- Email: [email protected]
Russian Federation medical student knowledge, attitudes and beliefs toward medical cannabis
Complementary Therapies in Medicine 48 (2020) 102274
Contents lists available at ScienceDirect
Complementary Therapies in Medicine journal homepage: www.elsevier.com/locate/ctim
Short Communication
Russian Federation medical student knowledge, attitudes and beliefs toward medical cannabis
T
Valentina Gritsenkoa, Vsevolod Konstantinovb, Alexander Reznikc, Richard Isralowitzc,* a
Department of Social Psychology, Moscow State University of Psychology and Education, Moscow, Russia Department of General Psychology, Penza State University, Penza, Russia c Regional Alcohol and Drug Abuse Research Center, Ben Gurion University of the Negev, Beer Sheva, Israel b
ARTICLE INFO
ABSTRACT
Keywords: Russia Medical students Medical cannabis Curriculum development Medical education
Objectives: To assess medical student knowledge, attitudes and beliefs about cannabis use for medical conditions in Russia where it is prohibited. Methods: This study uses data collected from 463 Russian origin medical students. Pearson Chi-square test for categorical variables was used to determine whether student knowledge, attitudes and beliefs of medical cannabis (MC) are affected by gender and religiosity. Results: Overall, Russian university medical students tend to reflect negative attitudes and beliefs toward MC. Female students were more inclined to recommend MC for patient treatment and its legalization; and, believe it is not addictive and does not pose physical or mental health risk. Students who support MC use believe it has treatment benefits, support additional research as well as policy change for its legalization. Secular, more than religious, students report more positive attitudes toward MC use. About 34% of the students indicate they have no knowledge about cannabis use for medical conditions; and, nearly half report feel they are able to answer patient questions about its use for medical condition if such a situation were to exist. Conclusions: This study is the first in Russia to examine medical students’ knowledge, attitudes and beliefs toward MC. Results evidence the majority of survey respondents do not support cannabis legalization for any purpose – medical or recreational. They report a dearth of knowledge about the substance and recommend additional evidence-based research and education to enhance their knowledge about its use. The present study has value in terms of providing usable information for possible curriculum development and education purposes as well as policy change about cannabis use for medical conditions in Russia.
1. Introduction Much attention is being given to cannabis as a means of addressing chronic pain and other health conditions for patients who have not responded to conventional medical intervention. Among future health care professionals, medical students will have significant roles for patient care. However, huge gaps in their education exist about medical cannabis1–13 including its dosing, delivery methods, misuse, adverse reactions and dependence among other issues of concern.3,4,5,6 Most studies of medical students and medical cannabis (MC) come from countries where the substance has been legalized. However, information about MC from countries where it is not authorized for use has value for curriculum development, education ⁎
and policy. This study presents survey results of Russian medical student knowledge, attitudes and beliefs about MC. Presently, Russia maintains a fundamental position against cannabis use for any purpose – medical or recreational. However, consideration is being given to evaluating the public harms and therapeutic value of cannabis and its related substances along with scientific information for possible re-evaluation of its present policy – a World Health Organization recommendation.7 In spite of the present Russia position toward cannabis, this study was conducted to better understand Russian origin medical students’ position toward MC and generate usable information for multiple purposes including education. For this study, we hypothesized that medical student knowledge, attitudes and beliefs of MC are affected by gender and religiosity factors.
Corresponding author at: Regional Alcohol and Drug Abuse Research Center, Ben Gurion University of the Negev, Beer Sheva, 8410, Israel. E-mail address: [email protected] (R. Isralowitz).
https://doi.org/10.1016/j.ctim.2019.102274 Received 28 October 2019; Received in revised form 26 November 2019; Accepted 27 November 2019 Available online 14 December 2019 0965-2299/ © 2019 Published by Elsevier Ltd.
Complementary Therapies in Medicine 48 (2020) 102274
V. Gritsenko, et al.
2. Methods
Table 1 Medical Student Background Characteristics by Gender*.
2.1. Study setting Medical students at a major university in central Russia were asked to complete a questionnaire about their MC knowledge, attitudes and beliefs. There are 4,296 enrolled students from Russian and foreign countries, particularly those in the Middle East (e.g. Iraq, Egypt, and Lebanon) and India in the 6-year medical program. On graduation, students receive a medical degree that is recognized by the WHO, the General Medical Council of major European countries including Great Britain and France, and other international medical boards.
