Cannabis based drugs: GPs will have to manage patients’ expectations, says expertBMJ 2018; 363 doi: https://doi.org/10.1136/bmj.k4354 (Published 16 October 2018) Cite this as: BMJ 2018;363:k4354
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We read with interest the words of Ian Hamilton, quoted in Gareth Iacobucci’s article 1. Mr Hamilton advises GPs without specialist knowledge of the evidence for medicinal cannabis to discuss with colleagues in their team and to use Google Scholar to resolve uncertainties, until such as time as NHS England and the National Institute for Health and Clinical Excellence produce guidance
We acknowledge that the evidence for medicinal cannabis in a number of conditions is unclear, but it does exist and is discoverable, for example, a recent Cochrane review of cannabis‐based medicines for chronic neuropathic pain 2, and evidence summaries in point of care tools such as DynaMed Plus3.
While Google Scholar is an admirable and innovative resource, any one search tool, whether bibliographic database, search engine, or hybrid, will only give a partial view of the literature. We would suggest that there is a better and more efficient way to fill knowledge gaps: to use the services of an expert in evidence synthesis and appraisal, a librarian. In doing so, clinicians can save time, and be assured that literature from multiple sources has been brought together into a comprehensive and reliable view of the current state of knowledge. A 2016 study of clinical librarians’ impact on patients and health care organisations4 found positive effects on continuing professional development (CPD), decision making and evidence-based practice. These could be helpful for a GP whose specialist knowledge of medicinal cannabis, as Hamilton notes, may be limited. In addition, many health librarians are experts in teaching critical appraisal, a crucial skill when searching and reading the literature.
Librarians may be found in NHS Library and Knowledge Services, Royal Colleges and other membership organisations, and in higher education. While local access arrangements vary within England, primary care and community NHS staff in Wales and Scotland can access both online resources and physical library stock. All HSC staff in Northern Ireland (including primary and secondary care) are eligible to access online resources and physical library stock, as well as advice and support from specialist librarians. We recommend GPs or other NHS staff based in England contact their local hospital to discover what access they have to library resources: services may be located using the Health Library and Information Services Directory (HLISD)5 website is searchable by location so staff can find their nearest service. We are aware that access to library services may be uneven across the UK; we believe this presents an opportunity to resolve this issue, and for the information profession and other interested bodies such as the Royal College of General Practitioners (RCGP) to work more closely towards solutions.
We would urge any health professional who needs a succinct usable summary of current evidence to ask a librarian.
The authors work as librarians in the NHS and higher education
1 Iacobucci Gareth. Cannabis based drugs: GPs will have to manage patients’ expectations, says expert BMJ 2018; 363 :k4354
2 Mücke M, Phillips T, Radbruch L, Petzke F, Häuser W. Cannabis‐based medicines for chronic neuropathic pain in adults. Cochrane Database of Systematic Reviews 2018, Issue 3. Art. No.: CD012182. DOI: 10.1002/14651858.CD012182.pub2.
3 DynaMed Plus [Internet]. Ipswich (MA): EBSCO Information Services. 1995 - . Record No. 901291, Medical uses of cannabinoids; [updated 2018 Aug 22]; [about 33 screens]. Available from http://www.dynamed.com/login.aspx?direct=true&site=DynaMed&id=901291. Registration and login required.
4 Brettle A, Maden M, Payne C. The impact of clinical librarian services on patients and health care organisations. Health Information and Libraries Journal [internet]. 2016 Feb 17 [cited 2018 Oct 22]; 33(2): 100-120. Available from: doi:https://doi.org/10.1111/hir.12136
5 Health Library and Information Services Directory (HLISD). [Internet] 2018 [cited 2018 Oct 22]; [50+ screens]. Available from: https://www.hlisd.org/
Competing interests: No competing interests
Further to Ian Hamilton’s recommendation that GPs with less experience discuss the issue with other members of the practice team and consult Google Scholar, we write to remind readers in England that NICE and Health Education England (HEE) provide a wealth of evidence resources to inform clinical decisions, and to invite them to contact their local healthcare library and knowledge service.
NICE Evidence search is a search engine which provides access to selected and authoritative evidence in health, social care and public health. It focuses on synthesised secondary evidence. It includes resources from over 800 sources such as the British National Formulary, Clinical Knowledge Summaries, SIGN, the Cochrane Library, Royal Colleges, Public Health England and GOV.UK, with further good quality systematic reviews added by information and knowledge specialists at NICE. It includes systematic reviews on the use of cannabis in treatment of epilepsy, neuropathic pain and asthma. This service is freely available to everyone in the UK at https://www.evidence.nhs.uk
NICE also provides access to the Cochrane Library for everyone in England. A search in Cochrane for ‘cannabis medicinal use’ returns articles such as ‘Cannabis‐based medicines for chronic neuropathic pain in adults’ (2018), ‘The medical use of cannabis for reducing morbidity and mortality in patients with HIV/AIDS’ (2013) and ‘Cannabinoids for fibromyalgia’ (2016).
In addition healthcare staff in England have free access to a wealth of specialist healthcare databases and full text journals, purchased by HEE on behalf of the NHS in England and made available online in partnership with NICE. To search these resources at https://hdas.nice.org.uk/ you need an NHS OpenAthens account. Register at https://www.nice.org.uk/about/what-we-do/evidence-services/journals-and-....
Moreover, NHS-funded healthcare librarians and knowledge specialists can help you search for evidence and provide summarised evidence searches. We encourage practices to contact their local healthcare library. Check http://hlisd.org if you are unsure who to speak to.
HEE is committed to working with NHS bodies to ensure that all staff can freely access knowledge services and the expertise of healthcare librarians and knowledge specialists. Currently only a third of Clinical Commissioning Groups have access arrangements in place for their staff and member practices. By all means connect to your regional HEE Library Lead for advice. See https://www.hee.nhs.uk/our-work/library-knowledge-services).
Competing interests: We are responsible for the delivery of of the services described in this response.
I would like to point out that all GPs and primary care staff in NHS Scotland have free access to all the digital library subscription resources provided by NHS Education for Scotland. These include point of care evidence summary services, full text journals, books and a range of databases available via The Knowledge Network. To help answer questions there are NHS librarians in each health board and the national clinical enquiry and response service CLEAR. For more information contact firstname.lastname@example.org
Competing interests: No competing interests