In cases where it must be conceded that the young adult will use medicinal marijuana regardless of medical opinion, the transition clinic team should respond by engaging the patient in a conversation that covers the following points:
- Long-term outcome. The patient must be able to distinguish between treatments for disease suppression and approaches to pain management. Marijuana’s ability to provide relief through dissociation of the pain experience does not in any way signify that arthritis is inactive or in remission.
- Known risks. First, human brain development continues into the early 20s, and exposure to cannabinoids may result in impaired neural connectivity in areas of the brain important for learning, alertness, executive function and inhibitory control.12 Second, herbal cannabis may impair motor coordination leading to an increased rate of serious injury or death in motor vehicle collisions.13 Third, legal implications exist when undertaking the acquisition of a controlled substance if the appropriate bureaucratic sanctions are not in place.
- Administration options. The oral route (edibles) eliminates the immediacy of a head high and, therefore, presumably reduces the risk of addiction.14 Vaping instead of toking provides greater protection to respiratory health.15 Products with higher cannabidiol (CBD) to tetrahydrocannabinol (THC) ratios reportedly maximize pain relief while providing greater protection from psychoactive effects.16
Individual Differences in Adjustment
Coping with changes in quality of life—The main predictors of impaired health-related quality of life for children and adolescents with JIA have been found to be functional ability, pain, subjective burden of medication use and school absence.17 The nature of flares is also particularly hard on patients. The seemingly random and sporadic appearance and disappearance of symptoms may cause the patient to experience relatively rapid swings between feeling in control to feeling powerless, from feeling hope and optimism to feeling disappointment and frustration.18
This emotional roller coaster of uncertainty may lead to a predicament in which managing treatment becomes the major focal point to the young adult’s life. Well-meaning recommendations and referrals can readily consume a huge chunk of the patient’s spare time. A balance must be struck that allows patients to make time for activities that inject fun and passion into their lives.
Striving to live a normal life—Young adults typically don’t want to be perceived as different from their peers. However, pain and visible signs of disability can set the patient apart, not only by creating forced dependency on others, but by stoking the unsavory sensation of being on stage rather than being just part of the crowd. The corollary problem is that some patients endure stigma when symptoms are largely invisible to outside observers. Trivialization of the disease may occur, or even worse, the patient is labeled weak because of difficulty they experience in performing certain physical or recreational activities.