Religious preference Christian Muslim Jewish Non denomination Religiosity Secular Religious Prior cannabis use
Total N = 463 (%)
Male1 N = 255 (%)
Female1 N = 208 (%)
p value2
267 (58.4) 130 (28.4) 2 (0.4) 58 (12.8)
180 (71.4) 55 (21.8) 2 (0.8) 15 (6.0)
87 (42.4) 75 (36.6) 0 (0.0) 43 (21.0)
< 0.001
94 (20.5) 364 (79.5) 15 (3.3)
34 (13.4) 219 (86.6) 4 (1.6)
60 (29.3) 145 (70.7) 11 (5.4)
< 0.001 0.025
1
2.2. Participants/Recruitment/Data collection
Up to six subjects in each group missing data on some variables. χ2 test for categorical variables was used to evaluate gender differences. * Mean age of study cohort is 20.5 years (SD = 2.0). No gender difference was found for age among male and female students. 2
The questionnaire was distributed in classes to medical students. This method, rather than an on-line approach, was chosen to maximize the number of responses in the limited time period allowed for data collection. To control for possible country of origin impact, only Russian origin student (n = 463) responses are discussed for this paper. The data were collected from March to April 2019. Participation was voluntary and all students agreed to participate. No incentive or compensation was provided for participation.
questions, depending on the domain, included categories of agree/disagree, effective/ineffective or don’t know. Scores were calculated and analyzed for differences according to gender and religiosity.
2.3. Survey development
3.1. Demographics1–13
In 2018, the Ben Gurion University of the Negev (Israel) - Regional Alcohol and Drug Abuse Research (RADAR) Center and the University of Colorado, Anschutz Medical Campus (CU) agreed to a transdisciplinary global partnership for substance abuse research. A starting point focused on the need for information about MC and relevant to medical and allied health student education. Drawing on CU research of medical student attitudes and beliefs about marijuana,8 the RADAR Center with permission modified the CU data collection instrument for use at BGU and with other international partners including those in Russia. The data collection instrument, in English, Russian, Hebrew, Thai and Greek languages, is available on request from the RADAR Center. The data collection instrument includes items selected from a literature review of cannabis in educational and clinical settings in domains of usefulness, risks, benefits, treatment, training and research. Also, the data collection instrument was culturally adapted by the participating study teams. For this study of Russian medical students, faculty members of Penza State University and Moscow State University of Psychology and Education worked with BGU-RADAR Center personnel on the instrument. Questions were developed in English, translated to Russian and back translated to English to ensure content and vocabulary were appropriate to the students surveyed. This process involved native Russian and English-speaking faculty members of the universities involved. The data collection instrument, consisting of 54 demographic and MC questions, went through multiple versions prior to distribution. The study design, protocol, and survey instrument were granted exempt status by Russian university authorities prior to administration. This approval process is equivalent to the institutional review board (IRB) process used in the United States and elsewhere to ensure the methods proposed for research are ethical. However, it is recognized that even with complete de-identification of all study participants, possible psychological and/or political risk is possible since all students were recruited from one, known medical school. No external funding was received for the study.
The 463 medical students that took part in the survey were 55% (n = 255) male and 45% (n = 208) female (p = .029). The distribution of respondents based on year of study was: 16.4% (n = 76) first year, 35.4% (n = 164) second year, 33.3% (n = 154) third year, 11.4% (n = 53) fourth year, 2.6% (n = 12) fifth year, and 0.9% (n = 4) sixth year. Age (median 20 years) did not significantly influence student responses; therefore, a comparison of students based on year of study was not conducted. Females were more secular than males (29.3% vs. 13.4%; p < .001) and reported more personal cannabis use (5.4% vs. 1.6%; p = .025) (Table 1).
