Over the last few years, awareness around the medical potential of cannabis has gone increased massively, with more studies and clinical trials being conducted than ever before and an ever-expanding list of countries opting to legalise the medical use of the plant. It suffices to say that much of the information regarding cannabis – and anything else for that matter – is now perpetuated by the unstoppable force of the internet.
The world wide web has undoubtedly connected more people than ever, allowing more and more of us to share information that at one time we might not have had access to. In many ways, we are more informed now than at any other point in history. Yet, this toll which has made knowledge more accessible than ever has also made it easier to spread misinformation on a never-ending supply of topics. Whether it be linked to politics, celebrity, or medicine, ‘fake news’ has become a serious phenomenon, of which most people have fallen victim to.
Medical cannabis is slowly becoming more accessible to patients around the world – including here in the UK. It is now available for a wide variety of conditions for which there is evidence of its potential efficacy. Cannabis has been used medicinally for thousands of years, however, there remains a relative lack of modern clinical evidence to support much of these historic uses. Therefore, only a small number of cannabis-based medicines have been approved for clinical uses, including in the treatment of epilepsy, chemotherapy-induced nausea and vomiting, and spasticity associated with multiple sclerosis.
Nonetheless, evidence suggests that the spread of misinformation and ‘anecdotal’ evidence on the internet may lead to a misalignment of expectations regarding medical cannabis. A recent study, published in the Journal of Cannabis Research, aimed to understand how patients could be affected by information published on the interned about the therapeutic potential of medical cannabis.
Methods of the Study
Surveys and polls demonstrate that a significant percentage of the population may actively search for health-related information online. One 2017 survey showed that this was true of over one-third (37.5%) of US adults. The quality of information available online has therefore been an ongoing area of research. The researchers therefore also theorise that, as medical cannabis products become more widely available, many patients will use the internet to locate information on their efficacy and availability.
In order to get a clear idea of the information available on the internet regarding the therapeutic potential of cannabis, the researchers opted to analyse the search results of the most popular global search engine, Google.com. The primary aim of the study was to assess the available information on medical cannabis both in terms of information quality criteria and content and the completeness of the information.
The first 243 web results were collected for the search term: “medical cannabis” in June 2019. Of these, 67 websites were excluded as they were deemed irrelevant to the study aim. Therefore, a total of 176 webpages were analysed for their content using previously validated methodology. The researchers classified the webpages as commercial, government, health portals, news, non-profit, scientific journal, or other.
Following categorisation, each webpage was assigned a JAMA score based on information including author, date, references to the source of information provided, and ownership of the website. The presence of each of these items was counted as ‘1’, giving a final score of between 0 and 4.
Next, the researchers analysed the content of each webpage, including: the indication(s) mentioned in relation to the use of medical cannabis; the stance on the efficacy or use of medical cannabis (positive, neutral, or negative); the mention of potential side effects and regulatory/legal issues associated with the use of cannabis products.
Results of the Study
Of the webpages included for statistical analysis, the majority (52%) were from news outlets, followed by government websites (14%); however, no news websites were present in the top ten Google results, making them less accessible. A higher ranking was given by Google to non-profit organisations (20% in the top ten vs. 8% in the whole sample), health portals (20% in the top ten vs. 4% in the whole sample), and government websites (30% in the top ten vs. 14% in the whole sample).
In terms of location, the majority of included websites were from the USA (59%), followed by the UK (19%) and Ireland (95) with a small number of websites originating from other countries.
The 176 pages had a median JAMA Score of 3, however, the score differed significantly across typology of websites. Health portals and scientific journals scored the highest (median 4). In comparison, commercial, government, and non-profit scored significantly lower (median 1, 2, and 2, respectively) than the rest of the sample.
Medical cannabis has only been approved for use in a limited number of diseases and conditions; however, the researchers found that many more the websites included for review mentioned many more conditions in relation to the potential benefits of medical cannabis products.
The most commonly mentioned conditions across all webpages were pain, epilepsy, and multiple sclerosis. Other conditions/diseases mentioned included nausea, spasticity, chemotherapy, anxiety disorders, HIV/AIDS, and neoplasia. Health portals mentioned, on average, the highest number of conditions (median 13) while news mentioned the fewest. (median 2).
On average, only 22% of the websites mentioned potential side effects of cannabis use, while 82% mentioned legal or regulatory guidelines. Side effects were most often mentioned by health portals (100%) and non-profit organisations. By contrast, only 5 of the 91 news websites mentioned potential side effects of cannabis use.
Furthermore, the vast majority of websites (81%). were deemed to have a neutral stance towards medical cannabis, compared with 17% that were positive, and 2% that were negative. Commercial websites were significantly more likely to portray a positive stance towards medical cannabis, with 5 out of 6 (83%) being categorised in this way. Non-profits were also significantly more likely than the remaining websites to portray medical cannabis in a positive way. On the other hand, all health portals and 88% of the news websites had a neutral view. Only 4 websites had a negative stance on medical cannabis.
Having analysed the reliability and stance of the content portrayed across these websites, the researchers conclude that the information available and most circulated on the internet may produce an unrealistic view of medical cannabis. Notably, the analysis of content relating to conditions/diseases which may benefit from medical cannabis showed a mismatch between web mentions and those for which there is regulatory approval.
To conclude, the researchers note that it would be helpful if news outlets and commercial websites provided more complete information – including references to clinical trials and information regarding the potential side effects of medical cannabis. Furthermore, the evidence gathered in this study suggests that health professionals should point their patients towards non-profit organisation websites or health portals as they tended to score higher on reliability and content completeness.
On the Sapphire Institute for Medical Cannabis Education you can find a broad selection of educational materials and answers to frequently asked questions about medical cannabis including discussion on potential uses and side effects.
While a high proportion of websites were found to be relatively unreliable in terms of content completeness, it is reassuring that the ranking mechanism employed by Google gives higher visibility to health portals and non-profit organisations. Nonetheless, these findings suggest that public health authorities should focus their strategies to better disseminate information regarding medical cannabis.