Cannabis-Based Medicines and Medical Cannabis in Rheumatic Diseases: A Treasure Chest or Pandora’s box

Cannabis-Based Medicines and Medical Cannabis in Rheumatic Diseases: A Treasure Chest or Pandora’s box:

Abstract

Purpose

Interest in cannabinoids as a therapy in rheumatic diseases has grown exponentially. With legalization of medical and recreational cannabis in many jurisdictions worldwide, patients have easier access and opportunity to explore medicinal use. We report on the evidence for effect of cannabinoids in rheumatic diseases and critically address the current challenges surrounding use.

Recent findings

Preclinical study of cannabinoids points to an effect on pain and inflammation, fundamental features of rheumatic diseases. The findings of the few randomized controlled trials (RCTSs) of cannabis-based medicines in rheumatic diseases are limited by short study duration, small study samples, and methodology flaws. There are no RCTs of medical cannabis in rheumatic diseases. Therefore, current guidelines mostly recommend against use of any cannabinoid product for rheumatology patients.

Summary

Even with limited clinical evidence, patients are increasingly showing interest in cannabis. Rheumatologists must be diligent in exploring other established treatment options prior to a trial of cannabinoids in any form. Cannabis holds potential as a treasure chest for rheumatic disease treatment, but with true effect and risks largely unknown and requiring study. Governments’ move to legalize medical cannabis has bypassed the established procedures of drug approval and opened Pandora’s box.