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P552 Gastroenterologists’ perceptions on use of medical cannabis for IBD

B. Koslowsky*1, A. Bar-Gil Shitrit1, E. Goldin1, B. Mazuz1

1Shaare-Zedek Medical Center, Digestive Diseases Institute, Jerusalem, Israel

Background

The use of medical cannabis (MC) for numerous medical indications is expanding. Current evidence does not support the efficacy of MC for reducing inflammation in IBD patients. Even so, many gastroenterologists encounter the issue of recommending use of MC to IBD patients.

Methods

A computerised survey was conducted to 250 gastroenterologists in Israel. 84 (34%) physicians completed the questionnaire.

Results

Out of 84 physicians whom completed the questionnaire, 59 (70%) were male, 34 (40%) were under age 50, 71 (85%) were adult gastroenterologists, and 53 (63%) work mainly in a hospital. Forty-four per cent, 41% and 15% of physicians think that MC is very effective, mildly effective and not effective at all, respectively. Physicians will commonly, rarely and never recommend MC in 42%, 35% and 22%, respectively. Older physicians (above age 50) were significantly more likely to have a positive attitude towards MC in both questions, p = 0.003, p = 0.004. Despite clear recommendations stated by the Israeli Gastroenterological Association, 48% of physicians did not know the initial dose recommended for MC. Fifty-two (62%) physicians say that at least 60% of their prescriptions were to patients already using unauthorised cannabis, and only 10 (12%) initiate MC as opposed to 88% who prescribe MC due to the patients request. Female gastroenterologists were significantly more likely to initiate MC, p = 0.007. When asked if you would continue prescribing MC as long as the patient requests or when the patient is in mucosal remission, 35% and 20% would continue, 38% and 31% would consider and 27% and 49% would stop prescribing MC, respectively. When presented with a clinical scenario of a patient in deep remission, and requests to increase the dose, 32% would increase the dose, 49% would maintain the dose, and only 18% would stop prescribing MC altogether. In one tertiary Israeli medical centre, ninety-one patients are currently receiving MC. 85% of patients have Crohn’s disease, and the others ulcerative colitis and IBD-U. Fifty-eight per cent of patients are between ages 20–40, and 2 patients over the age of 70 are currently receiving MC. In the younger age groups, 20–30 and 30–40, smoking is the most popular way of administration as opposed to oil in the older age group (above age 50).

Conclusion

The use of MC for IBD patients is encountered by many IBD physicians. Different doctors hold completely different attitudes regarding this treatment. Age above 50 and female physicians generally had a more positive attitude towards the use of MC. Guidelines and clear recommendations are needed.