3. Results
3.2. Student attitudes, beliefs and knowledge about medical Cannabis Table 2 compares MC attitudes by gender (male/female) and religiosity (secular/religious). Many Russian people in the country affiliate with a religion (e.g., Orthodox Christian, Muslim, etc.). However, they tend to practice religious tenets at a very low level.9 In the event of MC legalization in Russia, female students indicated that they would be more likely to recommend MC for patient treatment (41.7% vs. 26.1%; p < .001) and cannabis legalization for recreational purposes (31.7% vs. 18.6%; p = .001). Also, they believed cannabis is not addictive (30.7% vs. 16.5%; p < .001) and does not pose serious physical (39.8% vs. 22.6%; p < .001) or mental health (34.6% vs. 20.2%; p = .001) risk. Regarding religiosity, secular students reported more positive attitudes toward MC use than those who reported to be religious. They were more inclined to recommend MC for patient treatment (57.6% vs. 27.0%; p < .001), believed it has benefits for physical (54.3% vs. 28.2%; p < .001) and mental health (56.7% vs. 31.8%; p < .001) purposes, supported additional research (76.1% vs. 61.5%; p = .009), and supported legalization of recreational cannabis (36.6% vs. 21.8%; p = .003). Regarding chronic pain, 41.1% (n = 179) of the students believed MC acceptable and 24.6% (n = 107) unacceptable for patient treatment. More than 34% (n = 149) indicated they had no knowledge about cannabis use for medical conditions of chronic pain as well as cancer, arthritis and multiple sclerosis; and, 48.3% (n = 219) said they were ready to answer patient/client questions about medical cannabis Regarding information about MC, students reported their sources are medical literature (47.1%), classroom lectures (20.1%), clinical
2.4. Data analysis Pearson Chi-square test for categorical variables was performed using Statistical Package for the Social Sciences (SPSS), version 25. SPSS is one of the most popular tools for processing and analyzing research results in medical and social sciences. Responses to MC 2
Complementary Therapies in Medicine 48 (2020) 102274
V. Gritsenko, et al.
Table 2 Student Medical Cannabis Attitudes and Beliefs: Gender and Religiosity. Gender1
I would recommend MC for patient/client use There are significant physical health benefits using MC There are significant mental health benefits using MC Cannabis should be legalized for recreational use Cannabis is not addictive Using cannabis does not pose serious physical health risks Using cannabis does not pose serious mental health risks Additional research regarding MC use should be encouraged 1 2
Religiosity1
Male N = 255 (%)
Female N = 208 (%)
p value2
Secular N = 94 (%)
Religious N = 364 (%)
p value2
65 (26.1) 78 (31.7) 78 (32.1) 46 (18.6) 41 (16.5) 56 (22.6) 50 (20.2) 157 (64.1)
86 (41.7) 73 (35.6) 86 (42.4%) 65 (31.7) 63 (30.7) 82 (39.8) 71 (34.6) 131 (64.2)
< 0.001 0.382 0.025 0.001 < 0.001 < 0.001 0.001 0.976
53 50 51 34 23 37 33 70
97 (27.0) 100 (28.2) 112 (31.8) 77 (21.8) 80 (22.4) 99 (27.7) 86 (24.2) 217 (61.5)
< 0.001 < 0.001 < 0.001 0.003 0.598 0.020 0.024 0.009
(57.6) (54.3) (56.7) (36.6) (25.0) (40.2) (35.9) (76.1)
Up to six subjects in each group missing data on some variables. χ2 test for categorical variables was used to evaluate gender and religiosity (i.e., secular and non-secular) differences.
practical setting (6.7%), physicians (14.3%), and other (11.8%). Most students (86.9%) indicated there is a lack of education about MC. As mentioned above, year of study (first, second, third, fourth and more) did not significantly influence student responses.
based on years of cross-national effort, mutual trust, respect and publication among the researchers involved.11,12,13 Similar type relations are considered to be an important foundation for future research especially where cannabis use in any form is prohibited.
4. Discussion & conclusion
Ethical approval
The role of MC for pain and other medical conditions such as cancer, arthritis and multiple sclerosis tends to evolve based on social, political, legal, economic and other conditions. When it does, in a country such as Russia, up to date information drawn from evidence-based research as well as student and clinical practitioner knowledge, attitudes and beliefs should contribute to informed decision making for possible curriculum development, education and policy purposes. To the best of our knowledge, this is the first study of Russian medical students about MC. Study results show the majority of Russian origin medical students do not support cannabis for medical conditions. However, results evidence that gender and religiosity influence student knowledge, attitudes and beliefs about possible MC use and legalization. Previous studies of physicians suggest being secular or less religious is associated with greater support for legalizing cannabis.8,10 Present study results of Russian secular medical students are consistent with such findings. Finally, the vast majority of medical students report a lack of MC education. This is expected in a country that does not legitimize its use. Among the students surveyed, about 34% report no knowledge about MC while a significant portion of the remaining students (i.e., 48%) indicate, based on what knowledge they have, that they are prepared to answer client questions about MC. Future research of medical student MC knowledge, attitudes and beliefs should be conducted, across locations throughout Russia, to enhance generalization of the present study findings. Further study of a comparative nature where MC is legal or prohibited may contribute to universal MC education.
