Rheumatic conditions such as osteoarthritis, rheumatoid arthritis, and lupus are thought to affect between 9.8% and 33.2% of the general population. Such conditions represent a heavy burden on primary care services and are the most common medical causes of long-term absence from work, reportedly accounting for more than half of all sickness. Patients with rheumatic conditions can experience a range of symptoms, including joint stiffness, sleep problems, and pain.
Evidence reveals that pain is the most common reason individuals are prescribed medical cannabis. It is acknowledged that patients with chronic pain, including those living with rheumatic conditions, have long considered cannabis an option for managing their symptoms. Individuals with rheumatic conditions frequently report that current treatment strategies are not effective for satisfactory pain control. As a result, a growing number of older patients are turning to cannabis despite limited evidence of its efficacy in the treatment of rheumatic conditions.
Patients and clinicians alike face uncertainties and unanswered questions regarding the use of medical cannabis in this setting. To address this, the authors of a recent qualitative descriptive study aimed to develop a tool to guide clinicians and rheumatic patients about cannabis use.
Design and Methods of the Study
The study took place in Alberta, Canada where medical cannabis was legalised in 2001 and cannabis dispensaries retailing recreational products have been permitted since 2018. The researchers chose a qualitative descriptive design as little is known about the topic of interest. The objective of the study was to “uncover beliefs, perceptions, and learning needs of adults with rheumatic conditions regarding cannabis.”
Potential participants were recruited through the local academic rheumatology clinic where clinicians identified eligible patients and invited them to contact the research assistant if they were interested in participating in the study. Participating patients were interviewed in focus groups using a semi-structured interview guide developed by the research team. Two focus groups based on cannabis use patterns (users and non-users) were conducted separately.
Results of the Study
A total of 12 patients participated in the study, all of whom were identified as members of the older population (range 52-85). Over half (58.3%; n = 7) of participants reported cannabis use while 41.7% (n = 5) were non-users. The researchers did not seek information regarding specific diagnoses as their primary focus was patient experiences with and views about cannabis. Participants in both groups shared very similar views allowing researchers to identify the three themes that emerged from the analysis: pain and desperation; stigma; and need for information.
Pain and Desperation
Pain was identified as a trigger for patients to either use cannabis products or seek further information about potentially using these products and was the main reason for using or considering using cannabis. It was revealed that patients often initiated cannabis consumption in response to pain and a desire to improve their quality of life. Patients also discussed other methods that may not have worked for them to control these symptoms.
Furthermore, non-users reported that their pain is not well controlled. It became clear that there was a level of desperation among most participants to find solutions to living with their pain. For this reason, many non-users considered that pain management would justify cannabis use.
While both users and non-users discussed their experiences with cannabis use or consideration of cannabis use, many were reluctant to do so with their healthcare providers. Users preferred when their care provider introduced the topic of cannabis use. Non-users feared that discussing cannabis with their care providers would negatively impact their relationships with health professionals as well as the subsequent treatment of their condition. There was a clear desire among participants for healthcare providers to bring up the topic of cannabis use in an open and non-judgemental manner and to provide guidance about the benefits and risks of cannabis for the management of pain.
Both users and non-users addressed the stigma associated with cannabis use. For some, the legalisation of cannabis in Canada had removed this stigma, while for others it remained. Some participants expressed discomfort entering cannabis retail outlets that were similar to “feelings they had about being in a liquor store.” The researchers noted that hesitation in using cannabis products seemed to be related to societal norms of the participants’ youth, including the common concern that cannabis can lead to the use of other drugs.
However, some non-users were beginning to be reassured knowing that some professionals and family members were using cannabis products. Nonetheless, both users and non-users appeared opposed to smoking cannabis with other forms of cannabis (e.g., oils and edibles) appearing to be more socially acceptable.
Need for Information
While non-users of cannabis were curious about the potential of cannabis for symptom management, a lack of information prevented them from exploring this further. Both users and non-users expressed a need for information regarding the use of cannabis and reported that accessing information was often challenging. Participants relied on various sources for information about cannabis, including family members, friends, cannabis stores, and some health professionals.
However, both users and non-users wanted credible sources of information to be more available. For example, participants identified many members of the health care team who could provide information on this topic, including physicians, pharmacists, nurses, and rehabilitation therapists. Participants also recommended that health professional-led cannabis-use support groups would be beneficial.
While the present study has some limitations, including the recruitment of participants from only one academic rheumatology clinic, the findings yielded were similar to those of other projects involving different patient populations. The authors consider their most important finding to be patients’ desire for health professionals to initiate conversations about cannabis use. They note that, “for participants, health professionals approaching the subject is destigmatizing and can facilitate discussion about goals related to pain management.”
Finally, the authors note that failure to provide information in an open and non-judgemental manner and to initiate conversations about cannabis use, there is a risk that patients with rheumatic conditions will conceal their use of cannabis products which could have negative implications on their health and treatment.