Crowley et al. Harm Reduction Journal (2017) 14:4
DOI 10.1186/s12954-016-0129-7

RESEARCH

Open Access

Irish general practitioner attitudes toward
decriminalisation and medical use of
cannabis: results from a national survey
Des Crowley2, Claire Collins2, Ide Delargy2, Eamon Laird3 and Marie Claire Van Hout1,2*

Abstract
Background: Governmental debate in Ireland on the de facto decriminalisation of cannabis and legalisation for
medical use is ongoing. A cannabis-based medicinal product (Sativex®) has recently been granted market
authorisation in Ireland. This unique study aimed to investigate Irish general practitioner (GP) attitudes toward
decriminalisation of cannabis and assess levels of support for use of cannabis for therapeutic purposes (CTP).
Methods: General practitioners in the Irish College of General Practitioner (ICGP) database were invited to complete
an online survey. Anonymous data yielded descriptive statistics (frequencies, percentages) to summarise participant
demographic information and agreement with attitudinal statements. Chi-square tests and multi-nominal logistic
regression were included.
Results: The response rate was 15% (n = 565) which is similar to other Irish national GP attitudinal surveys. Over halfof Irish GPs did not support the decriminalisation of cannabis (56.8%). In terms of gender, a significantly higher
proportion of males compared with females (40.6 vs. 15%; p < 0.0001) agreed or strongly agreed with this drug
policy approach. A higher percentage of GPs with advanced addiction specialist training (level 2) agreed/strongly
agreed that cannabis should be decriminalised (54.1 vs. 31.5%; p = 0.021). Over 80% of both genders supported theview that cannabis use has a significant effect on patients’ mental health and increases the risk of schizophrenia(77.3%). Over half of Irish GPs supported the legalisation of cannabis for medical use (58.6%). A higher percentageof those who were level 1-trained (trained in addiction treatment but not to an advanced level) agreed/strongly
agreed cannabis should be legalised for medical use (p = 0.003). Over 60% agreed that cannabis can have a role inpalliative care, pain management and treatment of multiple sclerosis (MS). In the regression response predicatoranalysis, females were 66.2% less likely to agree that cannabis should be decriminalised, 42.5% less likely to agree
that cannabis should be legalised for medical use and 59.8 and 37.6% less likely to agree that cannabis has a role inpalliative care and in the treatment of multiple sclerosis (respectively) than males.
Conclusions: The majority of Irish GPs do not support the present Irish governmental drug policy of
decriminalisation of cannabis but do support the legalisation of cannabis for therapeutic purposes. Male GPs andthose with higher levels of addiction training are more likely to support a more liberal drug policy approach tocannabis for personal use. A clear majority of GPs expressed significant concerns regarding both the mental andphysical health risks of cannabis use. Ongoing research into the health and other effects of drug policy changes on
cannabis use is required.
Keywords: Cannabis, Decriminalisation, Legalisation, Medical use, Cannabis for therapeutic purposes (CTP), Generalpractitioner* Correspondence: mcvanhout@wit.ie
1School of Health Sciences, Waterford Institute of Technology, Waterford,
Ireland2
Irish College of General Practitioners, Dublin, Ireland
Full list of author information is available at the end of the article© The Author(s). 2017 Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0
International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, andreproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to
the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver(http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

