Introduction

Epilepsy is considered one of the most common neurological diseases, with a global prevalence of approximately 50 million people [1]. Recent studies stated that the estimated figure of epileptic patients in Saudi is 6.54 per 1,000 people [2]. Despite the approval of various anti-epileptic medications over the last two decades, there is still a need to expand the number of medication options for physicians to prescribe since one-third of epileptic patients have drug-resistant epilepsy [3].

Over the last decade, various countries and institutions have shown a huge interest to investigate the role of cannabidiol (CBD) and its efficacy in treating pediatric epilepsy. CBD is a chemical that can be extracted from the cannabis plant and lacks the euphoria-inducing characteristic of tetrahydrocannabinol (THC), another cannabis component. Among these two cannabis constituents, CBD shows superior anti-epileptic potential, which has been proven by multiple studies [4].

The exact mechanism behind CBD’s capability in treating epilepsy is still an area of research; however, several theories have been proposed. One of which is the role of CBD in modulating intracellular calcium through a variety of transient receptor potential (TRP) channels. Furthermore, another study revealed that CBD has an anti-inflammatory action via modulating tumor necrosis factor (TNF) alpha release or inhibiting the reuptake of adenosine, which is also postulated to be the cause behind CBD’s anti-seizure effect [3,4]. The effectiveness of CBD has been supported by various studies. In particular, four randomized control trials and 31 non-randomized studies supported cannabidiol and its potency in decreasing the number of seizures among patients with drug-resistant epilepsy [5,6].

Consequently, the use of CBD in pediatric epilepsy was approved by the US Food and Drug Administration (FDA) in 2018. It is approved to treat seizures in children who fulfill the criteria that state the following: firstly, children who are diagnosed with either Dravet Syndrome (DS) or Lennox-Gastaut Syndrome (LGS), and secondly, children two years of age or older [7]. This medication is considered to be the first FDA-approved drug containing a purified drug substance derived from cannabis. Moreover, CBD is also the first FDA-approved drug for the treatment of patients with Dravet syndrome.

Despite the FDA approval, physicians’ attitude toward CBD is controversial. As some physicians support the use of CBD and present it as a treatment option for patients or their families, others are still reluctant to prescribe and suggest this medication. According to a study involving 155 physicians, practitioners only discuss CBD as an option upon request by patients or their parents and only about 40% of them would recommend CBD treatment actively [8].

This division in physicians’ opinions could be attributed to several factors such as the novelty of the supportive evidence. Various studies have been conducted over the last five years to address the knowledge gap regarding this medication; however, there is still a need for more research to unravel the drug characteristics and mechanism of action [5]. Another reason that could be behind practitioners’ reluctance in prescribing CBD is the stigma of using it due to the fact of abusing its natural source, cannabis, over the years. According to a recent study that involved 531 dermatologists in the US, 48% of them were concerned about a negative stigma when proposing cannabinoid therapies to patients [9]. Multiple studies have been done worldwide to assess practitioners’ acceptance of prescribing CBD for patients, but none in Saudi Arabia. Therefore, we aim to measure physicians’ acceptance of the use of CBD in managing epilepsy patients in Saudi Arabia. cbd oil saudi arabia

Materials and methods

Study area

In this cross-sectional study, an electronic survey hosted through the Google survey webpage was distributed between September 2021 and October 2021 among pediatricians and neurologists along with pediatric neurologists including residents, associate consultants, and consultants at King Abdulaziz Medical City (KAMC) Jeddah, Saudi Arabia.

Data collection method

In light of the available literature, a self-administered questionnaire was constructed with the assistance of a previously published article [10]. The validity of the questionnaire was ensured by performing face validity, content validity, and a pilot study. Also, the reliability of the questionnaire was confirmed through Cronbach’s alpha test. The self-assessment section of the questionnaire has yielded reliable results (Cronbach’s alpha = 0.965). Also, the attitude section contained eight items with Cronbach’s alpha = 0.683 making it reliable as well. cbd oil saudi arabia

Sample size

All those in the field of neurology and pediatrics, regardless of their subspecialty, were invited to contribute to the study. Knowing that the estimated number of physicians at KAMC-J is 95, we calculated the sample size using an online sample calculator (Raosoft) with a 5% margin of error and a 95% confidence level. The required minimum sample size was determined to be 65 subjects. Thus, 94 responses are considered a strongly representative sample.

