Cannabis as a medical treatment for individuals suffering with pain and inflammation is becoming a more accepted treatment, especially in the United States and Canada. A 2014 article from the journal Arthritis Care and Research reports that up to 80% of patients in the United States and up to 65% of patients in Canada that seek medically prescribed cannabis do so in order to alleviate the severe pain inflicted from rheumatoid arthritis (RA) or other musculoskeletal pain.
Cannabis and Pain Relief
As a pain reliever, cannabis has been known to be effective for at least 5,000 years. In clinical trials in Western medicine, however, it has only been seriously studied for the last 20 years. Indications of its efficacy in controlling symptoms of RA specifically are somewhat lacking according to an article as recent as 2014 in the International Journal of Clinical Rheumatology. The medicinal use of cannabis is, of course, known to relieve stress, promote sleep and increase appetite for those that are in need of either gaining weight or increasing their nutrition. There are side-effects for many though that should be considered before using cannabis as a treatment for RA. The stimulation of appetite may not be a desirable outcome for individuals that may already be overweight or obese. Cannabis use, especially if over-used by those self-medicating, can have mood effects, cognitive and psychological impairment and changes in the cardiovascular system. Those individuals that smoke cannabis as opposed to taking it in a pharmaceutically prepared form such as a pill or spray may also experience negative respiratory symptoms. Despite these side-effects, there are several forms of cannabinoids that, due to extensive study, do have known efficacy and predictable side-effects for individuals suffering from arthritis.
The same 2014 issue of the International Journal of Clinical Rheumatology as referenced above cites three such examples of these cannabinoids. A synthetic “analog” of tetrahydrocannabinol (THC) is the product Nabilone. Dronabinol is another, which is a stereoisomer of THC. A spray form has also been developed, Nabiximols. These pharmaceutical developments have been created to have more long-term anti-inflammatory effects and fewer psychoactive effects than the recreational forms of cannabis. A 2006 article in the Journal Rheumatology cites yet another cannabis-based medication (CBM), Sativex.
A double-blind, five-week long study conducted by British researchers from the departments of Rheumatology at Northampton General Hospital, Selly Oak Hospital, the Royal National Hospital for Rheumatic Diseases and the Cannabinoid Research Institute at Oxford studied the efficacy of Sativex on 58 individuals suffering from RA. They found statistically significant improvement from the individuals actually receiving Sativex and not a placebo. These improvements ranged from the patients achieving more and better sleep to experiencing less pain and attaining better scores on the standard inflammation activity measure test, the DAS28. The improved sleep resulting from the use of Sativex was postulated by the researchers to be due to the pain relief of the medication, and hot from any hypnotic effect of the medication.
Israeli researchers as cited in a 2016 article from the Israeli publication Rambam Maimonides Medical Journal are not as sure, but still suggest that CBMs could help with the pain associated with suffering from RA. Only 17% of the Israeli rheumatologists that were surveyed suggested that there was “no role” for cannabis as a treatment option for those suffering from symptoms of arthritis. Those 83% that did feel there was a role were “willing to prescribe herbal cannabis if other treatments failed.” A noted shortcoming of this study, however, was its low response rate from professionals that could be unfairly influencing its outcomes.
Evidence cited in the Journal of Experimental and Integrative Medicine is supportive of the role of cannabis in treating pain and suffering associated with RA. It notes the role cannabis plays as an anti-inflammatory agent and pain reducer. Cannabis can remove harmful stimuli and help to begin the process of healing the damaged tissues that can result from arthritis. Additionally, rheumatoid joints contain high numbers of receptors for cannabinoids making this particular treatment highly effective. The article further states cannabis’ ability to inhibit edema, a sometimes side-effect of inflammation where fluid can accumulate between the joints and the skin.
Medical Cannabis in the United States
More recently (June 2015) here in the US, the Obama administration removed the Public Health Service (PHS) review, which had previously made available funding for research into the health benefits of medicinal cannabis use extremely scarce and difficult to obtain. This will also increase the amounts of cannabis that researchers can have on hand at any given time during their study. Ironically, this same review initiated during the Clinton presidency was intended to make research funds available to start looking into the health benefits of cannabis. Its cumbersomeness ended up creating unintended roadblocks and impediments for researchers. Researchers Fabian Hernandez and Sathees Chandra of the Department of Biomedical Sciences, College of Nursing and Health Sciences at Barry University, stated in a 2016 article in the Journal of Experimental and Integrative Medicine that this removal “will initiate the next generation of research on cannabis. By permitting more federal funding and access to samples, the medicinal benefit and their bio-molecular pathways will be better understood… As federal funding for cannabis research increases all over the world, a better understanding of these healing benefits will be reached.” Hernandez and Chandra cite the undeniable evidence of the benefits of cannabis to sufferers of not only RA, but other inflammatory ailments as well as its benefits to those afflicted with anything from insomnia, broken bones and cancer.
It seems as if there is hope for those suffering from the painful effects of rheumatoid arthritis to be found from CBMs. Physicians though are still obligated to counsel against their use as a first response. Factors such as a patient’s past recreational use of cannabis, their history of addiction and family history of mental and psychoactive disorders must all be taken into account before a health professional will likely prescribe a cannabis-based pharmaceutical for sufferers of RA.