In recent years, Israel and Western countries have seen a sharp increase in the use of medical cannabis for a range of medical conditions. With the rise in the use of medical cannabis, nurses are at the forefront of care and are available to their patients around the clock. However, the study shows that most of the participants did not feel qualified to answer their patients' questions about medical cannabis (72%). Most (91%) of the students had not received formal training on this topic, and 98.2% believed that nursing students should receive formal training about medical cannabis use.

Also, 85.6% of the participants believed that nursing students should receive training about the legal aspects of medical cannabis use. Evanoff and colleagues (2017) found that medical students who reported receiving training about medical cannabis stated that they were much more willing to answer questions about medical cannabis and to prescribe it to patients than those who had not received training.

It should be noted that when comparing the attitudes of nursing students from Lev Academic Center to those from Ben-Gurion University regarding the need for training about medical cannabis, both populations had similar opinions (97.2% in the study population and 97.4% in Ben-Gurion University) that healthcare and medical staff should receive formal training regarding the use of medical cannabis before recommending it to their patients.

Most of the students supported adding the topic of medical cannabis to the academic curriculum, apart from 3.2% at Lev Academic Center and 4.2% at Ben-Gurion University who did not agree to this unambiguously. Efforts invested in developing a curriculum about medical cannabis will contribute to the accumulation of reliable professional knowledge and to positive attitudes toward the use of cannabis for medical purposes. These results also support the findings of Edelstein (2022) and Findley and colleagues (2021), emphasizing the importance of training.

However, apart from a few private courses, such as a course aimed at qualified professionals, the topic has yet to be included in the academic curriculum as part of the degree studies in any academic institute in Israel and in most places around the world. Despite Israel having medical indications for the use of cannabis published by the Ministry of Health, the students are not familiar with all of them.

One of the main conclusions from a comprehensive meta-analysis by Weisman and Rodriguez (2021) is that it is very important to include the issue of medical cannabis in the curriculum. This is due to the growing recognition of cannabis studies in recent years, both among students and among medical staff. Their strong desire for new programs requires the development and promotion of such curricula, to guarantee evidence-based knowledge and to grant certainty among medical professionals regarding treatment and clinical effects. Likhitsathian and colleagues (2021) also support the importance of education about medical cannabis.

When students were asked about the sources of information they would use to learn about medical cannabis, the largest group of students chose to use information provided in classroom lectures (84.2%). Thus, we can recommend including contents about medical cannabis in classroom lectures, since their wish to receive this information in the classroom supports the conclusion that students want to add this topic to the curriculum.

Despite the limited availability of evidence-based research regarding the risks and benefits of medical cannabis, nursing schools should provide a dedicated curriculum and promote a professional discourse aimed at allowing nursing students to interpret correctly the existing information and to ensure appropriate care for patients (Zolotov et al., 2021a).

Regarding students' attitudes, the study's findings show that the more religious the students, the more negative their attitudes toward medical cannabis. This aligns with other research on this topic, showing that the attitude of religious students toward the use of cannabis for medical purposes and toward legalization of recreational use were more negative (Edelstein et al., 2020a, 2020b). This can be explained by the different lifestyle of the ultra-Orthodox community, which is opposed to modern society and very different to non-ultra-Orthodox life (Bilu & Witztum, 1993).

Most of the ultra-Orthodox live in closed communities and send their children to religious Jewish schools. Their exposure to the media is limited; television, cinema, theater, reading literature, and using the internet are very limited and strictly controlled (Loewenthal, 2014). Religion serves as an important shield against the use of alcohol and other drugs (Wallace, 2003). There is extensive evidence that rabbis' rulings and instructions have a large following, which may partially explain the lower incidence of addiction among ultra-Orthodox Jews (Loewenthal, 2014). Religious leaders play a crucial role in guiding health decisions, balancing traditional beliefs with modern medical practices (Woolford & Horner, 2024).

Regarding the religious population as a whole, it has been found that a religious environment and religious education are linked to lower alcohol use and risky behavior (Isralowitz & Reznik, 2015). Since cannabis is currently defined as a drug in Israel, there is less use of it among the religious population.

According to Finkelstein (2017), the only explained reference by the great rabbis in Israel to using cannabis products is a short reply by Rabbi Moshe Feinstein, written in 1973, where he forbids the smoking of cannabis for various reasons, such as: physical and cognitive damage, debauchery, removal of restraint, and disrespect of parents. Because in the past, and sometimes also in the present, the use of cannabis was not identified with normative behavior but was perceived as part of a criminal culture, this rabbinical and institutional opposition is understandable.

The strict attitude toward cannabis products among most rabbis led to the ban on the use of cannabis. The ruling mentioned above probably influenced the attitudes of religious students toward the use of cannabis. However, in an article from 2016, Rabbi Reznikov permitted the use of cannabis for medical purposes. The rabbi did not view it as a drug but as a medicine that relieves suffering, and he even permitted its use on the Sabbath according to Halakhic priority order: food, pills, steaming, and smoking.

However, he understood that one of the problems is that cannabis use for recreational purposes is popular, and that there is a leaking of cannabis into the "black market", for non-medical purposes, which he does not support (Reznikov, 2016). His attitude is reflected in the study's findings showing that the participants recognize the medical benefits of cannabis but oppose its recreational use.

The study found that the most positive attitude among the students was that "The use of medical cannabis has significant health benefits" (mean 1.57), and the fewest participants believed that "Cannabis should be legal for recreational purposes too" (mean 2.66). Like Rabbi Reznikov, the students supported the use of medical cannabis and believed that it could have great benefits for medical conditions, but they opposed the recreational use of cannabis.

If we compare the study's findings with Isralowitz and colleagues (2021), less than a fifth of nursing students at Lev Academic Center think that cannabis should be legal for recreational purposes too, compared with over half the healthcare professions students at Ben-Gurion University. According to researchers from Ben-Gurion University, this could be partially linked to the fact that the Israeli media greatly supports the benefits of medical cannabis, and such reports could increase the positive attitude toward its use (Isralowitz et al., 2021).

In contrast, at the Lev Academic Center the student population is more conservative and perhaps less exposed to the national media, but instead only to conservative media that report and stress completely different contents. The more religious the students and the more closed their society, the less exposed they are to national media. This could explain their more negative attitudes, compared to traditional students, for example. This demonstrates the need to teach the topic in the classroom, to present up-to-date studies, and to show objective data about medical cannabis, particularly for religious student populations. A recent study conducted among Orthodox Jewish university and college students in the USA also concluded that higher levels of religiosity correlate negatively with cannabis use (Liberman, 2024).

Another explanation for the finding that most of the study's participants disagree with the legalization of cannabis for recreational purposes is that most students believe cannabis is addictive, apart from 4.1% who disagree with this statement. This is in contrast with the nursing students at Ben-Gurion University. Forty-nine-point four percent of the students there reported that they did not agree that cannabis was addictive. This comparison shows once again the gap between the attitudes of secular students compared with religious students who have a more conservative lifestyle. However, despite religious students believing that cannabis is addictive, they support its medical use.

Most of the study's participants (81%) reported that they had never used cannabis recreationally, unlike the mostly secular nursing students at Ben-Gurion University, over half of whom (52%) reported that they had used cannabis recreationally during their lifetime. According to the researchers, people who use cannabis or know cannabis users personally are more likely to hold positive or permissive attitudes toward cannabis (Isralowitz et al., 2021). Regarding students who had used cannabis in the past, researchers assume that their personal experience of not having any negative effects after using cannabis convinced them that the historical attitude to the risks of medical cannabis was exaggerated (Chan et al., 2017).