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethics standards. Author contribution statement Dr. Valentina Gritsenko: Conceptualization, Methodology, Reviewing and Editing; Dr. Vsevolod Konstantinov: Organization, Survey Instrument Validation and Translation in Russian; Dr. Alexander Reznik: Survey Instrument Validation and Translation in Russian and English, Data Analyses; Writing; Dr. Richard Isralowitz: Survey Instrument development; English Writing and Editing Declaration of Competing Interest The authors declare that they have no conflict of interest. Acknowledgements Drs. Toby and Mort Mower are acknowledged for their generous support of the Ben Gurion University of the Negev, Regional Alcohol and Drug Abuse Research Center. References 1. MacCallum CA, Russo EB. Practical considerations in medical cannabis administration and dosing. Eur J Intern Med. 2018;49:12–19. 2. McGuire P. Medical marijuana education for medical students. Retrieved from University of Massachusetts Medical School; 2017https://escholarship.umassmed. edu/cgi/viewcontent.cgi?article=1004&context=capstone. 3. Di Forti M, Quattrone D, Freeman TP, et al. The contribution of cannabis use to variation in the incidence of psychotic disorder across Europe (EU-GEI): a multicentre case-control study. Lancet Psychiatry. 2019;6(5):427–436. 4. Evanoff AB, Quan T, Dufault C, Awad M, Bierut LJ. Physicians-in-training are not prepared to prescribe medical marijuana. Drug Alcohol Depend. 2017;180:151–155. 5. Gage SH. Cannabis and psychosis: triangulating the evidence. Lancet Psychiatry. 2019;6(5):364–365. 6. Isralowitz R, Reznik A. Cannabis use in Israel: a cross sectional overview of multiple study groups. Int J Ment Health Addict. 2018;16(4):832–842. 7. World Health Organization (WHO). News briefing - 40th WHO expert committee on drug dependence (ECDD). Retrieved from 2018; 2018https://www.who.int/medicines/ news/2018/news_briefing_ecdd/en/. 8. Chan MH, Knoepke CE, Cole ML, McKinnon J, Matlock DD. Colorado medical students’ attitudes and beliefs about marijuana. J Gen Intern Med. 2017;32(4):458–463. 9. Zabaev I, Mikhaylova Y, Oreshina D. Neither public nor private religion: The Russian Orthodox Church in the public sphere of contemporary Russia. J Contemp Relig.
5. Limitations The primary limitation of our study is the number of medical students surveyed from one university, at one point in time, in a political environment that strictly prohibits cannabis use in any form – medical or recreational. While no differences were found based on age/year of study, it is recognized the data collected are weighted toward younger students. Future research should look into whether MC knowledge, attitudes and beliefs are affected by age/year of study. However, in an environment where MC is strictly prohibited, such as Russia, it is not believed older students will evidence opinions different from those reported in the present study. This is contrary to research where the substance is legal showing MC knowledge, attitudes and beliefs among older students are affected by more exposure to this topic in their clinical years. Additionally, it should be mentioned that this study is 3
Complementary Therapies in Medicine 48 (2020) 102274
V. Gritsenko, et al. 2018;33(1):17–38. 10. Charuvastra A, Friedmann PD, Stein MD. Physician attitudes regarding the prescription of medical marijuana. J Addict Dis. 2005;24(3):87–93. 11. Gritsenko V, Gavronova Y, Khalepo O, Reznik A, Isralowitz R. University student attitudes toward illicit drug use and trafficking in Russia. Int J Ment Health Addict. 2017;15(2):350–355.
12. Isralowitz R, Reznik A, Gritsenko V, Khalepo O, Kovaleva Y. Alcohol use and related problem behavior: a survey among Russian Federation and Israeli Female University students. Int J Ment Health Addict. 2018;16(3):707–710. 13. Reznik A, Isralowitz R, Gritsenko V, Khalepo O, Kovaleva Y. Russian Federation university student alcohol use: Smolensk City – a case example. J Ethn Subst Abuse. 2018. https://doi.org/10.1080/15332640.2017.
