One of the sessions at the Canadian Rheumatology Association meeting held last month focused on the Association’s recently created Position Statement on the use of Medical Cannabis in Rheumatic Disease. Patients seen by rheumatologists who report using cannabis, indicate pain as being the most common reason for using medical cannabis, however there are no trials and limited information on its’ use for this patient group. Recognizing that better pain control is needed and the fact that this drug is now legal in Canada, it is necessary to address this issue. It is important to recognize that medical cannabis is not a replacement for disease modifying therapies prescribed by rheumatologists that prevent the progression of conditions such as rheumatoid arthritis, psoriatic arthritis and ankylosing spondylitis. Many other modalities for treating arthritis such as physiotherapy are part of the foundation for joint health. Cannabis would be seen as an additional therapy to augment evidence based treatments.
With that in mind, the recommendation is that medical cannabis be avoided in patients under 25, as neurological development continues into the early 20s. Use before this age may impact brain maturation, and has an impact on lifetime achievement. The product chosen should have a low THC to high CBD ratio. It is important that smoking/edibles are avoided as oil is preferred to avoid harm to the lungs and to offer a uniform reliable amount per dose. There is not one ideal ratio as each person’s response can be different, so starting with low doses and gradually increasing the amount is suggested. Most people will use 1-3 grams/day. It important to try both prescription and non prescription methods to relieve pain prior to trying medical cannabis, as the long term effects of medical cannabis for this patient group are unknown. The use of opioid pain killers is not suggested for treating arthritic conditions.
For more information, please see the Canadian Rheumatology Association Position Statement on Medical Cannabis Use in Rheumatic Disease January 2019.
Carolyn Whiskin is the Pharmacy Manager for Charlton Health. Carolyn specializes in the treatment of autoimmune diseases, pharmaceutical compounding, women’s health, pain and smoking cessation. Carolyn has won provincial and national awards for her commitment to patient care and public service.