Medicinal Cannabis Use for Rheumatic Conditions in the US Versus Canada: Rationale for Use and Patient-Health Care Provider Interactions

• Published in: ACR open rheumatology Vol. 5; no. 9; pp. 443 - 453
• Main Authors: Boehnke, Kevin F, Martel, Marc O, Smith, Tristin, He, Ying, Bergmans, Rachel S, Kruger, Daniel J, Andwele, Michele, Bevan, Sian, Williams, David A, Fitzcharles, Mary-Ann
• Format: Journal Article
• Language: English
• Published: United States John Wiley & Sons, Inc 01-09-2023; Wiley Periodicals, Inc; Wiley
• Subjects: Arthritis; Chronic pain; Decision making; Global health; Information sources; Medical marijuana; Narcotics; Original; Patient satisfaction; Physicians; Primary care; Questionnaires; Review boards; Rheumatic diseases; Tetrahydrocannabinol; THC; Canada; United States > US; Michigan
• ISSN: 2578-5745; 2578-5745
• DOI: 10.1002/acr2.11592

Understanding how medical cannabis (MC) use is integrated into medical practice for rheumatic disease management is essential. We characterized rationale for MC use, patient-physician interactions around MC, and MC use patterns among people with rheumatic conditions in the US and Canada.
We surveyed 3406 participants with rheumatic conditions in the US and Canada, with 1727 completing the survey (50.7% response rate). We assessed disclosure of MC use to health care providers, MC authorization by health care providers, and MC use patterns and investigated factors associated with MC disclosure to health care providers in the US versus Canada.
Overall, 54.9% of US respondents and 78.0% of Canadians reported past or current MC use, typically because of inadequate symptom relief from other medications. Compared to those in Canada, fewer US participants obtained MC licenses, disclosed MC use to their health care providers, or asked advice on how to use MC (all P values <0.001). Overall, 47.4% of Canadian versus 28.2% of US participants rated their medical professionals as their most trusted information source. MC legality in state of residence was associated with 2.49 greater odds of disclosing MC use to health care providers (95% confidence interval: 1.49-4.16, P < 0.001) in the US, whereas there were no factors associated with MC disclosure in Canada. Our study is limited by our convenience sampling strategy and cross-sectional design.
Despite widespread availability, MC is poorly integrated into rheumatic disease care, with most patients self-directing use with minimal or no clinical oversight. Concerted efforts to integrate MC into education and clinical policy is critical.