The reluctance of healthcare providers to engage in medical cannabis discussions with arthritis patients reveals a complex web of professional uncertainty that could be limiting treatment options for millions of older adults. While cannabis legalization has opened therapeutic doors, the clinical reality shows providers struggling with knowledge gaps, role confusion, and interpersonal dynamics that prevent effective shared decision-making. Interviews with 12 healthcare professionals across multiple specialties identified three critical barriers preventing meaningful cannabis consultations: how providers perceive the decision itself, their assumptions about patient and colleague attitudes, and their own internal conflicts about recommending cannabis therapies. The study revealed that pharmacists, family physicians, rheumatologists, and nurses all experience decisional uncertainty, but express this differently based on their professional training and scope of practice. Knowledge deficits emerged as the primary obstacle, with providers citing insufficient evidence about dosing, drug interactions, and efficacy compared to conventional arthritis treatments. This research illuminates a significant gap in geriatric pain management that extends beyond cannabis policy into fundamental questions about provider education and support systems. The findings suggest that arthritis patients seeking cannabis alternatives may encounter well-intentioned but inadequately prepared healthcare teams. While the study focused on Canadian providers, similar patterns likely exist across healthcare systems grappling with cannabis integration. The identified need for tailored decision support interventions represents an opportunity to improve both provider confidence and patient access to comprehensive pain management discussions, potentially transforming how older adults navigate chronic arthritis management in an era of expanding therapeutic options.