Measures

The 39-question survey consisted of three sections that included demographics, the physicians’ knowledge regarding cannabidiol (CBD) as a medication, and the respondents’ attitudes toward the usage of CBD. The questions were assessed on a 5-Likert scale with response categories ranging from “Strongly Disagree” (1) to “Strongly agree” (5), combined with a yes/no or true/false response item.

Procedure of analysis

The obtained data from the questionnaire were entered into Microsoft Excel 2016 (Microsoft Corporation, Redmond, WA, USA) and then analyzed using Statistical Package for the Social Sciences, SPSS 23rd version. Frequency and percentages were used to display categorical variables. Minimum, maximum, mean, and standard deviation were used to present continuous variables. Independent t-test and ANOVA test were used to test for the presence of association. ANOVA test was followed by the Tukey post hoc test to determine where the exact difference between groups exists. The level of significance was set at 0.05.

Ethical considerations

This study was conducted after receiving Institutional Review Board (IRB) approval from King Abdullah International Medical Research Center (KAIMRC), Jeddah, Saudi Arabia (IRB approval number: JED-21-427780-119885). The contributions of physicians were voluntary. Before participation in the research, informed consent was gained from all participants. thc vape juice cbd oil in saudi arabia/

Scoring systems and assessment of levels

Three-scoring systems were established to assess the participants’ self-assessment of knowledge toward cannabis, actual knowledge toward cannabis, and attitude toward the use of cannabinoids in treating epilepsy in pediatrics. The scoring system of self-assessment of knowledge toward cannabis consisted of 22 items, those who answered not knowledgeable at all/not familiar were given 0 scores, those who answered somewhat knowledgeable/slightly familiar were given 1 score, those who answered moderately knowledgeable/moderately familiar were given 2 scores, those who answered very knowledgeable/very familiar were given 3 scores, and those who answered extremely knowledgeable/extremely familiar were given 4 scores. The total score was then summed, and the total self-assessment of knowledge regarding cannabis was generated for each participant (the lowest possible score was 0, and the highest score was 88). The level of self-assessment of knowledge toward cannabis was then constructed for the participants based on the score, those who had a total score of less than 50% (43 and less) were considered to have a low level, those who had a total score between 50% and 75% (44-66) were considered to have a moderate level, and those who had a total score higher than 75% (67 and more) were considered to have a high level. https://k2sheetsliquid.com/product/black-mamba-liquid-k2-on-paper/

The scoring system of the actual knowledge regarding cannabis consisted of four items, those who answered the questions correctly were given a 1 score, and those who answered incorrectly were given a 0 score. The total score was then summed, and the total knowledge score toward cannabis was generated for each participant (the lowest possible score was 0, and the highest score was 4). black mamba liquid k2 on paper/

The scoring system of attitude toward the use of cannabinoids in treating epilepsy in pediatrics consisted of eight items, those who answered strongly disagree, disagree, or neutral were given 0 scores, those who answered agree were given 1 score, and those who answered strongly agree were given 2 scores. The total score was then summed, and the total attitude toward the use of cannabinoids in treating epilepsy in pediatrics was generated for each participant (the lowest possible score was 0, and the highest score was 16). The level of attitude toward the use of cannabinoids in treating epilepsy in pediatrics was then constructed for the participants based on the score, those who had a total score less than 50% (7 and less) were considered to have a low level, those who had a total score between 50% and 75% (8-12) were considered to have a moderate level, and those who had a total score higher than 75% (13 and more) were considered to have a high level.

Results

A total of 94 participants were included in this study. Thirteen (13.8%) of them were in the field of neurology, 77 (81.9%) were in pediatrics, and only four (4.3%) of them were in pediatric neurology. As for age, the majority of the participants, 78 (83%), were between 24 and 44 years, 13 (13.8%) were between 45 and 55 years, and three (3.2%) were between 56 and 75 years. Participants were equally divided in regard to gender: 47 (50%) for each gender. As for the participants’ professional tenure, 52 (55.3%) were residents/trainees, five (5.3%) had a tenure of less than five years, 12 (12.8%) had a tenure between six and 10 years, 13 (13.8%) had a tenure between 11 and 20 years, and 12 (12.8%) had a tenure more than 20 years (Table 1). thc vape juice/