Crowley et al. Harm Reduction Journal (2017) 14:4

Background
Cannabis is the most prevalent illicit drug used globally[1]. The policy landscape around cannabis is dynamic [2],with three drug policy options available, prohibition, decriminalisation and legalisation [3]. In recent years, thelegal status of cannabis has been extensively debated inacademic and policy domains, with many jurisdictions
making or considering major changes in their domestic
laws and policies on this issue. The International Centre
for Science in Drug Policy have advised that such policy
responses need to be based on best available evidence [4].
The United Nations (UN) Drug Conventions support
the prohibitionist approach and require signatories tomake the possession of cannabis a criminal offence
under their domestic laws [5]. Policy makers challenging
this approach argue that the criminalisation of cannabis
is an expensive and ineffective drug control policy which
has no impact on reducing availability or use despite its
significant financial costs [6]. Proponents for policychange support a less punitive approach to cannabis
users with a greater emphasis on public health and human rights [2, 5, 6]. The decriminalisation drug policy
approach involves the removal of criminal sanctions for
those found in possession of small amounts of the drugfor their own use [5]. However, the use of the drug is notlegal, and non-criminal offences may still be applied [5].
Underpinning this approach is the argument that cannabis
is a relatively safe drug when compared to alcohol and tobacco, and criminal sanctions for personal use and possession of small amounts are excessive [6]. Prohibitionist
continues to argue that removal of criminal barriers willlead to increased supply, use, dependence and harm [3].
With increasing public support for the decriminalisation of cannabis use, some jurisdictions are now developing and implementing a range of legally regulated
market models for recreational cannabis use [2]. Legalisation of cannabis usually refers to the removal of all
criminal and non-criminal sanctions for its use, production and supply. However, legal regulation will set out therules and restrictions around how these can occur [5].
Despite widespread prohibition, many multiple sclerosis and chronic pain patients use cannabis for analgesia
and psychological support [7]. Some states in the USA
have moved toward allowing individuals to use cannabis
for medical purposes [5], with resultant debate onwhether these laws have led to increased use [8]. Debates around legalisation of medical cannabis centre on
the beliefs that cannabis has medical effects, medicalcannabis is addictive and that legalisation leads to increased use for recreation (i.e. spillover effects) [9]. Some
reports indicate the potential value of cannabis for therapeutic purposes (CTP) [10–15]. However, some concerns
around the addictive potential of cannabis are evident[4, 5, 16] but with a weak evidence base indicating

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lower probability of dependence and physical and social
harm when compared to alcohol, cocaine, opiates andnicotine [4]. Legalisation in the form of de facto legal supply for medical use (CTP) does not appear to have createda significant threat to public health and safety, or caused
increased consumption or related harms [17–20]. In termsof patient experience, legalisation appears to increase patient’s feelings of safety and awareness [21].
To date, eight US states (Alaska, California, Colorado,
Oregon, Massachusetts, Maine, Nevada and Washington)
have now voted to legalise cannabis for both medical andnon-medical use, and one state (Washington DC) has
legalised it for personal use but not commercial sale [5].
Regulatory debates are ongoing in many countries including Canada, Jamaica, Italy, Spain, several Latin Americancountries and additional US states [5].
To date, research on medical practitioner views on thisissue remains scant [17]. In the past 20 years, only aminority of oncologists surveyed in the USA were in support of the rescheduling of cannabis for medical purposes[22] and the availability of cannabis on prescription [23].
More recently, in the USA, medical practitioner views on
medical cannabis are generally less supportive of medicaluse, underpinned by recognition of its potential for serious
mental and physical health risks [24, 25]. Israeli practitioners have voiced partial acceptance for therapeutic use,with further research warranted to investigate educationaland regulatory needs [26]. Israeli rheumatologists in 2016
report majority opinion of some role for cannabinoids inthe management of rheumatoid disease [27].
Our study is the first of its kind in Ireland and aimed
to investigate Irish general practitioner (GP) attitudes toward decriminalisation of cannabis and assess levels of
support for CTP. The study was undertaken on foot ofseveral regulatory developments and debates in Ireland,in particular, a recent governmental debate and reporting from the Oireachtas Justice Committee on the proposed decriminalisation of cannabis. The committee
recommended that possession of small amounts of cannabis for personal use should not be dealt with throughthe criminal justice system and that small-scale users
should be treated with compassion. Other debates
centred on CTP in Ireland with authorisation necessary
from the Health Products Regulatory Authority (HPRA)or, in the case of certain medicinal products, the European
Medicines Agency (EMA). In July 2014, regulations wereamended to allow for certain cannabis-based medicinal
products to be used in Ireland. The HPRA granted a marketing authorisation for a cannabis-based medicinal product (Sativex®) which is indicated for the treatment of
spasticity for people with multiple sclerosis. However, themost recent national treatment data indicates cannabis is
the most common problem drug among new cases presenting for drug treatment [28].