4
Contents lists available at ScienceDirect
Complementary Therapies in Medicine journal homepage: www.elsevier.com/locate/ctim
Short Communication
Russian Federation medical student knowledge, attitudes and beliefs toward medical cannabis
T
Valentina Gritsenkoa, Vsevolod Konstantinovb, Alexander Reznikc, Richard Isralowitzc,* a
Department of Social Psychology, Moscow State University of Psychology and Education, Moscow, Russia Department of General Psychology, Penza State University, Penza, Russia c Regional Alcohol and Drug Abuse Research Center, Ben Gurion University of the Negev, Beer Sheva, Israel b
ARTICLE INFO
ABSTRACT
Keywords: Russia Medical students Medical cannabis Curriculum development Medical education
Objectives: To assess medical student knowledge, attitudes and beliefs about cannabis use for medical conditions in Russia where it is prohibited. Methods: This study uses data collected from 463 Russian origin medical students. Pearson Chi-square test for categorical variables was used to determine whether student knowledge, attitudes and beliefs of medical cannabis (MC) are affected by gender and religiosity. Results: Overall, Russian university medical students tend to reflect negative attitudes and beliefs toward MC. Female students were more inclined to recommend MC for patient treatment and its legalization; and, believe it is not addictive and does not pose physical or mental health risk. Students who support MC use believe it has treatment benefits, support additional research as well as policy change for its legalization. Secular, more than religious, students report more positive attitudes toward MC use. About 34% of the students indicate they have no knowledge about cannabis use for medical conditions; and, nearly half report feel they are able to answer patient questions about its use for medical condition if such a situation were to exist. Conclusions: This study is the first in Russia to examine medical students’ knowledge, attitudes and beliefs toward MC. Results evidence the majority of survey respondents do not support cannabis legalization for any purpose – medical or recreational. They report a dearth of knowledge about the substance and recommend additional evidence-based research and education to enhance their knowledge about its use. The present study has value in terms of providing usable information for possible curriculum development and education purposes as well as policy change about cannabis use for medical conditions in Russia.
1. Introduction Much attention is being given to cannabis as a means of addressing chronic pain and other health conditions for patients who have not responded to conventional medical intervention. Among future health care professionals, medical students will have significant roles for patient care. However, huge gaps in their education exist about medical cannabis1–13 including its dosing, delivery methods, misuse, adverse reactions and dependence among other issues of concern.3,4,5,6 Most studies of medical students and medical cannabis (MC) come from countries where the substance has been legalized. However, information about MC from countries where it is not authorized for use has value for curriculum development, education ⁎
and policy. This study presents survey results of Russian medical student knowledge, attitudes and beliefs about MC. Presently, Russia maintains a fundamental position against cannabis use for any purpose – medical or recreational. However, consideration is being given to evaluating the public harms and therapeutic value of cannabis and its related substances along with scientific information for possible re-evaluation of its present policy – a World Health Organization recommendation.7 In spite of the present Russia position toward cannabis, this study was conducted to better understand Russian origin medical students’ position toward MC and generate usable information for multiple purposes including education. For this study, we hypothesized that medical student knowledge, attitudes and beliefs of MC are affected by gender and religiosity factors.
Corresponding author at: Regional Alcohol and Drug Abuse Research Center, Ben Gurion University of the Negev, Beer Sheva, 8410, Israel. E-mail address: [email protected] (R. Isralowitz).
https://doi.org/10.1016/j.ctim.2019.102274 Received 28 October 2019; Received in revised form 26 November 2019; Accepted 27 November 2019 Available online 14 December 2019 0965-2299/ © 2019 Published by Elsevier Ltd.
Complementary Therapies in Medicine 48 (2020) 102274
V. Gritsenko, et al.
2. Methods
Table 1 Medical Student Background Characteristics by Gender*.
2.1. Study setting Medical students at a major university in central Russia were asked to complete a questionnaire about their MC knowledge, attitudes and beliefs. There are 4,296 enrolled students from Russian and foreign countries, particularly those in the Middle East (e.g. Iraq, Egypt, and Lebanon) and India in the 6-year medical program. On graduation, students receive a medical degree that is recognized by the WHO, the General Medical Council of major European countries including Great Britain and France, and other international medical boards.
