Dr. Fitzcharles perceives a similar interest in medical marijuana by patients and physicians both in her home country of Canada—where medicinal marijuana has been legal since 2001—as well as in the U.S., where its use is increasing each year. One issue that she sees cannabinoid treatments trying to address is pain—always a concern of patients. “Although pain is the most common reason why patients seek care from a rheumatologist, specific pain management has not been featured prominently in rheumatology care in the past. We have been so focused on achieving the best outcome for patients with inflammatory disease that attention to the suffering of patients has often taken second place,” she said. With the concern in North America now on overuse of opioids, Dr. Fitzcharles speculated that there may be a flip to a greater use of cannabis for patients with rheumatic pain—yet another reason why rheumatologists need to be up to speed about its realistic effectiveness.
Further Research Areas
Researchers have work to do in several areas related to rheumatology and cannabinoid treatment, Dr. Fitzcharles said. That includes studies focused on the effects of the whole cannabis plant, which has hundreds of molecules and may interact in unknown ways or on individual molecules; which specific molecules have a therapeutic effect; symptoms that can be best addressed with the use of cannabinoids (e.g., pain or sleep disturbance); how cannabinoids interact with other medications used to treat rheumatic diseases; and short- and long-term adverse effects in patients with rheumatic disease.
“We have no idea at this time about the ideal molecule, dosage, pharmacokinetics, efficacy, or safety of various cannabinoid preparations in the management of rheumatic complaints. Unfortunately, medicinal herbal cannabis use is currently driven by political/financial agendas, and advocacy has outrun science. The health community must maintain a strong voice to demand competent study, and we must maintain a strong voice to demand competent study and protect both patients and society,” Dr. Fitzcharles said.
Dr. Fitzcharles and fellow researchers are working on a study about ingested marijuana in the form of an extracted oil for painful conditions, such as fibromyalgia.
Vanessa Caceres is a medical writer in Bradenton, Fla.
References
- Fitzcharles MA, Ste-Marie PA, Hauser W, et al. Efficacy, tolerability, and safety of cannabinoid treatments in the rheumatic diseases: A systematic review of randomized controlled trials. Arthritis Care Res (Hoboken). 2016 May;68(5):681–688.
- Blake DR, Robson P, Ho M, et al. Preliminary assessment of the efficacy, tolerability, and safety of a cannabis-based medicine (Sativex) in the treatment of pain caused by rheumatoid arthritis. Rheumatology (Oxford). 2006 Jan;45(1):50–52.
- Skrabek RQ, Galimova L, Ethans K, Perry D. Nabilone for the treatment of pain in fibromyalgia. J Pain. 2008 Feb;9(2):164–173.
- Ware MA, Fitzcharles MA, Joseph L, Sheir Y. The effects of nabilone on sleep in fibromyalgia: Results of a randomized controlled trial. Anesth Analg. 2010 Feb 1;110:604–610.
- Huggins JP, Smart TS, Langman S, et al. An efficient randomized, placebo-controlled clinical trial with the irreversible fatty acid amide hydrolase-1 inhibitor PF-04457845, which modulates endocannabinoids but fails to induce effective analgesia in patients with pain due to osteoarthritis of the knee. Pain. 2012 Sep;153(9):1837–1846.
