Medical cannabis growing in acceptance, improves pain in several rheumatic diseases
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ORLANDO — Medical cannabis is growing in acceptance and has benefits for managing pain in patients with rheumatic diseases, but more research is required, a presenter said at the 2022 Rheumatology Nurses Society Conference.
“Whether you are for it or against it, societal norms are moving toward the support of medical marijuana,” Alvin F. Wells, MD, PhD, director of the department of rheumatology at the Advocate Aurora Medical Group, in Wisconsin, told attendees. “Current data support the use of medical marijuana for pain, seizure disorders and other conditions, but we need more data on its effect on inflammation.”
One of the reasons to adopt medical cannabis, Wells said, is the ongoing opioid crisis. States that have moved forward with medical cannabis have seen decreases in total prescriptions for opioids and the number of overdose deaths. Additionally, Wells explained the potential impact of medical cannabis in several rheumatic diseases, including scleroderma, rheumatoid arthritis and osteoarthritis.
Discussing systemic sclerosis, Wells acknowledged the difficulty in treating the disease effectively with currently approved drugs.
“Well, what impact might cannabis have on that? We know that CB1 activates fibrosis,” Wells said. “Skin biopsies from patients with diffuse scleroderma have overexpression; they have more CB1 and CB2 receptors, compared with healthy controls.”
However, there are not enough data to suggest any benefit in blocking those receptors, Wells added.
“We don’t have the data yet, and so the jury is still out for that,” he said.
In patients with OA, CB1 and CB2 receptors are expressed in synovia and chondrocytes, according to Wells. Endocannabinoids are found in the synovial fluid in patients with OA, but not healthy controls, he added.
“The drugs might work for a neuropathic-type pain, but for inflammatory or degenerative pain, like OA, it might not be the best,” Wells said.
If a patient wants to attempt treatment with medical cannabis, it may be worthwhile, but the therapy may not exhibit effective responses, Wells said.
In RA, CB1, CB2, AEA and 2-AG receptors are expressed in the synovium. Referencing a study from 2012 focusing on the Cochrane Database, Wells pointed out a 0.7-point improvement on a scale of zero to five for pain improvement and a 12% improvement in sleep quality in patients receiving medical cannabis, compared with a control group.
“All drugs can have side effects, and the most common ones we need to talk about are dizziness, light headedness, dry mouth and the nausea,” Wells said. “These same side effects can occur from the CBD that your patients can get over the counter.
“We don’t have the data yet to say that this works for all of our inflammatory diseases — it might help the pain associated with those, but it really does not make a big dramatic impact,” Wells added. “Whether you’re doing it yourself or you have patients or family members as well, that is besides the point. We — society — is already there; almost all states have approved this as well.”
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Wells AF. Evidence based medicine: Cannabis in rheumatology. Presented at: Rheumatology Nurses Society annual conference; August 3-6, 2022 (virtual meeting).
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