Supplementary Material for: Gastroenterologists’ Attitude Regarding Medical Cannabis for Inflammatory Bowel Diseases in Israel

Background: The use of medical cannabis (MC) for inflammatory bowel diseases (IBDs) 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 Web-based survey was completed by 84 (34%) gastroenterologists in Israel. Results: Out of 84 physicians whom completed the questionnaire, 59 (70%) were male, 34 (40%) were under age 50 years, 71 (85%) were adult gastroenterologists, and 53 (63%) work mainly in a hospital. Of them, 15, 41, and 44% 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 31, 47, and 22%, respectively. Older physicians (above age 50 years) were significantly more likely to have a positive attitude towards MC in both questions. When presented with a clinical scenario of a patient in deep remission, requesting to increase the dose, 32% would increase, 49% would maintain, and only 18% would stop prescribing MC altogether; 48% of physicians did not know the recommended initial dose for MC. Only 2 (2.5%) physicians initiated the use of MC to all patients. Female gastroenterologists were significantly more likely to initiate MC, p = 0.048. Conclusion: The use of MC for IBD patients is commonly encountered. Completely different attitudes regarding this treatment were seen. Age above 50 years and female physicians generally had a more positive attitude towards the use of MC. Guidelines and clear recommendations are needed.

背景：医用大麻（medical cannabis, MC）用于炎症性肠病（inflammatory bowel diseases, IBDs）的治疗场景正不断增多。现有证据尚不支持医用大麻可减轻炎症性肠病患者的炎症反应。尽管如此，诸多消化科医师（gastroenterologists）仍面临向炎症性肠病患者推荐使用医用大麻的临床困境。
研究方法：以色列共有84名消化科医师完成了本次网络问卷调查，应答占比为34%。
研究结果：在完成问卷的84名医师中，59人（70%）为男性，34人（40%）年龄不足50岁，71人（85%）为成人消化科医师，53人（63%）主要就职于医院。其中，分别有15%、41%、44%的医师认为医用大麻疗效极佳、疗效温和且完全无效。分别有31%、47%、22%的医师会经常、极少、从不推荐炎症性肠病患者使用医用大麻。年龄超过50岁的医师在上述两个调研问题中均更倾向于对医用大麻持积极态度。当面对一名处于深度临床缓解期且要求增加用药剂量的患者时，32%的医师会调整增加剂量，49%的医师会维持现有给药方案，仅18%的医师会完全停止开具医用大麻处方；48%的医师不清楚医用大麻的推荐初始给药剂量。仅有2名（2.5%）医师会向所有炎症性肠病患者开具医用大麻处方。女性消化科医师更倾向于开启医用大麻治疗，差异具有统计学意义（p=0.048）。
研究结论：临床中经常会遇到炎症性肠病患者使用医用大麻的相关诉求与决策问题。目前针对该治疗方案的临床态度存在显著分歧。年龄超过50岁的医师及女性消化科医师通常对医用大麻的使用持有更为积极的态度。亟需制定针对炎症性肠病患者使用医用大麻的临床指南与明确推荐方案。