Cannabis Use Up Among Patients with Rheumatic Diseases

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Cannabis use among patients with rheumatic diseases has increased since 2014, and those who tried cannabis tended to have worse pain, disease activity, and symptoms and were taking more analgesics, according to a study presented at the annual meeting of the American College of Rheumatology in Atlanta on November 13.

Previous research has shown inconsistent results on the tolerability and safety of cannabis-based medicines for any chronic pain, and little is known about the use and effectiveness of cannabis in rheumatic diseases.

“We sought to evaluate the trends of cannabis use and associations with rheumatic disease characteristics in a U.S.-wide registry,” wrote the authors of the study, presented by Teresa Simon, M.P.H., of Bristol-Myers Squibb in Princeton, New Jersey.

The study included 11,006 patients who were participants in FORWARD -The National Databank for Rheumatic Diseases longitudinal study and had indicated in a 2014 and/or 2019 questionnaire whether they had ever used marijuana, cannabis, or cannabidiol for symptom relief and whether they found it helpful. Demographics, disease activity/status assessments, medications, comorbidities, and diagnosis were compared between cannabis users and nonusers in 2014 and 2019.

The prevalence of past or current cannabis use in patients with rheumatic disease increased from 6.3 percent in 2014 to 17.6 percent in 2019.

“At both time points, patients reporting use were younger, had worse measures on all disease activity/status assessments, and were more likely to have a history of smoking cigarettes, have fibromyalgia, report a history of depression, and report opioid use,” the authors said.

In 2014, users were also less likely to be Caucasian, married, and have health insurance, but in 2019 there were fewer demographic differences. Of the patients, 74 percent in 2014 and 62 percent in 2019 reported that cannabis was helpful in relieving symptoms. Since 2014, prevalence of use increased in 49 US states, with the highest prevalence in and near states where cannabis use is legal.

“The probability of cannabis use increases with increasing polysymptomatic distress, and the same is true for opioid use,” the authors wrote.

Meanwhile, a separate study presented at the annual meeting of the American College of Rheumatology  on November 10 found that patient and clinician perceptions differ regarding the benefits of marijuana and cannabidiol (CBD), especially around pain medication requirements. Worsening disease severity influenced patient use and over half of the 419 patients surveyed agreed that they were able to decrease use of pain medication when marijuana or CBD was used. However, nearly half of clinician respondents disagreed that marijuana or CBD should be recommended as medical therapy for patients with rheumatologic disorders. Many clinicians disagreed that use of pain medication decreases with marijuana or CBD use.

The authors suggested that further research is needed to better understand the benefits and risks of marijuana and CBD use in rheumatology patients.

REFERENCE

“2929- Cannabis Use Among Patients in a Large US Rheumatic Disease Registry.” Teresa Simon, M.P.H., 11 a.m., Wednesday, Nov. 13. 2019 ACR/ARP Annual Meeting, Atlanta