A clinician can minimize the financial burden by helping the patient navigate the paperwork necessary to ensure continued medication/health service coverage during the transition from dependence on parental insurance carriers to enrollment in governmental or private sector funding bodies.
The rise of social media’s influence on adherence to treatment—As noted earlier, a young adult may view noncompliance with recommended treatment as a direct expression of personal independence. Others, due to an unstable home situation, lack a strong social support system that would fortify their adherence to a medication regimen. For a few patients, there may be psychological comfort in avoiding anxiety about being accountable for treatment decision making and feelings of dread over the implications of treatment failure.
There may be other factors at work, too. A significant proportion of young adults view pharmacological approaches with a high degree of suspicion. They may have already experienced side effects from medication. But it is more likely that they have accessed the Internet and read negative personal narratives about an individual medication or class of drug. Thus, the power of opinion on social media sites, often cloaked in skepticism or even disinformation, to formulate impressions on treatment should not be discounted.
It is entirely valid for the patient to raise concerns about the impact of treatment on appearance, relationships and education. Therefore, opportunities to discuss the effects of treatment should be provided early and regularly.8 Social media can be enlisted as a useful ally to assist the patient in securing online tools that promote disease self-management. For example, healthy lifestyle behaviors can be supported by encouraging the patient to go online and seek out apps that promote long-term health goals, such as maintenance of a healthy diet and regular exercise.
The emergence of medicinal marijuana for pain management—Medicinal marijuana is increasingly advocated as a treatment for rheumatic pain.9 This resonates for many arthritis patients, who are characteristically open-minded about complementary therapies. Confounding the issue somewhat is the social trend among young adults of viewing marijuana use for relaxation as a socially acceptable and rather harmless solution to anxiety—in much the same way their grandparents and parents viewed minor tranquilizers. These two popular beliefs drive the contemporary social movement for marijuana legalization and, in all probability, foreshadows an increasing demand by rheumatology patients for physician-approved access to cannabis and cannabinoid products as alternative medicine.
Unfortunately, there is not yet a sufficient body of clinical trials of medicinal marijuana in various rheumatic conditions to allow for definitive conclusions regarding effects.10,11 The crux of the matter is that, for the scientifically trained rheumatologist, caution is required, because research has yet to determine what quantity of medical marijuana (e.g., dosage or measurement) delivered by a specific route (e.g., individual differences in frequency and length of inhalation, as well as availability of edibles) will produce a known result (e.g., predicted outcome). Therefore, it is foreseeable that most rheumatologists will continue to approach medicinal marijuana, especially for young persons with rheumatic disease, as a public health issue.