Crowley et al. Harm Reduction Journal (2017) 14:4

Methods
In Ireland, medical training for general practitioners isoverseen by the Irish College of General Practitioners(ICGP). Training in substance misuse is provided aslevels 1 and 2 training. GPs trained to these levels haveacquired additional knowledge and experience in thetreatment and management of substance use problems.
Ethical approval was granted by the ICGP. In early 2016,
an online survey was undertaken with all GPs in the
ICGP database based in the Republic of Ireland. Electronic invitations included information on the study andconsent information, and a link to access the online survey was sent. A notice encouraging response was also
placed on the substance misuse section of the ICGP
website. The survey was designed based on a review ofthe literature and in consultation with the project team.
The instrument contained a series of closed questions
relating to participant profile and practice location, specialist registration, experience in treating opioid users
and their responses toward a five-point Likert scalemeasuring agreement with a series of statements. Statements measured attitude toward decriminalisation of
cannabis, legalisation for CTP, potential for decriminalisation to increase cannabis use, adverse mental andphysical health effects of cannabis use, cannabis use inyoung people and risk of development of schizophrenia
and role of CTP in pain management, treatment of multiple sclerosis and palliative care. The survey took an estimated 10 min to complete. While the response rate forthis online survey was low (15%), it is consistent withthe response rates from GPs nationally and internationally for similar type of studies [29–31].
Anonymous data yielded descriptive statistics (frequencies, percentages) to summarise participant demographic
information and agreement with attitudinal statements.
Statistical analysis was performed using the Statistical
Package for Social Sciences (Version 21.0; SPSS UK Ltd;
Chersey, UK). Where appropriate, chi-square tests wereapplied to determine the statistical significance (p < 0.05).
Multi-nominal logistic regression analysis was used to determine predictors of answer responses with the neutral
response category as the reference.
Results
Participant characteristics

The participant characteristics are displayed in Table 1.
There was no significant difference in the proportion ofmales or females sampled (p = 0.180). The majority ofmales (50.5%) tended to be older (>50 years), while themajority of females were aged between 30–50 years(62.4%). Most of the participants were full-time practitioners, (71.3%) though significantly more males were retired compared with females (8.6 vs. 4.2%; p = 0.030),
while significantly more females were trainees (23.0 vs.

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15.1%; p = 0.017). Over 70% of respondents were on the
GP Specialist Register of the Irish Medical Council with
85% working in general practice. Nearly 30% of the sample
was level 1-trained managing opioid users, while only
4.4% were level 2-trained. There was no difference acrossgender in the practice population with the majority working in an urban area (43.7%) with nearly 40% working inan area of deprivation. Selection bias is limited as all
demographics of the responding group are consistent with
the national data on GPs [32, 33] (Table 1).
Statement responses

The answer responses were examined by gender, age andtraining level. A significantly higher proportion of males
compared with females (40.6 vs. 15.0%; p < 0.0001) agreed
or strongly agreed that cannabis should be decriminalised,
while more males than females also agreed that cannabis
should be legalised for medical use (p = 0.002). There wereno significant differences in the responses to the remaining
questions by gender; for example, approximately 80% of
both genders agreed that cannabis use has a significant effect on patients’ mental health and increases the risk ofschizophrenia (77.3%), while over 60% of both males andfemales agreed that cannabis can have a role in pain management, multiple sclerosis and palliative care (Table 2).
When analysed by age, only 29% of those aged <50 years
agreed that cannabis should be decriminalised. In contrast,
a significantly higher proportion of those aged >50 years
agreed that cannabis should be legalised for medical use
compared to the younger GPs sampled (71.1 vs.
79.6%; p = 0.044). When analysed by level of training,a higher percentage of those who were level 1-trained
agreed/strongly agreed cannabis should be legalised for
medical use (p = 0.003). However, a significantly lower
proportion of this group agreed/strongly agreed that cannabis has a role in pain management (p = 0.032), in treatment of multiple sclerosis (p = 0.037) and in palliative care(p = 0.047) compared to those who are not level 1-trained.
In contrast, a higher percentage of those level 2-trained
agreed/strongly agreed that cannabis should be decriminalised compared to those without this training (54.1 vs.
31.5%; p = 0.021) (Tables 3, 4 and 5).
In the regression response predicator analysis, females
were 66.2% less likely to agree that cannabis should be
decriminalised, and 42.5% less likely to agree that cannabis should be legalised for medical use compared withmales. Females were also 59.8 and 37.6% less likely toagree that cannabis has a role in palliative care and arole in the treatment of multiple sclerosis (respectively)
than males. Furthermore, GPs based in a non-deprived
area were 56.4% more likely to agree that cannabis has arole in pain management compared to those working in
a deprived area, while GPs aged 30–50 years were
189.5% more likely to disagree that cannabis can have aCrowley et al. Harm Reduction Journal (2017) 14:4

