Emmanouil Rampakakis, PhD

Patients with more severe rheumatic diseases are much more likely to use medicinal cannabis compared to other patients.

A team, led by Emmanouil Rampakakis, PhD, JSS Medical Research, assessed the prevalence of medical cannabis use, symptoms treated, and rheumatologist perceptions for patients attending rheumatology clinics in Ontario.

Cannabis Use

Medical cannabis is commonly used to treat common symptoms of patients with chronic conditions, including patients with rheumatologic diseases.

“With cannabis legalisation in Canada and easier access, it is important that rheumatologists understand its potential impact on their practice,” the authors wrote.

The study included data from 8 rheumatology clinics in which adult patients and rheumatologists participated in a 3-part medical cannabis survey.

The first part of the survey was completed by the rheumatologist, the second part was completed by all patients, while the third and final component was completed by medical cannabis users.

The investigators used student t-test and Chi-square test to compare medical cannabis users to never users.

In total, 799 patients were included in the study, 20.4% (n = 163) of which were currently using medical cannabis or within 2 years of using medical cannabis. The remaining 636 participants never used medical cannabis.

Trends

The results show current or past users were younger, more likely to be taking opioids or anti-depressants, have psychiatric or gastrointestinal disorders, and have used recreational cannabis (P <0.05) compared to never users. This group also had higher physician (2.9 vs 2.1) and patient (6.0 vs 4.2) global scores, and pain (6.2 vs. 4.7) (P <0.0001).

Some symptoms were more common than others, including pain (95.5%), sleeping (82.3%), and anxiety (58.9%), while 78.2% of current or past users reported that medical cannabis was at least somewhat effective.

The surveys from rheumatologists show the doctors were uncomfortable authorizing medical cannabis, largely because of a lack of evidence, knowledge, and product standardization.

“Medical cannabis use among rheumatology patients in Ontario was two-fold higher than that reported for the general population of similar age,” the authors wrote. “Use was associated with more severe disease, pain, and prior recreational use. Reported lack of research, knowledge, and product standardisation were barriers for rheumatologist use authorisation.”

A Different Perspective

In an accompanying editorial, a group, led by H. Ouatah, Rheumatology Department, Clermont-Ferrand University Hospital, added some commentary with some data on some French observances on rheumatological patients using cannabis for medicinal reasons.

The investigators added the data from 501 patients in France, where cannabis is not legalized.

Of this group, only 4.6% (n = 23) reported using medical cannabis. Of this group, 26% used it for pain, 22% used cannabis to relax, 21% used it to correct sleep issues, 10% used it to reduce anxiety, and 14% used cannabis to have fun. This group was also younger (43.8 vs. 52.5 years; P = 0.003), more often men (73.9% vs. 40.6%; P = 0.002), smokers (65.2% vs. n=23.9%; P = 0.001), and alcohol users (91.3% vs. 68.0%).

For specific disease states, cannabis users were more likely to be patients with anklyosing spondylitis or psoriatic arthritis than patients with rheumatoid arthritis.

Cannabis use resulted in lower levels of anxiety (5.27±1.93 vs. 7.27±3.88; P = 0.01), while pain intensity was higher (5.9±2.2 vs. 4.7±2.0; P = 0.01). There were no differences found in depression, catastrophizing, precariousness, central pain sensization, or levels of biological inflammation.

“We hypothesised that people with rheumatic diseases would be more likely to use cannabis to relieve their pain, but of the 501 patients in our study, only 4.6% were current cannabis users,” the authors wrote.

The study, “Medical cannabis use by rheumatology patients in routine clinical care: results from The Ontario Best Practices Research Initiative,” was published online in the Clinical and Experimental Rheumatology.