Session Information
Session Type: Abstract Submissions (ACR)
Background/Purpose: The pharmacologic treatment of chronic rheumatic pain is often sub-optimal, leading patients to seek alternate treatments. Although herbal cannabis (marihuana) has had medicinal use for pain management for centuries, scientific study of cannabinoid effects is recent. With patient advocacy for access to cannabinoids, regulatory bodies worldwide are considering the merits of legalizing medical cannabis. As arthritis is cited as a common reason for medical cannabis use, rheumatologists should be better informed to advise patients. We have assessed rheumatologists’ self-reported confidence in their knowledge of cannabinoids and their perceived competence in providing prescriptions.
Methods: Using a 19-question needs assessment survey, sent via email to the entire Canadian Rheumatology Association membership, we have examined rheumatologists’ confidence in 1) knowledge of cannabinoids in general, including phyto-, syntheto- and endocannabinoids, and 2) perceived competence and ability to advise patients regarding indications, use and precautions for cannabinoids in general, and herbal cannabis specifically.
Results: 128 (25%) of all 510 members responded. Over three quarters were not confident in their knowledge of cannabinoid molecules, with two thirds reporting poor knowledge of the physiology of the endocannabinoid system. While 45 % of respondents stated no current role for any cannabinoid preparations for rheumatology patients, 70% believe this applies specifically to medical cannabis. Only 16 (13%) had ever previously recommended a trial of medical marihuana. Over 90% were not confident in writing a prescription for medical cannabis when required to indicate dosing, frequency and method of administration. When respondents were grouped as “Confident” in knowledge of cannabinoid molecules (n=33) vs. “Not-Confident” (n=95), the following were reported respectively: Current role for medical cannabis 48% vs. 23%; Previous prescription of pharmacological cannabinoid 33% v.12%; Previous recommendation for medical cannabis 27% vs.7%; No previous recommendation for either 39% vs. 81%; Would not recommend any cannabinoid in future 33% vs. 67%. Only 33% of knowledge confident respondents reported competence in prescribing medical cannabis. Concerns about risks of marihuana use were in line with current literature.
Conclusion: The overwhelming majority of rheumatologists reported lack of confidence in their knowledge of cannabinoids, and uncertainty about their competence to prescribe cannabinoid treatments and herbal cannabis in particular. This survey highlights a major disconnect between patients’ advocacy, policy makers and physician need to provide competent patient care within the bounds of medical ethics and deontology. Guidance is required to inform rheumatologists on the prevailing evidence for the safe and effective use of cannabinoids in rheumatic conditions.
Disclosure:
M. A. Fitzcharles,
Purdue Pharma L.P.,
5,
Eli Lilly and Company,
5,
Pfizer Inc,
5,
Valeant,
5;
P. A. Ste-Marie,
None;
D. J. Clauw,
Nuvo, Merck, Cerephex, Pfizer,
2,
Lilly, Pfizer, Forest, Nuvo, Cerephex, Purdue,
5;
S. Jamal,
Abbott Immunology Pharmaceuticals,
5,
Amgen,
5,
Bristol-Myers Squibb,
5,
Roche Pharmaceuticals,
5,
Janssen Pharmaceutica Product, L.P.,
5,
Ucb,
5,
Pfizer Inc,
5;
J. Karsh,
Roche Pharmaceuticals,
2,
Bristol-Myers Squibb,
5,
Amgen,
5,
Roche Pharmaceuticals,
5,
Abvie,
5,
AstraZeneca,
5;
S. Leclercq,
Roche Pharmaceuticals,
5;
J. J. McDougall,
Eli Lilly Co. USA,
2;
Y. Shir,
Purdue Pharma L.P.,
8,
Paladin Labs,
8,
Paladin Labs,
5;
K. Shojania,
None;
Z. Walsh,
None.
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ACR Meeting Abstracts - https://acrabstracts.org/abstract/rheumatologists-lack-confidence-in-their-knowledge-of-cannabinoid-molecules-and-use-in-the-management-of-rheumatic-disease-patients-analysis-of-a-needs-assessment/