Rheumatologists lack confidence in their knowledge of cannabinoids pertaining to the management of rheumatic complaints

Abstract

BackgroundArthritis pain is reported as one of the most common reasons for persons using medical herbal cannabis in North America. “Severe arthritis” is the condition justifying legal use of cannabis in over half of all authorizations in Canada, where cannabis remains a controlled substance. As champions for the care of persons with arthritis, rheumatologists must be knowledgeable of treatment modalities both traditional and non-traditional, used by their patients. As study of cannabinoid molecules in medicine is recent, we have examined the confidence in the knowledge of cannabinoids expressed by Canadian rheumatologists.MethodsThe confidence of rheumatologists in their knowledge of cannabinoid molecules and mechanisms relevant to rheumatology, and their ability to advise patients about cannabinoid treatments was recorded by an online questionnaire circulated via email to the entire Canadian Rheumatology Association membership.ResultsOver three quarters of the 128 respondents lacked confidence in their knowledge of cannabinoid molecules. While 45% of respondents believed there was no current role for cannabinoids in rheumatology patient care, only 25% supported any use of herbal cannabis. With 70% never having previously prescribed or recommended any cannabinoid treatment, uncertainty regarding good prescribing practices was prevalent. Concerns about risks of cannabis use were in line with the current literature.ConclusionsRheumatologists lacked confidence in their knowledge of cannabinoid molecules in general and in their competence to prescribe any cannabinoid for rheumatic complaints. In line with this uncertainty, there is reticence to prescribe cannabinoid preparations for rheumatology patients. Guidance is required to inform rheumatologists on the evidence regarding cannabinoids.

Efficacy, Tolerability, and Safety of Cannabinoid Treatments in the Rheumatic Diseases: A Systematic Review of Randomized Controlled Trials

“…In total, there is currently no sound evidence on which to base any recommendation for use of cannabinoids for symptom relief in the rheumatic conditions. As one may expect, this lack of evidence translates into the lack of confidence expressed by Canadian rheumatologists regarding their knowledge of cannabinoids in general . In light of the extensive scientific but limited clinical evidence, patients may have numerous reasons to advocate for use of cannabinoids in general and herbal cannabis in particular.…”

“…As a preliminary step, the CRA convened a working group to conduct a needs assessment concerning rheumatologist confidence regarding cannabinoid preparations in general and herbal cannabis in particular. Rheumatologists reported considerable lack of confidence in their knowledge of cannabinoids in general and in their ability to provide advice regarding use of cannabinoids for rheumatology patients in general . Thereafter, a librarian from the McGill University Health Centre (TL) conducted the literature search.…”

The Dilemma of Medical Marijuana Use by Rheumatology Patients

“…In a survey of family physicians in Colorado, only 19% thought that physicians should recommend medical marijuana, with 92% reporting the need for more education (). Similarly, two‐thirds of Canadian rheumatologists recently surveyed expressed poor confidence in their knowledge of cannabinoid medical use, with 70% stating that there is currently no role for herbal cannabis in the treatment of rheumatic symptoms (). Even in the setting of some reasonable knowledge of cannabinoid molecules and the endocannabinoid system, the absence of evidence for clinical use of herbal cannabis in rheumatic conditions must be discomforting for any health care professional or rheumatologist intending to provide an herbal cannabis treatment recommendation.…”

Expanding Medical Marijuana Access in Canada: Considerations for the Rheumatologist

“…Advice provided by healthcare professionals must also be based on sound knowledge derived from scientific study, clearly absent for herbal cannabis. Canadian rheumatologists have expressed a lack of confidence in their knowledge and ability to responsibly advise patients on the rational use of cannabinoid agents, including herbal cannabis, when recently polled 19 .…”