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Table 1 Participant characteristics
Total (n 565)

Male (n 278)

Female (n 287)

p value

41 (7.3)

16 (5.8)

25 (8.7)

0.180

Age n (%)
<30 years
30–50 years

300 (53.2)

121 (43.7)

179 (62.4)

0.288>50 years

223 (39.5)

140 (50.5)

83 (28.9)<0.000118 (3.2)

8 (2.9)10 (3.5)

0.681

Membership of the ICGP n (%)
Associate, part-time, others
Full-time403 (71.3)

204 (73.4)

199 (69.3)

0.288

Retired36 (6.4)

24 (8.6)

12 (4.2)

0.030

Trainee108 (19.1)

42 (15.1)

66 (23.0)

0.017

On the GP specialist register

435 (77.5)

216 (78.3)

219 (76.8)

0.687

Working in general practice482 (85.3)

242 (87.1)

240 (83.6)

0.250

Training n (%)

Working in academic general practice

129 (23.0)

64 (23.4)

65 (22.7)

0.859

Level 1-trained GP managing opioid users

169 (29.9)

77 (27.7)

92 (32.1)

0.258

Level 2-trained GP managing opioid users

25 (4.4)

16 (5.8)9 (3.1)0.130

Practice population n (%)
Mixed

211 (39.7)

110 (41.5)

101 (38.0)

0.405

Rural

88 (16.6)42 (15.8)

46 (17.3)

0.655

Urban

232 (43.7)

113 (42.6)

119 (44.7)

0.626

Working in an area of deprivation

211 (39.4)

99 (37.4)

112 (41.5)

0.329

Values are n (%); chi-square analysis for categorical variables for comparisons of distributions between genderrole in the treatment of multiple sclerosis compared tothose not in that age group (Table 6).

Discussion
This study yielded unique findings with regard to Irish
GP views on decriminalisation of cannabis and the medical use of cannabis (CTP). The majority of GPs did notsupport the decriminalisation of cannabis, but male respondents were significantly more likely to support thisdrug policy approach than their female counterparts.
This majority view is contrary to current Irish

government policy on the issue. Nearly 60% of GPs supported the legalisation of cannabis for medical use witholder (>50) and male GPs more likely to favour this approach. In contrast to the view on decriminalisation, thismajority view supports Irish government policy on CTP.
In 2000, the Irish Drug Related Knowledge, Attitudes
and Beliefs survey found that males reported greater useof cannabis and knowledge of cannabis users than females [34]. This study, while dated, indicated that only
24% were in favour of legalisation of cannabis. Of interest is that the majority of GPs trained to a more

Table 2 Statement responses by genderTotaln (%) Agreed
FemaleMalep value

Cannabis should be decriminalised

156 (27.6)

43 (15.0)

113 (40.6)<0.0001

Cannabis should be legalised for medical use

331 (58.6)

146 (50.9)

185 (66.5)

0.002

The decriminalisation of cannabis use would lead to its increased use

373 (66.0)

200 (69.7)

173 (62.2)

0.089

Cannabis use has a significant adverse effect on patients’ mental health467 (82.7)

246 (85.7)

221 (79.5)

0.346

Cannabis use has a significant adverse effect on patients’ physical health339 (60.0)

175 (61.0)

164 (59.0)

0.111

Cannabis use among young people increases the risk of schizophrenia

437 (77.3)

228 (79.4)

209 (75.2)

0.990

Cannabis has a role to play in pain management359 (63.5)

166 (57.8)

193 (69.4)

0.511

Cannabis can have a role in the treatment of multiple sclerosis

352 (62.3)

165 (57.5)

187 (67.3)

0.914

Cannabis can have a role in palliative care

387 (68.5)

175 (61.0)

212 (76.3)

0.362

Total agreed (strongly agree and agree). Values are n (%); chi-square analysis for categorical variables for comparisons of distributions between genderCrowley et al. Harm Reduction Journal (2017) 14:4

