The sample size was based on power analysis and previous relevant studies.A total of 357 questionnaires were distributed between January and February 2020 during lectures and 296 questionnaires were returned . Two participants were excluded because their field of study was other than nursing. Finally, 294 respondents were included in the sample. The “Attitudes, Beliefs and Knowledge towards Medical Cannabis Questionnaire” included 54 items for data collection purposes.Sixteen items were used to assess student attitudes and beliefs towards MC; and, twenty items assessed knowledge on MC effectiveness. MC education/training was assessed by 3 items. A section for reporting demographic, educational and personal data was included. The data collection tool used for this survey evidences internal consistency across multiple locations with Cronbach’s alpha values ranging from 0.767 to 0.831.The instrument was translated from English to Greek and back translated. Cultural adaptation of the translated version was performed by a group of experts including five academic and clinical instructors. The study was designed according to the Declaration of Helsinki and the protocol was approved by the Ethics Committee of the NKUA Department of Nursing . Permission was obtained to use the tool for data collection purposes. Each questionnaire was accompanied by a cover letter providing details about the researchers’ affiliation, contact information and study purpose. Assurance was provided about the voluntary nature of participation and anonymity of collected data. Also, it was clearly stated that returning a completed questionnaire was considered informed consent to participate in the study. Senior undergraduate participants reported more positive attitudes towards MC use for mental health, fibromyalgia and terminal illness treatment purposes than junior undergraduate participants . Present study results provide the opportunity to compare studies elsewhere of nursing students.Moreover, other data show neutral attitudes towards MC among physicians.Differences between these studies and present Greek findings may be attributed to cultural differences and other factors including the nature and scope of prevailing legislation and regulations. Present study results evidence junior undergraduate respondents are more inclined to believe serious physical health risks are associated with cannabis use. This finding is consistent with that of Khamenka et al.,Chan et al. and Gritsenko et al. who reported the majority of undergraduate medical students believe cannabis use poses serious physical and mental health risks.
The NKUA Nursing Department offers 3rd year students a 3 h lecture on medical cannabis through an elective course titled “Psychoactive Substances”. Consequently, because of the elective nature of the course, few undergraduate students each year receive theoretical education on MC. This may partially explain the present finding that most of the undergraduate participants reported that they should receive formal education on MC laws and regulations. Moreover, undergraduate survey participants were more likely to report a need for MC academic education and clinical practice purposes than postgraduate survey participants. The dearth of MC undergraduate education has been reported in multiple locations.Undergraduate respondents, compared to postgraduates, tend to be less positive about MC effectiveness for medical conditions. Also, they report less personal cannabis use for recreational purposes. The latter issue is consistent with the findings of Khamenka et al.among Belarus undergraduate medical students who reported less personal cannabis use. Overall, personal cannabis grow system and other substances use tends to be associated with more positive attitudes towards MC benefits. For example, in the study by Vujcic et al.,on undergraduate medical students in Belgrade, the majority of those students believed MC use is safe and associated with health benefits. This result was found associated with positive attitudes towards cannabis use legalization and personal cannabis and alcohol use. Current study postgraduate respondents were more likely, than undergraduate students, to report family member medical and/or recreational use. Moreover, most undergraduate respondents agreed that they should receive MC academic and clinical education/training, including information about laws and regulations, during their nursing studies. These results are consistent with findings of other international studies.Social workers are on the front line dealing with hurmful substance use on individual, family and society levels. The potential increase of MC use among the general population as additional states approve its use, can influence social work practice linked to substance use disorder and criminal justice, health care and child/social welfare institutions and systems.In these domains, social workers have a significant role; therefore, there is ample justification that they should be trained about MC potential benefits and harms. Changing policies and regulations are expected to position social work professionals with significant roles and responsibilities linked to MC. However, little is known about social work student attitudes and beliefs about MC- aspects that would contribute to curriculum development. The aim of this study was to assess MC attitudes and beliefs among social work students from the United States and Israel.
