Medicinal use of non-prescribed cannabis: motives for use, perceived effectiveness and barriers to treatment (MEDUSA)

Background
Around half a million people in the Netherlands use cannabis-based products for medicinal purposes. However, the vast majority of them does not have a prescription for medical cannabis. They obtain their cannabis from coffeeshops or Social Clubs, grow it themselves, or obtain it via other illicit routes. The aim of the MEDUSA-study is to gain insight into this population of people who use non-prescribed cannabis for medicinal purposes, and to identify factors that impact access to treatment with medical cannabis.
 
Methods
The study includes a convenience sample of people who self-report using cannabis for physical or mental health symptoms. More than a 1000 individuals completed an online questionnaire and 33 individuals participated in in-depth interviews.
 
Results
The participant sample is highly diverse. Individuals have a high comorbidity and use a wide range of cannabis products for different physical and mental health conditions. They rate cannabis as effective for improving their symptoms and enhancing their quality of life. We also examined cannabis as an alternative to pharmaceutical medications, in terms of self-reported effectiveness and side effects. Furthermore, concerns around addiction, contaminants, illegality, and stigma as a drug user are explored. Gender differences are investigated. Finally, we identified barriers to treatment pertaining to systemic, physician-related and patient-related factors. 
 
Conclusions
Significant changes in policy, prescription practices, product availability and information provision are needed to improve access to treatment and meet patient needs. Providing regulated clean products under medical supervision provides an opportunity to mitigate harms, address addiction concerns, and reduce the stigma surrounding cannabis as medicine.