Open Access Open Badges Research article

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

Mary-Ann Fitzcharles12*, Peter A Ste-Marie23, Daniel J Clauw3, Shahin Jamal4, Jacob Karsh5, Sharon LeClercq6, Jason J McDougall7, Yoram Shir2, Kam Shojania48 and Zach Walsh9

Author Affiliations

1 Division of Rheumatology, Montreal General Hospital, McGill University Health Centre, 1650 Cedar ave, Montreal, Quebec H3G 1A4, Canada

2 Alan Edwards Pain Management Unit, McGill University Health Center, Montreal, Canada

3 Department of Anaesthesiology, Chronic Pain and Fatigue Research Center, University of Michigan Medical Center, Michigan, USA

4 Division of Rheumatology, University of British Columbia, Vancouver, Canada

5 Division of Rheumatology, The Ottawa Hospital, Ottawa, Canada

6 Department of Medicine, University of Calgary, Calgary, Canada

7 Departments of Pharmacology and Anaesthesia, Dalhousie University, Halifax, Canada

8 Arthritis Research Centre of Canada, Vancouver, Canada

9 Department of Psychology, University of British Columbia, Vancouver, Canada

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BMC Musculoskeletal Disorders 2014, 15:258  doi:10.1186/1471-2474-15-258

Published: 30 July 2014



Arthritis 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.


The 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.


Over 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.


Rheumatologists 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.

Cannabinoids; Rheumatic diseases; Physician knowledge