The MC regulations of these two countries differ; and, therefore, it is hypothesized that differences exist between the study groups in terms of the factors studied. Based on college/university level MC education,we believed a cross-national comparison of social work students will reveal MC attitude and belief differences attributed to culture and experience with MC. Drawing on research of student attitudes and beliefs about MC,a data collection instrument was modified for cross- national social work survey purposes. Questions were developed in English, translated to Hebrew and back translated to English to ensure content and vocabulary were appropriate to the students surveyed. This process involved native Hebrew and English-speaking university social work faculty members. The resulting questionnaire used in this survey consisted of 40 short and simply worded questions about MC effectiveness for various conditions, risks, benefits, treatment, training and research. Detailed information about the instrument have been recently published elsewhere.The study was conducted during the 2018–2020 academic years in two institutions of higher education – one in the southern region of Israel and the other in New Jersey . The survey also included a question about student recreation cannabis use. This was included because students’ recreational use has been found correlated with positive attitudes, beliefs and knowledge about medical cannabis including education and training.The aim of this study was to assess medical cannabis attitudes and beliefs among a cross national study cohort of social work students. Overwhelming support was found for MC and substantial acceptance of its therapeutic value. These findings are similar that found among other health professionals such as oncologists and pharmacists.The present study did not evidence any difference based on gender and students who reported personal cannabis use, compared to non-users, were more likely to recommend MC for treatment. Students, regardless of country, who used cannabis were less inclined to believe cannabis use poses serious physical or mental health risks. Finally, despite the beliefs about its use, both groups of students reported a dearth of formal education about MC. Some differences were found between the two groups of students. In most cases, US students reported more favorable attitudes toward MC than those from Israel. The decision to use US and Israeli students for comparison stems from both similarities as well as differences between the two cultures. For example, the State of Israel’s culture is distinctly US orientated; and, ’American’ values, practices, and culture influence many living conditions in the country including political traditions and economic policies among others.Moreover, despite cultural differences, both US and Israel share values that originated in Western society and guide social work studies and practice.
Future studies should include cultural factors such as student substance related norms to deepen the understanding of the similarities and differences found in the current study. There is an ethical dilemma that needs to be addressed with respect to student expressed use of cannabis for recreational purposes when they know it is not legal in areas where they are residing. In the United States, the National Association of Social Workers Code of Ethics does not specifically address the issue of MC; however, the Code’s preamble highlights the dual focus social work professionals have on individual and society.For example, Baker & Randolph conducted a study to examine the ethical dilemmas that face social workers when they provide to clients who use MC.These researchers found that even though social workers must practice under the NASW Code of Ethics by promoting the self-determination of clients, the dispute over the medical cannabis laws creates controversy for the profession regarding this basic tenet. Furthermore, they point out that social workers should be aware of where and how their clients are acquiring MC. If the client is obtaining it illegally, this places the social worker in the ethical dilemma of knowing his/her client is breaking the law. Despite all of this, the NASW Code specifies the professional values of a social worker including service, social justice, the dignity and worth of all people, as well as the integrity of the profession. These values are also reflected in the Israeli social work code of ethics.Therefore, although there is a lack of uniformity of the acceptance of MC, under the codes of social work ethics inboth the US and Israel, it is clear that social workers have a role to serve people in need,advocate for both clients and society-at-large, and to practice in an honest and trustworthy manner.Education on MC should address medical, social, and ethical issues related to it. This will provide social work students with a comprehensive understanding of the substance and promote their ability to relate to dilemmas that might arise while addressing individuals in need. Notwithstanding their lack of knowledge and training, the vast majority of survey respondents reported that they would recommend MC for their clients. This may be explained by the fact that social workers do not have the legal competency to authorize such use ; therefore, potential professional and legal ramifications are not at stake. Indeed, previous studies reported those peoplelegally eligible to certify for MC use tend to hold more permissive and favorable attitudes about marijuana grow system use for medical conditions.Likewise, since only two universities were included in this study the findings may not be generalizable to other Israeli or US students due to age, cultural and religious differences. Similarly, the majority of Israeli respondents were undergradate students while all of the US students were graduate students. There may be differences in these two samples based on the differing academic levels. Additionally, the survey relies on self-reporting which can lead to biases from respondents that may not accurately represent their attitudes about MC.
Despite these limitations, this study provides information that can guide additional research to further explore attitudes about MC among professionals and potentially influence policy change. Medical cannabis is legal in many countries, with much regulatory variability. The legality of MC has changed considerably over the past several decades, particularly with evidence of its value for chronic illnesses and related symptoms.1 For example, cannabis or cannabinoids have been proven to be useful for the treatment of chronic pain, chemotherapy-induced nausea and vomiting, and for improving multiple sclerosis spasticity.For nearly three decades, Israel has been officially using the substance to treat selected medical conditions. More recently, Thailand has become the first country in Southeast Asia to approve medical cannabis. As these countries move forward with the substance for medical purposes, key questions persist about the nature of knowledge, attitudes, and beliefs about MC among medical students who will become clinical practitioners, medical consultants, and health service decision-makers. For centuries, the chemicals in cannabis and cannabinoids have been used for medical purposes. The psychoactive compound of cannabis, THC or tetrahydrocannabinol, is linked to a sense of euphoria or a “feel good” condition, which may encompass positive effects for certain conditions, but is also associated with potential negative effects, such as psychotic symptoms or cognitive impairment.A second compound is cannabidiol or CBD, which is non-psychoactive and is considered to be associated with many therapeutic effects.MC has been found useful for chronic neuropathic pain,reducing chronic or neuropathic pain in advanced cancer patients, and as an adjunct to traditional analgesic therapy.Despite these positive results, the potential benefits of cannabis-based medicines for chronic neuropathic pain may be outweighed by their potential harm when used in combination with opioids.Indeed, increased anxiety and depression have been reported among such patients, including those who use tobacco, alcohol, cocaine, and sedatives.