Lack of Research Stymies Uptake of Medical Marijuana for Rheumatic Pain Save

Differing State Laws Are Barriers to Providers and Patients Accessing Potential Therapy for Pain 

A new review article from CreakyJoints, the international digital community for millions of arthritis patients and caregivers who seek education, support, advocacy, and patient-centered research, finds that there has been limited progress in understanding the potential of cannabis based therapies for the treatment of pain associated with rheumatic conditions in the past five years because of a lack of standardization of clinical research and barriers to conducting research due to existing federal and state regulations. The article, “Cannabis for rheumatic disease pain: A review of current literature,” published in the latest issue of Current Rheumatology Reports.

The review found that legalization and decriminalization of cannabis at the state level reflects and promotes changing attitudes about cannabis corresponding to its increased use across a broad range of conditions, including rheumatic diseases. In addition, over 90 percent of Americans overall now support legal use of medicinal marijuana. Unfortunately, while there is strong, preclinical (animal) evidence showing that cannabis-based products play a role in alleviating pain and reducing inflammation, the highly variable state and federal statutes have limited patient-centered prospective research, education of clinicians, and comfort of patients in disclosing use of these therapies to their clinicians.

“In 2019, CreakyJoints presented data from our ArthritisPower Research Registry study showing more than half of arthritis patients reported wanting information on or actually had tried marijuana and/or cannabidiol products for a purpose they perceived as medical (often for pain relief and help sleeping) and yet, three years later, there’s been virtually no advancement in the research necessary to provide clinical evidence that rheumatologists and patients need to make decisions about cannabis use for symptom relief in combination with approved treatments” said W. Benjamin Nowell, PhD, Director, Patient-Centered Research at CreakyJoints, principal investigator of the ArthritisPower Research Registry.

“Without this research, it is impossible to develop clinical guidelines for medicinal cannabis in the U. S., which is vital for patients a seeking the full range of treatment options to explore in partnership with their physicians. The best way to treat rheumatic conditions is through the use of U.S. Food and Drug Administration approved medications, which are backed by evidence demonstrating their effectiveness and safety profile,” he added.

Only three cannabis-based medications are approved by the U.S. Food and Drug Administration and none of them are for treatment of pain or other symptoms related to rheumatic conditions.

Lack of Research in Arthritis Limits Potential

In the review, researchers explain that many studies have shown that cannabinoids are very effective in the laboratory at decreasing inflammation in cells and reducing both inflammation and pain in mice and rats. In addition, studies in humans that support efficacy are primarily surveys of people using medicinal marijuana who report relief of pain. In rheumatic diseases, there are very few studies of cannabis-based therapies in humans and the clinical trials conducted to date have very small sample sizes and inconsistent methods.

“Although the clinical evidence about cannabis for rheumatic disease pain is lacking, it is nevertheless important to educate patients about the known benefits and risks of alternative treatments, including medical cannabis. As a rheumatologist who treats patients with pain, I am aware that some of my patients have found cannabis to be an effective option when traditional medications fail to reduce their pain,” said Dr. Stuart Silverman, MD, FACP, FACR, rheumatologist, Clinical Professor of Medicine, Cedars-Sinai Medical Center and UCLA School of Medicine and Medical Director, OMC Clinical Research Center, Beverly Hills, CA. “I am open to discussing medical cannabis when patients express an interest in its use. Then, if they choose to use it, I follow them closely to monitor efficacy and any side effects and to ensure that they do not consider it as a replacement for FDA-approved disease-modifying drugs.”

CreakyJoints recommends that rheumatologists and healthcare providers be prepared to discuss medicinal cannabis with their patients in an empathetic, nonbiased manner. Suggestions include:

• Ensure patients understand medical cannabis is not an alternative to standard-of-care and guideline-based treatments, which should be continued.
• Explain that the available dose and purity of cannabis products is variable because of the lack of standardization and regulation by a body such as the FDA.
• Consider the most common reasons why patients have interest in medicinal cannabis, particularly pain relief and/or sleep promotion and offer alternative treatments, including nonpharmacologic modalities first, but also acknowledge that some individuals may prefer a trial of medical cannabis over other options, including opioids.
• Recognize some individuals may have symptomatic relief with medicinal cannabis, but educate patients about the lack of clinical research.
• Ensure understanding of short-term adverse events, including immediate psychomotor effects, dizziness, appetite changes, effect on mood, which are likely to be the same in people with rheumatic disease as in the general population and warn of the unknown long-term risks of medical cannabis
• Discourage medicinal cannabis use in patients with rheumatic disease who are under age 25.
• Support the urgent need for further research regarding the effects of medical cannabis in rheumatic disease.