No matter who you talk to in the chronic pain, arthritis, and musculoskeletal disease community — patients, clinicians, researchers, public health experts — medical marijuana is controversial. Is it safe? Is it effective for treating pain and inflammation? Should it be legal?
While more clinical trials are sorely needed to understand the benefits and side effects of using medical marijuana to treat conditions like arthritis, it’s important to understand how patients think about and use marijuana to manage their conditions. The United States has a complicated quilt of state laws about the legal use of marijuana. Presently, 33 U.S. states have laws that allow for the legal use of marijuana for medical reasons, according to the National Conference of State Legislatures. (When you add recreational marijuana use and the legality of cannabidiol or CBD to the mix, things get even more confusing.) We have to recognize that its legal status may, in fact, influence whether patients use marijuana — or feel comfortable talking to their doctor about it. So researchers, including those from our non-profit organization, the Global Healthy Living Foundation (GHLF), set out to study this.
In research presented at the 2019 American College of Rheumatology/Association of Rheumatology Professionals (ACR/ARP) Annual Meeting in Atlanta, researchers surveyed 1,059 patients through the CreakyJoints patient community and the ArthritisPower research registry. Of those, 37 percent of people reported using marijuana for medical purposes, either presently or in the past. Of those, the majority said they did so to manage a specific health condition, such as:
- Rheumatoid arthritis: 51 percent
- Osteoarthritis: 46 percent
- Fibromyalgia: 35 percent
Nearly two-third of people currently using medical marijuana reported doing so at least once a day.
How Medical Marijuana’s Legal Status Affects Patients’ Usage
In this study, 77 percent of current or past marijuana users live in a state where it is legal for medical reasons. Just 40 percent of current or past users said they used a medical marijuana card to purchase it. Among the 60 percent of study participants who did not use a medical marijuana card, the top reasons included:
- Not being legal where the patient lives: 42 percent
- Cost of marijuana is more expensive through a dispensary: 19 percent
- Difficulty getting a card: 18 percent
Of the approximately two-thirds of patients surveyed who said they had never used marijuana for medical purposes, illegality played a big role: 40 percent cited that as a reason they haven’t used it. Other reasons for not using marijuana included:
- Potential impairment: 24 percent
- Not knowing where to obtain it: 21 percent
- Not knowing how to obtain it: 20 percent
How Medical Marijuana’s Legal Status Affects the Doctor-Patient Relationship
Our research found that there was a link between whether medical marijuana was legal where patients lived and whether patients spoke with their doctor about their usage. Among patients who live in states where marijuana is medically legal, 68 percent said they told their doctor about using it, while only 54 percent of patients in states where medical marijuana was not legal talked with their doctor about it.
“It’s alarming that not everyone is telling their doctor about their marijuana use, regardless of its legal status,” says study co-author W. Benjamin Nowell, PhD, director of Patient-Centered Research at the Global Healthy Living Foundation. “It is important that your rheumatologist and other providers are aware of what you might be using in addition to prescribed medication.”
A Lack of Research and Mixed Messages About Effectiveness
If you’re a patient who uses medical marijuana (or CBD, for that matter) to help treat your arthritis symptoms, your health care providers should know about it. Ideally, providers would make patients aware of potential side effects and interactions with other medications they use, advise on dosages, and help patients monitor and evaluate whether these treatments are helping. But our research, and that of others, indicates this isn’t always the case.
Earlier findings from the same survey, for example, noted that only 42 percent of patients perceived that their health care provider integrated their medical marijuana usage into their overall care (for example, made note of it and discussed how it fits in with other medications they take).
In a separate, unrelated study presented at the 2019 ACR meeting, when researchers at the University of Vermont Medical Center surveyed rheumatology clinicians about their patients’ usage of medical marijuana and CBD, they found that 45 percent of more than 100 doctors disagreed that marijuana or CBD should be recommended as medical therapy for people with rheumatologic conditions.
Here, legality may play a role too: More doctors who practiced in states where marijuana was legal for medical and recreational use said they were comfortable addressing questions about usage than in states where it was not legal. The authors concluded that “surrounding laws likely impact clinician perception and comfort with medical use.”
Part of this challenge is a dearth of solid research that rheumatologists and other doctors need to feel comfortable making recommendations to patients. In fact, in a recent paper published in the journal Expert Review of Clinical Immunology, researchers reviewed animal and human clinical studies on the use of cannabis for treating rheumatoid arthritis, osteoarthritis, systemic lupus erythematosus, systemic sclerosis, and fibromyalgia. “Despite the presence of studies supporting the benefits of cannabis, the researchers were unable to definitively conclude that cannabis or cannabis-related products are safe and effective for treatment of rheumatic diseases,” reported Clinical Pain Advisor. “They noted a gap between animal and clinical studies, as well as the paucity of studies examining long-term adverse effects. Large-scale clinical trials are necessary to examine the safety and efficacy of cannabis before it can be recommended for the management of rheumatoid arthritis, osteoarthritis, and fibromyalgia.”
“Indeed, our [ArthritisPower and CreakyJoints] research shows that despite a lack of quality evidence to guide the usage of medical marijuana and regardless of its legal status, many patients with arthritis are using it — and need more support,” says study co-author Kelly Gavigan, MPH, manager of research and data science at the Global Healthy Living Foundation (GHLF). “We need high-quality randomized controlled clinical trials to better understand whether and how medical marijuana might be used to help patients manage these diseases, in conjunction with their recommended medication.”
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