Since 2001, medical cannabis has been a legal treatment option in Canada for certain health conditions, including arthritis. While cannabis can’t cure arthritis or slow disease progression, some people report that it helps to alleviate their symptoms.
“Medical cannabis” refers to any products made from cannabis or its active ingredients intended for health purposes. In Canada, the supply of medical cannabis is controlled by the federal government, which regulates production and distribution. While non-medicinal cannabis is now legal in Canada and may come from similar or the same plant sources as medical cannabis, the Arthritis Society recommends obtaining a document for medical cannabis from an authorized healthcare professional. Self-medicating with recreational cannabis is not a safe substitute for supervised care by a doctor or nurse practitioner. Not sure how to bring up the subject with your doctor? Visit our Talking to Your Doctor About Medical Cannabis resource.
In accordance with the guidelines of the Canadian Rheumatology Association, medical cannabis should not be used to treat rheumatology patients under the age of 25.
Lots of people are using medical marijuana to treat their arthritis and other muscle aches and pains, often without consulting their doctor, a new study reports.
As many as 1 in 5 patients who consult an orthopedic surgeon for chronic musculoskeletal pain are using a cannabis product to treat them, Canadian researchers found.
“We found 20% had reported past or current use of cannabis with the specific intention to manage pain,” said study author Dr. Timothy Leroux, an orthopedic surgeon at the University of Toronto. “Not just recreational users, but patients who said, ‘I’m using cannabis because I want to improve pain with this condition.’ “
There’s also a lot of interest in medical marijuana among arthritis sufferers who haven’t yet tried it, Leroux and his team found.
Two-thirds of nonusers are interested in trying a cannabis product to treat their muscle and joint pain, the researchers reported.
“A lot of patients feel they have a lack of knowledge and are staying on the sidelines while we gather more science,” Leroux said.
For this study, he and his colleagues surveyed more than 600 patients who visited a Toronto orthopedic clinic.
People using cannabis generally had high praise for the products. Nine out of 10 said it was effective in managing their pain, and 4 in 10 said it decreased their reliance on other pain medications. Nearly 6 in 10 said cannabis products were more effective than other drugs.
“This is encouraging in the face of the ongoing opioid epidemic, as we look to find safe alternatives to opioids for pain control,” said Dr. Yili Huang, director of the Pain Management Center at Northwell Phelps Hospital in Sleepy Hollow, N.Y.
“Cannabis may help decrease, or in some cases completely replace, the amount of opioid medication necessary to control pain,” said Huang, who wasn’t part of the study. “This may be because cannabis works on many different pain pathways in our body and can even interact with the separate chemical pathways opioids work on.”
Pain patients using medical cannabis in the study were more likely to have multiple conditions, report a greater burden of pain and a greater number of painful areas on their bodies. They were also more likely to have a history of pain clinic visits, a longer time with a painful condition and a higher rate of pain medication use, researchers found. They also were more likely to use or have used pot for recreation.
While people are seeking pain relief, however, they aren’t necessarily looking to get high.
The most common cannabinoid used was cannabidiol, or CBD, a marijuana compound that does not cause intoxication, researchers said.
Only about a quarter of people reported using a product with THC, which gets you high. Distressingly, the remainder of people “had no idea what they were taking,” Leroux said.
The most common way people took a cannabis product was by ingesting an oil, with 60% saying they used a marijuana-derived oil, researchers said.
“We found a general trend toward more edible products and products that were non-hallucinogenic,” Leroux said.
The study did reveal some concerning trends, however. Only a quarter of marijuana users said they’d talked with a physician first.
“Most people were not taking cannabis on the recommendation of a physician or seeking advice from a physician in order to take cannabis,” Leroux said. “They were using it in the way they would use a drug, but without physician oversight.”
That’s a problem because cannabis products can have side effects and might interact with other medications, he said.
While patients might benefit from a doctor’s advice, Leroux said unfortunately, many doctors shy away from conversations about medical marijuana.
“For the time being, I would suggest that you go about this with caution, and if you choose to use the product that you talk to someone more familiar with those products,” he said.
Leroux presented these findings at a virtual exhibition by the American Academy of Orthopaedic Surgeons. Such research is typically considered preliminary until published in a peer-reviewed journal.
Benefits for RA
The Cannabis sativa plant has more than 100 chemicals that can affect your body and mind. The two that scientists know the most about are THC and CBD.
THC, or delta-9-tetrahydrocannabinol, is what gets you high when you smoke, vape, or eat marijuana. CBD doesn’t affect your brain that way. For that reason, some people prefer the oil form of CBD for medical uses.
Rheumatoid arthritis is an autoimmune disease that can make your joints stiff, tender, and painful. RA also can affect your lungs, eyes, skin, and other body parts.
The federal ban on marijuana and CBD means studies on humans have been few. So researchers don’t know for sure that cannabis eases RA symptoms. But the results from several very small studies suggest that in people with rheumatic diseases, including RA and osteoarthritis, it may
- Curb morning pain (but not the overall level of pain)
- Improve sleep
- Lower inflammation in joints (but not joint stiffness)
Some lab testing suggests that cannabinoids may help tamp down the body’s immune response. But the studies have been limited to animals, not humans.
Doctors will need more proof before they can recommend cannabis products to treat rheumatic diseases. For example, we know very little about the effects on RA from smoking marijuana or other uses of herbal marijuana.
Medical Marijuana for Rheumatic Conditions
The effectiveness and safety of medical marijuana for rheumatic conditions, such as rheumatoid arthritis, lupus, and fibromyalgia, is not currently supported by medical evidence. An article published in March 2014 in Arthritis Care & Research advises doctors to discourage arthritis patients from using medical marijuana.2
According to the aforementioned Arthritis Care & Research article, that conclusion was drawn despite the fact that research has revealed 80 percent of marijuana users in a U.S. pain clinic were using the drug to control myofascial pain; in the United Kingdom and Australia, up to 33 percent of people were using marijuana to treat arthritis pain; and, in June 2013, the office of Information Commissioner of Canada listed severe arthritis as the reason 65 percent of Canadians were allowed to possess medical marijuana.
Authors of the study stated that, at this time, they cannot recommend the use of herbal cannabis (marijuana) for arthritis pain because there is a lack of efficacy data, potential harm from its use, and there are other safe and effective options for treating arthritis. They specifically point to these facts:
- Concentrations of THC (tetrahydrocannabinol) vary in the plant material by as much as 33 percent, and absorption rates can vary between 2 percent and 56 percent, making dosing unreliable and difficult.
- While cannabis can be ingested, most prefer to inhale it, raising the issue of adverse effects on the respiratory system.
- Short or long-term efficacy studies are lacking for rheumatic conditions.
- Studies that favor the use for cancer or neuropathic pain cannot be extrapolated to include arthritis because of different pain mechanisms.
- There is a risk of impaired cognitive and psychomotor function with marijuana use.
- Long-term marijuana use may lead to mental illness, dependence, addiction, and memory problems.
- There is an increased risk of depression among users of marijuana compared to non-users.