Religious preference Christian Muslim Jewish Non denomination Religiosity Secular Religious Prior cannabis use
Total N = 463 (%)
Male1 N = 255 (%)
Female1 N = 208 (%)
p value2
267 (58.4) 130 (28.4) 2 (0.4) 58 (12.8)
180 (71.4) 55 (21.8) 2 (0.8) 15 (6.0)
87 (42.4) 75 (36.6) 0 (0.0) 43 (21.0)
< 0.001
94 (20.5) 364 (79.5) 15 (3.3)
34 (13.4) 219 (86.6) 4 (1.6)
60 (29.3) 145 (70.7) 11 (5.4)
< 0.001 0.025
1
2.2. Participants/Recruitment/Data collection
Up to six subjects in each group missing data on some variables. χ2 test for categorical variables was used to evaluate gender differences. * Mean age of study cohort is 20.5 years (SD = 2.0). No gender difference was found for age among male and female students. 2
The questionnaire was distributed in classes to medical students. This method, rather than an on-line approach, was chosen to maximize the number of responses in the limited time period allowed for data collection. To control for possible country of origin impact, only Russian origin student (n = 463) responses are discussed for this paper. The data were collected from March to April 2019. Participation was voluntary and all students agreed to participate. No incentive or compensation was provided for participation.
questions, depending on the domain, included categories of agree/disagree, effective/ineffective or don’t know. Scores were calculated and analyzed for differences according to gender and religiosity.
2.3. Survey development
3.1. Demographics1–13
In 2018, the Ben Gurion University of the Negev (Israel) - Regional Alcohol and Drug Abuse Research (RADAR) Center and the University of Colorado, Anschutz Medical Campus (CU) agreed to a transdisciplinary global partnership for substance abuse research. A starting point focused on the need for information about MC and relevant to medical and allied health student education. Drawing on CU research of medical student attitudes and beliefs about marijuana,8 the RADAR Center with permission modified the CU data collection instrument for use at BGU and with other international partners including those in Russia. The data collection instrument, in English, Russian, Hebrew, Thai and Greek languages, is available on request from the RADAR Center. The data collection instrument includes items selected from a literature review of cannabis in educational and clinical settings in domains of usefulness, risks, benefits, treatment, training and research. Also, the data collection instrument was culturally adapted by the participating study teams. For this study of Russian medical students, faculty members of Penza State University and Moscow State University of Psychology and Education worked with BGU-RADAR Center personnel on the instrument. Questions were developed in English, translated to Russian and back translated to English to ensure content and vocabulary were appropriate to the students surveyed. This process involved native Russian and English-speaking faculty members of the universities involved. The data collection instrument, consisting of 54 demographic and MC questions, went through multiple versions prior to distribution. The study design, protocol, and survey instrument were granted exempt status by Russian university authorities prior to administration. This approval process is equivalent to the institutional review board (IRB) process used in the United States and elsewhere to ensure the methods proposed for research are ethical. However, it is recognized that even with complete de-identification of all study participants, possible psychological and/or political risk is possible since all students were recruited from one, known medical school. No external funding was received for the study.
The 463 medical students that took part in the survey were 55% (n = 255) male and 45% (n = 208) female (p = .029). The distribution of respondents based on year of study was: 16.4% (n = 76) first year, 35.4% (n = 164) second year, 33.3% (n = 154) third year, 11.4% (n = 53) fourth year, 2.6% (n = 12) fifth year, and 0.9% (n = 4) sixth year. Age (median 20 years) did not significantly influence student responses; therefore, a comparison of students based on year of study was not conducted. Females were more secular than males (29.3% vs. 13.4%; p < .001) and reported more personal cannabis use (5.4% vs. 1.6%; p = .025) (Table 1).