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Table 3 Statement responses by agen (%) Agreed<50 years>50 years

p value

Cannabis should be decriminalised

85 (29.7)

71 (37.3)

0.082

Cannabis should be legalised for medical use

190 (71.1)

141 (79.6)

0.044

The decriminalisation of cannabis use would lead to its increased use

232 (82.2)

141 (82.4)

0.960

Cannabis use has a significant adverse effect on patients’ mental health281 (92.4)

185 (92.5)

0.978

Cannabis use has a significant adverse effect on patients’ physical health

210 (81.3)

128 (81.5)

0.973

Cannabis use among young people increases the risk of schizophrenia

269 (91.8)

167 (89.3)

0.354

Cannabis has a role to play in pain management

221 (88.4)

138 (82.1)

0.072

Cannabis can have a role in the treatment of multiple sclerosis

208 (92.4)

144 (87.8)

0.123

Cannabis can have a role in palliative care

235 (90.0)

152 (85.3)

0.139

Total agreed (strongly agree and agree). Values are n (%); chi-square analysis for categorical variables for comparisons of distributions between age

specialist level in addictions supported decriminalisation(54.1% p = 0.021). This may in part be due to their experience treating patients with opioid dependence inparticular injecting drug users. In this patient cohort,cannabis use is often considered a secondary issue whenmanaging the high-risk behaviour and health issues associated with injecting drug use. In contrast, in terms ofgender, regression analyses revealed that females wereless likely to agree that cannabis should be decriminalised. Prevalence data in Ireland has reported littlechange in women’s rates of cannabis use, with prevalence rates highest among men and younger adults aged
15–34 years [35]. Research shows that individuals withpersonal experience of cannabis use are more inclined to
be in favour of legalising [36]. According to the National
Advisory Committee on Drugs and Alcohol (NACDA)
in 2012 general population survey, the majority of respondents agreed with medical use of cannabis and disagreed with recreational use of cannabis. This isconsistent with the drug policy approaches supported byIrish GPs in this survey.

Both genders of GPs in this study voiced concerns thatdecriminalisation would lead to increased use and themisuse of prescribed versions if available. Hall andLynskey [37] speculate that potential effects of legalising
recreational cannabis use, while substantially reducing
the price, increasing excessive use and related harms,
may also increase the number of new users. However, ofinterest, is recent reporting of a great overlap between
medicinal and recreational cannabis use in the USA [38].
Regulating the cannabis market via prohibition and decriminalisation has a marginal effect on onset of cannabis use and population consumption rates [6]. Yuyan etal. [39] in their review of 38 countries indicated thatcannabis liberalisation with depenalization and partial
prohibition policies was associated with higher levels of
regular cannabis use among adolescents. This is concerning given a recent Irish study [40] which underscored the relatively low levels of adolescent-perceived
risk of mental and physical health problems with use of
the drug. According to Eurobarometer [41], Ireland has
the highest number of young people who have used

Table 4 Statement responses by training level (level 1)n (%) Agreed
Not level 1

Level 1

p value

Cannabis should be decriminalised

114 (34.7)

42 (28.1)

0.156

Cannabis should be legalised for medical use

245 (78.5)

86 (65.1)

0.003

The decriminalisation of cannabis use would lead to its increased use

264 (83.0)

109 (80.1)

0.464

Cannabis use has a significant adverse effect on patients’ mental health321 (92.2)

146 (92.9)

0.767

Cannabis use has a significant adverse effect on patients’ physical health229 (80.3)

110 (83.9)

0.377

Cannabis use among young people increases the risk of schizophrenia

301 (89.5)

136 (93.7)

0.142

Cannabis has a role to play in pain management262 (88.2)

97 (80.1)

0.032

Cannabis can have a role in the treatment of multiple sclerosis

257 (92.4)

95 (85.5)

0.037

Cannabis can have a role in palliative care

282 (90.0)

105 (83.3)

0.047

Total agreed (strongly agree and agree).Values are n (%); chi-square analysis for categorical variables for comparisons of distributions between level 1 trainingCrowley et al. Harm Reduction Journal (2017) 14:4

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Table 5 Statement responses by training level (level 2)n (%) Agreed
Not level 2

Level 2p value

Cannabis should be decriminalised

143 (31.5)

13 (54.1)

