Background/Purpose: To evaluate use of marijuana (MJ) and cannabidiol (CBD) as described by rheumatology patients at an academic medical center in Vermont, and to describe beliefs and practices of rheumatology clinicians regarding patient use of MJ and CBD in the United States.

Methods: A paper survey was distributed to adult patients during routine rheumatology clinic visits at the University of Vermont Medical Center between November 2018 and February 2019. A second survey was developed using Research Electronic Data Capture (RedCap) software and was disseminated via email to clinicians identified from the American College of Rheumatology membership list. Descriptive statistics were used to assess responses.

Results: A total of 419 patient surveys were collected with 148 (35.3%) reporting current use of MJ and/or CBD. Of those 148 patients, 42% were using both MJ and CBD, 36% only CBD, and 22% only MJ. RAPID3 scores of users were collected; 52% as high severity, 40% moderate, 36% low, and 21% near remission. Worsening disease severity influenced patient use (Wald χ2 (3) =15.3, p =0.0165). Over half (51%) agreed they were able to decrease use of pain medication when MJ or CBD was used. The average self-reported pain on a 0-10 scale before and after use of MJ and/or CBD was 6.9 and 4.4 respectively.

Nearly half of clinician respondents disagreed that MJ (45.2%; n = 106) or CBD (37.4%; n = 105) should be recommended as medical therapy for patients with rheumatologic disorders. Of those practicing in states where MJ is legal for medical and recreational use, 52.9% agreed that they were comfortable addressing questions surrounding use vs. 33.3% in states where MJ is illegal, although this was not statistically significant. Many disagreed that opioid and NSAID use decreases with marijuana use (33.9% and 40.9% respectively), this was similar for CBD (32.2% and 34.8% respectively). 

Conclusion: Patient and clinician perceptions are dissimilar regarding benefits of MJ and CBD use, especially around pain medication requirements. Worsening disease severity influences probability of use. Surrounding laws likely impact clinician perception and comfort with medical use. Additional research is needed to better understand the benefits and risks of MJ and CBD use in the rheumatologic patient population.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/evaluation-of-marijuana-and-cannabidiol-use-in-the-rheumatologic-population-from-a-patient-and-clinician-perspective-a-survey-based-study/