Patients report rheumatic disease improvement after swapping certain drugs for cannabis
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Key takeaways:
- Approximately 62% of participants reported switching certain drugs for medical cannabis.
- Pain, stiffness and other symptoms were reduced in people with rheumatic diseases who substituted for medical cannabis.
Nearly two-thirds of patients with rheumatic diseases reported swapping NSAIDs, opioids, sleep aids or muscle relaxants with medical cannabis, with most reporting higher symptom improvement with the cannabis, according to data.
“We wanted to understand why and how people with rheumatic conditions used medical cannabis, especially given the rapidly changing legal environment,” Kevin F. Boehnke, PhD, of the University of Michigan Medical School, told Healio. “This manuscript is also an extension of previous work conducted by my colleagues and I, where we showed that people use cannabidiol (CBD) and medical cannabis in place of other medications for fibromyalgia and chronic pain symptom management.”
To examine the prevalence of switching certain drugs for medical cannabis in patients with rheumatic diseases, Boehnke and colleagues analyzed data from an anonymous, online survey previously conducted in collaboration with the Arthritis Foundation and Arthritis Society Canada.
The cross-sectional survey asked participants to report their diagnosed rheumatic conditions and use of substances and medications. They were also asked whether they had substituted medical cannabis for any other medications, including opioids and disease-modifying anti-rheumatic drugs, as well as subsequent changes in their medication use and symptom severity. The researchers grouped survey participants by whether they had substituted medical cannabis or not, and used statistical methods to find between-group differences in their self-reported symptom changes, medication usage, cannabis ingestion methods and other characteristics.
The study sample included 763 adults (mean age, 59 years), 75.2% of whom said they previously used cannabis recreationally.
In total, 62.5% of participants reported substituting medical cannabis for at least one medication, most often NSAIDs (54.7%) and opioids (48.6%), but also sleep aids (29.6%), and muscle relaxants (25.2%), according to the researchers, who published their findings in ACR Open Rheumatology. Across medication classes, about 80% of participants reported decreasing or stopping medication use after starting medical cannabis.
Additionally, substituting medical cannabis was associated with significantly greater improvements, compared with non-substitution, in the following symptoms:
- Pain (Cohen’s d = 0.32; 95% CI, 0.16-0.47).
- Sleep (d = 0.21; 95% CI, 0.02-0.4).
- Joint stiffness (d = 0.31; 95% CI, 0.12-0.5).
- Muscle spasms (d = 0.31; 95% CI, 0.03-0.59).
- Inflammation (d = 0.23; 95% CI, 0.04-0.42).
Substitution was also associated with greater improvement in overall health, assessed using the PROMIS Global score (d = 0.32; 95% CI, 0.17-0.47), according to the researchers.
Common reasons participants reported for substituting medical cannabis were that they experienced fewer side effects (39%) and adverse effects (12%), as well as better symptom control (27%). These were also the top three reasons for substitution across individual medication classes.
“People perceived cannabis to be more helpful and less harmful than these conventional medications,” Boehnke said. “Because cannabis is so widely available in both the United States and Canada, clinicians need to be aware of its effects and how to provide compassionate, thoughtful guidance on using cannabis as a potential treatment option.”
According to Boehnke, the findings were generally consistent with his team’s previous work, but the larger cohort in this study adds value.
“To see these findings replicated in a large sample of people with rheumatic conditions was compelling and interesting, given the lack of clinical trial literature on many of the conditions for which people were using medical cannabis,” he said.
However, Boehnke additionally counseled caution in interpreting these results in clinical practice.
“We want to caution that medical cannabis does not work for everyone,” he said. “In the primary paper from this study, we showed that a substantial number of individuals discontinued cannabis use because it did not provide symptom relief. Moving forward, conceptualizing cannabis as a potential treatment option — ie, a tool in the toolbox — is much more helpful than framing it as a panacea or a poison.”
For more information:
Kevin F. Boehnke, PhD, can be reached at kboehnke@med.umich.edu; X (Twitter): @boehnkster.
Perspective
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Daniel J. Wallace, MD, FACP, MACR
A Canadian group collected 763 patients from patient advocacy groups and found that substituting THC for nonsteroidal anti-inflammatory drugs, opioids, sleep aids and muscle relaxants was associated with higher symptom improvements including sleep, pain and anxiety. It appears that this is true for a very specific subgroup of patients with musculoskeletal disease that does not represent the majority of North Americans as a whole.
The study group consisted of 85% females and included only 5% with inflammatory arthritis, a group committed to their symptoms enough to be part of a patient advocacy group, as well as 50% who were current or one-time smokers and 70% who were current drinkers of alcohol. This group is of course more likely to try cannabinoids. In addition, their diagnoses were self-reported and not validated. The study population represents a subgroup who is more likely to experiment with supplemental and complementary approaches.
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