone and online) regarding their knowledge and attitudes. The maximum margin of error is +/- 3.1 percent, and the study was commissioned by Flowery Field GmbH and the Arbeitsgemeinschaft Cannabis als Medizin.
Key Figures on Knowledge:
- 77 percent of respondents are familiar with the term medicinal cannabis, with above-average familiarity among respondents with pain patients in their personal environment (83 percent).
- Regarding spontaneous association (multiple responses possible) with the topic of cannabis, positive mentions (medical effects, pain relief, etc.) dominate at 72 percent, while 24 percent are neutral, and 50 percent are negative (drug, addiction, etc.).
- Among the known effects of medicinal cannabis, pain relief dominates at 86 percent, followed by antispasmodic effects (62 percent), treatment for depression (48 percent), anti-inflammatory effects (43 percent), and appetite stimulation (39 percent). The nausea-suppressing effect is less known (24 percent).
- In terms of spontaneous mention of how medicinal cannabis can be taken, the administration form as drops (39 percent) is ahead of smoking (35 percent).
“The assisted awareness of medicinal cannabis is high; around three-quarters have some understanding of the term. It’s interesting that positive associations significantly outweigh negative ones in spontaneous association. We don’t have comparative data, but this figure is remarkable considering that cannabis in Austria has been legally equated with heroin and subject to the same restrictions for sixty years,”says Hajek.
Attitude Figures:
- 61 percent advocate that medicinal cannabis should only be available with a doctor’s prescription and application.
- 59 percent support the idea that medicinal cannabis should only be available on prescription in pharmacies.
- There is clear opposition to general legalization from the age of 21 (64 percent), the right to personal cultivation for medical purposes (68 percent), and medicinal cannabis without a prescription in hemp shops (73 percent).
- 40 percent unequivocally and 33 percent rather affirm the coverage of cannabis flowers at the expense of health insurance companies as in Germany. There is high approval among respondents with pain patients in their personal environment (56 percent).
- 66 percent of respondents agree with the use of cannabis in nursing homes and care facilities, such as in California.
- 55 percent of respondents prefer medicinal cannabis, if prescribed by a doctor, over traditional medications (30 percent). Here, too, preference for medicinal cannabis is particularly high among respondents with pain patients in their personal environment, at 63 percent.
„The willingness to allow medicinal cannabis is high – provided that doctors and pharmacies maintain control. General cannabis legalization, personal cultivation for medical purposes, and purchase without a prescription in hemp shops are strictly rejected by the population. Here, the population is very clear. Respondents draw a strict distinction between medical benefit under medical supervision and the potential transition to non-medical consumption under the guise of medicinal cannabis,”says Hajek.
Also, experience with medicinal cannabis was surveyed. Within the sample, there were 22 percent chronic pain patients (220 respondents) and 17 percent who are familiar with pain patients in their environment.
Key Figures on Experience:
- Just under one in ten respondents have people in their environment who have already been treated with medical cannabis under medical supervision. 65 percent describe the treatment success as very good and 29 percent as rather good.
- 2 percent of respondents, which corresponds to an estimated 60,000 to 150,000 people in Austria, have already used medicinal cannabis.
- Only 4 percent of respondents have received information about medicinal cannabis from a doctor or pharmacist.
„“All in all, there is a high level of involvement from the population regarding medicinal cannabis. There is a very good level of knowledge among the population, but there is a need for improvement in information exchange between patients and doctors as well as pharmacists,”says Hajek.
Public Ahead of Politicians and Health Representatives
At this point, general practitioner and founder of the Arbeitsgemeinschaft Cannabis als Medizin, Kurt Blaas, also intervenes during the study presentation: “The results confirm my impression from conversations with patients. As a doctor, I experience great interest and well-informed patients who do not feel well treated in our healthcare system because of the information deficits, legal hurdles, and bureaucratic harassment.”
Cannabis is regulated in the Narcotic Drugs Act.
The formulations of the active ingredient THC (tetrahydrocannabinol) can be prescribed by specialist physicians and general practitioners and can be redeemed directly as private prescriptions in pharmacies. A chief medical officer’s approval is required if the costs of the medication are to be covered by health insurance companies. Documentation must show that all other conventional therapies have not led to improvement. And although clinical studies have already demonstrated the effectiveness of THC as an analgesic, antiepileptic, appetite stimulant, and oncological preparation for cancer supportive therapy.
Synthetic cannabis offerings dominate
Currently, three predominantly synthetic cannabinoid preparations are available to patients in Austria: Dronabinol as a magistral preparation of plant-derived or synthetically produced THC; the synthetic cannabinoid Nabilone; and Sativex, a mixture of synthetic THC and CBD. However, these products are not affordable. For the cannabis medication Dronabinol, health insurance companies currently only cover around 20 to 30 percent of the costs – unaffordable for many patients.
Natural cannabinoids work better
The synthetic and semi-synthetic offering restricts medical freedom of choice because natural cannabinoids in the form of cannabis flowers and extracts thereof are illegal. Synthetic cannabinoids also have the disadvantage that they lack all other potentially effective cannabinoids. Studies have also shown that natural cannabinoids are better tolerated by patients.
„We need legislation that no longer criminalizes patients. Just as in Germany, cannabis flowers and standardized plant extracts should be available in pharmacies in Austria. But without an ordeal, but on prescription and under medical supervision at the expense of health insurance companies. I f lawmakers do not create a quality-assured legal offering, the black market and quacks will step in,”says Blaas.
Lesch: Need for education and clinical studies
Otto Lesch, Professor and specialist at the Vienna University Clinic for Psychiatry and Psychotherapy, as well as President of the Austrian Society for Addiction Medicine, also advocates for a broader range of offerings and a new legal framework. In his studies, he was able to refute the thesis that cannabis is a gateway drug to harder drugs. Contrary to prejudice, cannabis in medical use and in the dosage proposed by a doctor also practically does not cause psychosis.
The fact is that only people predisposed to mental illnesses can be affected. When cannabis is taken in therapeutic doses, no physiological functions are disturbed or organs damaged. The addiction expert wishes above all for information and education, also among the medical profession, and advocates for clinical studies to explore the medical indications of the individual substances of the cannabis plant.
„“The cannabis plant is a true chemical factory – but with only marginal side effects. It is not a panacea, but potentially very effective where conventional therapies fail, and a real alternative to the use of opioids. It is now up to lawmakers to eliminate hurdles such as chief medical officer approval and narcotic drug prescriptions and regulate cannabis in the Medicinal Products Act. There is no way around legalizing medicinal cannabis,” says Lesch at the end of the study presentation.
Further representative studies are planned and will be published and presented in the coming months. The German Hemp Association also published a survey in autumn 2017 showing approval for legal cannabis trade.