The development of a cannabis risk assessment tool for patients with rheumatologic conditions: a Delphi study

Chronic pain is often a primary symptom for rheumatologic conditions. With the legalization of cannabis in Canada and many other jurisdictions, the use of cannabis is increasing. A risk assessment tool can guide clinicians and patients on the potential risk associated with cannabis use for alleviating the symptoms of rheumatologic conditions. The aim of this Delphi study is to identify key elements for the development of a risk assessment tool for the safe use of cannabis for people with rheumatologic disease.

International experts representing different healthcare professions in rheumatology were invited through targeted recruitment. The research team developed statements for the Delphi consensus based on literature review and focus groups. The number of rounds was dependent on when consensus was reached. The level of agreement was set at 75%.

A total of 12 experts participated, independently rated 45 statements. Consensus (≥ 75% agreement) was achieved on 40 of 45 items (88.9%) after two rounds, and all 40 items were confirmed in a third validation round. Statements were categorized as patient demographics, medical history, lifestyle, or socioeconomic. Demographic factors (age and gender) and medical conditions such as substance use disorders and schizophrenia were identified as important to consider with cannabis use along with cannabis consumption patterns, including the age of first use, method, and frequency of use.

This Delphi consensus identified essential elements for a comprehensive cannabis risk assessment tool for patients with rheumatologic conditions. The agreed-upon items provide a structured foundation to support clinicians in evaluating patient-specific risks and guiding safe cannabis use in rheumatology care. Further validation and clinical testing are recommended to optimize its utility in practice. Key Points • As increasing numbers of patients consider using cannabis for pain management of rheumatologic conditions, a guide would be helpful to consider a risk assessment tool for patients and healthcare providers. • The aim of this Delphi study was to gain a perspective of clinicians and experts regarding items that should be included in a cannabis safe use tool in rheumatology. • We collaborated with international experts to reach a consensus on key factors influencing cannabis use risk. • This study highlights the importance of factors such as age, gender, underlying medical conditions, and consumption patterns, including the age of first use, method, and frequency of use.