0.021

Cannabis should be legalised for medical use

313 (74.1)

18 (81.8)

0.422

The decriminalisation of cannabis use would lead to its increased use

360 (82.7)

13 (68.4)

0.110

Cannabis use has a significant adverse effect on patients’ mental health446 (92.7)

21 (87.5)

0.344

Cannabis use has a significant adverse effect on patients’ physical health323 (81.7)

16 (76.1)

0.521

Cannabis use among young people increases the risk of schizophrenia

416 (90.6)

21 (95.4)

0.443

Cannabis has a role to play in pain management341 (85.6)

18 (90.0)

0.588

Cannabis can have a role in the treatment of multiple sclerosis

337 (90.3)

15 (93.7)

0.650

Cannabis can have a role in palliative care

369 (88.2)

18 (85.7)

0.723

Total agreed (strongly agree and agree). Values are n (%); Chi-square analysis for categorical variables for comparisons of distributions between level 2 training

cannabis in the past year (28%), compared to a Europian
Union (EU) average of 17%; 58% of Irish youth havenever taken cannabis, which in 2014 is third lowest in
Europe and well below the EU average of 69%. Overall,
46% of young Irish people consider regular cannabis use
to be high risk, compared to an EU average of 63%. The
Eurobarometer in 2014 [41] also reported that 56% of
Irish 15–24-year-olds were of the view that the cannabis
market should be regulated, which is almost a reverse
position of the EU average, where 45% said cannabis
should be regulated, and 53% said it should continue tobe banned.
GPs in this national study agreed that cannabis use
has a significant effect on patients’ mental health and increases the risk of schizophrenia. Kondrad and Reid [25]have reported majority agreement of US physicians inColorado regarding the serious mental and physicalhealth risks of cannabis. Irish GPs in this study underscored their experience of the significant adverse effecton patient mental health and risks of schizophrenia inyoung users. Heavy use of cannabis at an earlier age isreported to heighten risk of dependence, depressive
disorders, psychosis, suicidal ideation, development ofschizophrenia and related negative social consequences[17]. This contributes to the debate around the cannabinoid hypothesis of psychosis, for example that exposure to cannabis and cannabinoid agonists is associatedwith psychosis outcomes through activation of CB1R
[42–44]. However, to date, a causal relationship has notbeen established [4].
Kondrad and Reid [25] in their 2013 study of physician
experiences and attitudes to medical cannabis reported
that nearly half of participants did not support CTP andthat only a minority thought therapeutic use of cannabis
conferred physical and mental health benefits. Israeli
practitioners in 2015 voiced partial acceptance for therapeutic use, and generally agreed that CTP could be helpful
for chronic and for terminally ill patients [26]. However,oncologists and pain specialists did not agree unanimouslythat medical cannabis can undermine mental health,whereas other physicians did [26]. CTP is driven by public
approval without scientific data routinely required to justify new medication regulation [45, 46]. In 2005, US physicians reported less support of CTP than the public [24].
Irish GPs who reported practicing in a non-deprived areain this study were more likely to agree that cannabis has a

Table 6 Statement response predicators
Category

Variable

Beta

Exp (B)p value

95% CI
lower

upper

Cannabis should be decriminalised

Agree

Female−1.0840.338<0.0001

0.19

0.602

Cannabis should be legalised for medical use

Agree

Female−0.553

0.575

0.017

0.365

0.907

Cannabis has a role to play in pain management

Agree

Female−0.644

0.525

0.003

0.343

0.805

Agree

Non-deprived area

0.447

1.564

0.041

1.018

2.403

DisagreeNot level 1−0.706

0.494

0.049

0.244

0.998

Cannabis can have a role in the treatment ofmultiple sclerosis

Agree

Female−0.472

0.624

0.019

0.42

0.926

Disagree

Aged 30–50 years

1.063

2.895

0.013

1.257

6.668

Cannabis can have a role in palliative care

Agree

Female

−0.91

0.402

<0.0001

0.255

0.636

Multi-nominal logistic regression analysis; reference category is neutral response

