The lack of research on medical cannabis for rheumatic disease or chronic pain syndromes makes this an area for potential exploration with a Rheumatology Research Foundation grant or U.S. National Institutes of Health grant, Dr. Hausmann says.
However, it’s clear the use of medical cannabis has increased with more legalization. Dr. Fitzcharles was part of two studies in Montreal that surveyed 1,000 patients with rheumatic disease before and after recreational legalization. Researchers found the use of medical cannabis doubled after legalization, from 15 to 30%.2
“Patients are now trying it themselves, so not necessarily coming through the medical stream because they can just go and buy it legally,” she says.
The demographics of patients trying medical cannabis have also changed. Ten years ago, younger patients were more likely to use cannabis recreationally, Dr. Fitzcharles says. Now, more women and patients over the age of 60 are using cannabis, particularly oral vs. smoke-based products.
Dr. Hausmann notes that patients may be seeking out medical cannabis because rheumatologists are not doing enough to help patients manage their pain. But it’s encouraging that these patients now have more options for pain management.
The majority of studies focus on pharmaceutical products vs. herbal cannabis, which makes it hard to collectively understand the effects of the herbal form of cannabis.
Pearls for Pain Management & Cannabis
Dr. Fitzcharles shared some pearls to help rheumatologists guide their patients on medical cannabis use.
1. Remember that medical cannabis is not for everyone.
The position statement from the Canadian Rheumatology Association on medical cannabis for outpatients has guidance on patients who should avoid medical cannabis.3 They include:
- Patients under the age of 25 because their brains are still developing;
- Pregnant patients because cannabinoids can cross the placenta and harm the fetus;
- Patients who are breastfeeding;
- Patients over the age of 60 because they are more likely to use multiple medications, which can increase the risk of drug interactions, and the use of cannabis may increase their risk of falling;
- Patients with mental health conditions; and
- Patients with moderate to severe cardiovascular or pulmonary disease.
Dr. Fitzcharles also discussed the dangers of driving while actively using cannabis, which can slow a person’s judgment.
2. Advise patients to focus on oral preparations rather than inhaled forms of medical cannabis.
This type of cannabis may help patients avoid the adverse effects of smoking on rheumatic disease.
3. Encourage patients to start with a low dose as a capsule or oil.
