Substituting Medical Cannabis for Medications Improved Rheumatic Disease Symptom Management

Kevin F. Boehnke, PhD

Credit: Sigma Nutrition

New research suggests that a number of people with rheumatic diseases substitute medications with medical cannabis (MC), often containing some THC, for symptom management.¹

“With growing societal use of MC, understanding the current trends in why and how people use MC in the context of rheumatic conditions is critical to complement the limited clinical trial literature. Only a handful of observational studies have investigated MC use among people with rheumatic conditions, a group that may have unique challenges owing to age, substantial use of concomitant medications, and high symptom burden. Thus, we investigated patterns of MC product substitution for symptom management among people reporting current use of MC for rheumatic conditions in the United States (US) and Canada,” lead investigator Kevin F. Boehnke, PhD, Assistant Professor of Anesthesiology, University of Michigan, and colleagues wrote.¹

Boehnke and colleagues conducted a secondary analysis from a cross-sectional survey conducted with patient advocacy groups in the US and Canada. They investigated differences in perceived symptom changes when substituting medications for MC and use patterns, including methods of ingestion, cannabinoid content (CBD vs THC), and use frequency. They aimed to provide some evidence to potentially support standardized use of MC among people with rheumatic, for which there is a scarcity of clinical trial literature.²

The investigators found that in 763 participants surveyed, 62.5% (n = 477) reported substituting MC products for medications, including nonsteroidal anti-inflammatory drugs (54.7%), opioids (48.6%), sleep aids (29.6%), and muscle relaxants (25.2%).¹

A greater proportion of participants in the substitution subgroup had fibromyalgia (OR 1.44; 95% CI 1.06–1.95; P = 0.021), chronic upper back pain (OR 1.67; 95% CI 1.11–2.53; P = 0.014), chronic neck pain (OR 1.59; 95% CI 1.14–2.23; P = 0.007), Ehlers Danlos syndrome (OR 4.61; 95% CI 1.05–20.31; P = 0.043), and Raynaud's disease (OR 1.91; 95% CI 1.11–3.28; P = 0.019).¹

Most participants that substituted medications decreased or ceased medication use. Participants’ reasons for substituting included fewer adverse events (AEs) with MC compared with medication (39%), better symptom management (27%), fewer AEs (12%), other (9%), ability to obtain (8%), and greater social acceptance (5%).A higher proportion of substitutors used inhalation routes than those who did not (P <.001).¹

More than half (n = 436, 57.3%) of the participants surveyed used MC daily. Compared with those who did not substitute MC for medications, those who substituted used MC more frequently, both daily (w = 0.23, P < 0.001) and weekly (d = 0.36; 95% CI 0.21–0.51; P < 0.001).More substitutors used THC products than those who did not substitute (w = 0.15, P = 0.002).¹

Substitutors reported statistically significant improvements for pain (d = 0.32; 95% CI 0.16–0.47; P = 0.018), sleep (d = 0.21; 95% CI 0.02–0.40; P = 0.034), joint stiffness (d = 0.31; 95% CI 0.12–0.50; P = 0.040), muscle spasm (d = 0.31; 95% CI 0.03–0.59; P = 0.047), inflammation (d = 0.23; 95% CI 0.04–0.42; P = 0.022), and overall health (d = 0.32; 95% CI 0.17–0.47; P < 0.001).¹

“The acceptance of MC as a treatment strategy for rheumatic conditions is evolving. The changing legal status of cannabis has allowed a greater openness with more people willing to try cannabis for symptom relief. These encouraging results of medication reduction and favorable effect of MC require confirmation with more rigorous methods. At this time, survey information may be seen as a signal for effect, rather than sound evidence that could be applicable to those with musculoskeletal complaints in general. Comparative effective clinical trials of MC versus other pain treatments are needed, as are more prospective studies investigating the effects of MC on the use of medications and other substances in rheumatic populations,” Boehnke and colleagues concluded.¹

REFERENCES

1. Boehnke KF, Scott JR, Martel MO, et al. Substituting Medical Cannabis for Medications Among Patients with Rheumatic Conditions in the United States and Canada. ACR Open Rheumatol. Published online September 5, 2024. doi:10.1002/acr2.11717
2. Fitzcharles MA, Ste-Marie PA, Häuser W, et al. Efficacy, tolerability, and safety of cannabinoid treatments in the rheumatic diseases: a systematic review of randomized controlled trials. Arthritis Care Res (Hoboken) 2016; 68(5): 681–688