3. Results
3.2. Student attitudes, beliefs and knowledge about medical Cannabis Table 2 compares MC attitudes by gender (male/female) and religiosity (secular/religious). Many Russian people in the country affiliate with a religion (e.g., Orthodox Christian, Muslim, etc.). However, they tend to practice religious tenets at a very low level.9 In the event of MC legalization in Russia, female students indicated that they would be more likely to recommend MC for patient treatment (41.7% vs. 26.1%; p < .001) and cannabis legalization for recreational purposes (31.7% vs. 18.6%; p = .001). Also, they believed cannabis is not addictive (30.7% vs. 16.5%; p < .001) and does not pose serious physical (39.8% vs. 22.6%; p < .001) or mental health (34.6% vs. 20.2%; p = .001) risk. Regarding religiosity, secular students reported more positive attitudes toward MC use than those who reported to be religious. They were more inclined to recommend MC for patient treatment (57.6% vs. 27.0%; p < .001), believed it has benefits for physical (54.3% vs. 28.2%; p < .001) and mental health (56.7% vs. 31.8%; p < .001) purposes, supported additional research (76.1% vs. 61.5%; p = .009), and supported legalization of recreational cannabis (36.6% vs. 21.8%; p = .003). Regarding chronic pain, 41.1% (n = 179) of the students believed MC acceptable and 24.6% (n = 107) unacceptable for patient treatment. More than 34% (n = 149) indicated they had no knowledge about cannabis use for medical conditions of chronic pain as well as cancer, arthritis and multiple sclerosis; and, 48.3% (n = 219) said they were ready to answer patient/client questions about medical cannabis Regarding information about MC, students reported their sources are medical literature (47.1%), classroom lectures (20.1%), clinical
2.4. Data analysis Pearson Chi-square test for categorical variables was performed using Statistical Package for the Social Sciences (SPSS), version 25. SPSS is one of the most popular tools for processing and analyzing research results in medical and social sciences. Responses to MC 2
Complementary Therapies in Medicine 48 (2020) 102274
V. Gritsenko, et al.
Table 2 Student Medical Cannabis Attitudes and Beliefs: Gender and Religiosity. Gender1
I would recommend MC for patient/client use There are significant physical health benefits using MC There are significant mental health benefits using MC Cannabis should be legalized for recreational use Cannabis is not addictive Using cannabis does not pose serious physical health risks Using cannabis does not pose serious mental health risks Additional research regarding MC use should be encouraged 1 2
Religiosity1
Male N = 255 (%)
Female N = 208 (%)
p value2
Secular N = 94 (%)
Religious N = 364 (%)
p value2
65 (26.1) 78 (31.7) 78 (32.1) 46 (18.6) 41 (16.5) 56 (22.6) 50 (20.2) 157 (64.1)
86 (41.7) 73 (35.6) 86 (42.4%) 65 (31.7) 63 (30.7) 82 (39.8) 71 (34.6) 131 (64.2)
< 0.001 0.382 0.025 0.001 < 0.001 < 0.001 0.001 0.976
53 50 51 34 23 37 33 70
97 (27.0) 100 (28.2) 112 (31.8) 77 (21.8) 80 (22.4) 99 (27.7) 86 (24.2) 217 (61.5)
< 0.001 < 0.001 < 0.001 0.003 0.598 0.020 0.024 0.009
(57.6) (54.3) (56.7) (36.6) (25.0) (40.2) (35.9) (76.1)
Up to six subjects in each group missing data on some variables. χ2 test for categorical variables was used to evaluate gender and religiosity (i.e., secular and non-secular) differences.
practical setting (6.7%), physicians (14.3%), and other (11.8%). Most students (86.9%) indicated there is a lack of education about MC. As mentioned above, year of study (first, second, third, fourth and more) did not significantly influence student responses.
based on years of cross-national effort, mutual trust, respect and publication among the researchers involved.11,12,13 Similar type relations are considered to be an important foundation for future research especially where cannabis use in any form is prohibited.
4. Discussion & conclusion
Ethical approval
The role of MC for pain and other medical conditions such as cancer, arthritis and multiple sclerosis tends to evolve based on social, political, legal, economic and other conditions. When it does, in a country such as Russia, up to date information drawn from evidence-based research as well as student and clinical practitioner knowledge, attitudes and beliefs should contribute to informed decision making for possible curriculum development, education and policy purposes. To the best of our knowledge, this is the first study of Russian medical students about MC. Study results show the majority of Russian origin medical students do not support cannabis for medical conditions. However, results evidence that gender and religiosity influence student knowledge, attitudes and beliefs about possible MC use and legalization. Previous studies of physicians suggest being secular or less religious is associated with greater support for legalizing cannabis.8,10 Present study results of Russian secular medical students are consistent with such findings. Finally, the vast majority of medical students report a lack of MC education. This is expected in a country that does not legitimize its use. Among the students surveyed, about 34% report no knowledge about MC while a significant portion of the remaining students (i.e., 48%) indicate, based on what knowledge they have, that they are prepared to answer client questions about MC. Future research of medical student MC knowledge, attitudes and beliefs should be conducted, across locations throughout Russia, to enhance generalization of the present study findings. Further study of a comparative nature where MC is legal or prohibited may contribute to universal MC education.