Crowley et al. Harm Reduction Journal (2017) 14:4

role in pain management compared to those who reported
working in a deprived area. Level of training for this Irish
sample reflected that a greater percentage of those participants with level 1 substance misuse training agreed/strongly agreed that cannabis should be legalised for medical use. While the clear majority of this group supported
the role of medical cannabis in pain management, treatment of multiple sclerosis and palliative care, they were
statistically less supportive than those without this training. Irish GPs aged 30–50 years were more likely to disagree that cannabis can have a role in the treatment ofmultiple sclerosis compared to those not in that age
group. Kondrad and Reid [25] found that age was significantly associated with the recommendation of medicalcannabis. They also found no significant association withphysician gender, years in practice, or type of licence andrecommendation of medical cannabis. In contrast, thisstudy found that female GPs in Ireland were less likely toagree that cannabis should be legalised for medical use
compared with males, and were also less likely to agree
that cannabis has a role in palliative care or a role in thetreatment of multiple sclerosis than males.

Conclusions
The study is unique in terms of describing Irish GP views
on different drug policy approaches to cannabis use and is
only one of a handful of studies worldwide that examines
physicians’ views on this topical issue. The majority of
Irish GPs do not support decriminalisation of cannabis
use which is now the policy choice of the Irish government. This study found interesting differences in views between male and female GPs and those with different levelsof addiction training and experience. Female GPs tended
to favour a more conservative drug policy approach, while
those with more advanced training supported a more liberal one. The finding of majority support for CTP among
Irish GPs in this study underpins and supports the proposed legislative changes that are presently being considered by the Irish parliament. While supporting this policy
initiative, a clear majority of GPs viewed that such an approach had the potential to increase cannabis use andexpressed concerns regarding both the mental and physical health risks associated with its use. This study captures the views of Irish GPs on potential policy changes
regarding both medical and recreational cannabis use at atime when both are prohibited and will facilitate further
research on how these views may change over timeand be influenced by a different policy approach. Further research is warranted to explore how gender andlevels of addiction training and experience impact
doctors’ views on drug policy.
Abbreviations
CTP: Cannabis for therapeutic purposes; EMA: European Medicines Agency;
EU: European Union; GP: General practitioner; HPRA: Health Products

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Regulatory Authority; ICGP: Irish College of General Practitioners;
NACDA: National Advisory Committee on Drugs and Alcohol; UN: United
Nations
Acknowledgements
Funding
None
Availability of data and materials
Anonymised copies of the survey tool may be obtained upon request fromdes.crowley@icgp.ie.
Authors’ contributions
DC conceived the idea for the study, collected the data and revised thedraught manuscript; CC contributed to the design of the study, coordinatedthe data collection, undertook the initial analysis and reviewed themanuscript; ID contributed to the design of the study and reviewed themanuscript; EL undertook quantitative data analysis and reviewed themanuscript; and MCVH contributed to the design of the study, undertook
the survey review, qualitative data analysis, manuscript drafting and reviewof the final submission. All authors read and approved the final manuscript.
Authors’ information
DC is the Assistant Director of the Substance Misuse Programme in Irish
College of General Practitioners, Dublin, Ireland.
CC is the Director of research in Irish College of General Practitioners, Dublin,
Ireland.
ID is the Director of the Substance Misuse Programme in Irish College ofGeneral Practitioners, Dublin, Ireland.
EL is a postdoctoral researcher in the School of Biochemistry and
Immunology, Trinity College Dublin, Dublin, Ireland.
MCVH is a senior Marie Sklodowska-Curie Actions fellow in the School of
Health Sciences, Waterford Institute of Technology, Waterford, Ireland, and isa clinical audit specialist of the Substance Misuse Programme in Irish Collegeof General Practitioners, Dublin, Ireland.
Competing interests
The authors received no financial support from any organisation for thesubmitted work; no financial relationships with any organisations that might
have an interest in the submitted work in the previous 3 years and no otherrelationships or activities that could appear to have influenced the submitted
work.
Consent for publication
The corresponding author has the right to grant on behalf of all authors anddoes grant on behalf of all authors consent for publication.
Ethics approval and consent to participate
Irish College of General Practitioners
Author details
1
School of Health Sciences, Waterford Institute of Technology, Waterford,
Ireland. 2Irish College of General Practitioners, Dublin, Ireland. 3School ofBiochemistry and Immunology, Trinity College Dublin, Dublin, Ireland.
Received: 8 July 2016 Accepted: 23 December 2016

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