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethics standards. Author contribution statement Dr. Valentina Gritsenko: Conceptualization, Methodology, Reviewing and Editing; Dr. Vsevolod Konstantinov: Organization, Survey Instrument Validation and Translation in Russian; Dr. Alexander Reznik: Survey Instrument Validation and Translation in Russian and English, Data Analyses; Writing; Dr. Richard Isralowitz: Survey Instrument development; English Writing and Editing Declaration of Competing Interest The authors declare that they have no conflict of interest. Acknowledgements Drs. Toby and Mort Mower are acknowledged for their generous support of the Ben Gurion University of the Negev, Regional Alcohol and Drug Abuse Research Center. References 1. MacCallum CA, Russo EB. Practical considerations in medical cannabis administration and dosing. Eur J Intern Med. 2018;49:12–19. 2. McGuire P. Medical marijuana education for medical students. Retrieved from University of Massachusetts Medical School; 2017https://escholarship.umassmed. edu/cgi/viewcontent.cgi?article=1004&context=capstone. 3. Di Forti M, Quattrone D, Freeman TP, et al. The contribution of cannabis use to variation in the incidence of psychotic disorder across Europe (EU-GEI): a multicentre case-control study. Lancet Psychiatry. 2019;6(5):427–436. 4. Evanoff AB, Quan T, Dufault C, Awad M, Bierut LJ. Physicians-in-training are not prepared to prescribe medical marijuana. Drug Alcohol Depend. 2017;180:151–155. 5. Gage SH. Cannabis and psychosis: triangulating the evidence. Lancet Psychiatry. 2019;6(5):364–365. 6. Isralowitz R, Reznik A. Cannabis use in Israel: a cross sectional overview of multiple study groups. Int J Ment Health Addict. 2018;16(4):832–842. 7. World Health Organization (WHO). News briefing - 40th WHO expert committee on drug dependence (ECDD). Retrieved from 2018; 2018https://www.who.int/medicines/ news/2018/news_briefing_ecdd/en/. 8. Chan MH, Knoepke CE, Cole ML, McKinnon J, Matlock DD. Colorado medical students’ attitudes and beliefs about marijuana. J Gen Intern Med. 2017;32(4):458–463. 9. Zabaev I, Mikhaylova Y, Oreshina D. Neither public nor private religion: The Russian Orthodox Church in the public sphere of contemporary Russia. J Contemp Relig.
5. Limitations The primary limitation of our study is the number of medical students surveyed from one university, at one point in time, in a political environment that strictly prohibits cannabis use in any form – medical or recreational. While no differences were found based on age/year of study, it is recognized the data collected are weighted toward younger students. Future research should look into whether MC knowledge, attitudes and beliefs are affected by age/year of study. However, in an environment where MC is strictly prohibited, such as Russia, it is not believed older students will evidence opinions different from those reported in the present study. This is contrary to research where the substance is legal showing MC knowledge, attitudes and beliefs among older students are affected by more exposure to this topic in their clinical years. Additionally, it should be mentioned that this study is 3
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V. Gritsenko, et al. 2018;33(1):17–38. 10. Charuvastra A, Friedmann PD, Stein MD. Physician attitudes regarding the prescription of medical marijuana. J Addict Dis. 2005;24(3):87–93. 11. Gritsenko V, Gavronova Y, Khalepo O, Reznik A, Isralowitz R. University student attitudes toward illicit drug use and trafficking in Russia. Int J Ment Health Addict. 2017;15(2):350–355.
12. Isralowitz R, Reznik A, Gritsenko V, Khalepo O, Kovaleva Y. Alcohol use and related problem behavior: a survey among Russian Federation and Israeli Female University students. Int J Ment Health Addict. 2018;16(3):707–710. 13. Reznik A, Isralowitz R, Gritsenko V, Khalepo O, Kovaleva Y. Russian Federation university student alcohol use: Smolensk City – a case example. J Ethn Subst Abuse. 2018. https://doi.org/10.1080/15332640.2017.
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