Cannabis as a Treatment Option
I often travel to conferences and meetings where I meet other patients living with rheumatoid arthritis (RA) or other chronic illnesses. In the course of getting to know each other, I almost always get asked where I am from. When I reply “Colorado,” I would say that at least 80% of the time the follow-up question concerns my thoughts on cannabis as a treatment option for RA.
Personally, I haven’t really pursued cannabis to alleviate my RA symptoms. For one thing, I’ve been pregnant three times in the last six years, and it isn’t something I want to experiment with while pregnant! For another, one of my biggest frustrations about life with RA is that it sometimes keeps me from being productive (yes, I am definitely more than a little Type A!) and cannabis isn’t something I generally associate with productivity. I do know that there are now more and more options for cannabis where “getting high” isn’t the main focus, so maybe it’s an option I would consider pursuing in the future.
In the meantime, as local governments move towards legalization of marijuana, many patients with RA and other chronic illnesses are curious about cannabis as a potential treatment option. What seems less clear, however, is how medical professionals feel about this possibility. For this reason, I was very interested to attend a talk at the 2017 American College of Rheumatology Annual Meeting called “Cannabis in Society and Medical Practice.”
The talk looked at the role of legalized marijuana in our society as well as in the practice of evidence-based medicine. In the United States, marijuana remains a Schedule I controlled substance at the federal level. However, 23 states and the District of Colombia have passed local laws allowing for the medical use of cannabis, and seven states and the District of Colombia have even legalized marijuana for recreational use.
Implications for society
The first speaker was Rosalie Pacula, a senior economist at the RAND Corporation, who launched the discussion by explaining that it took multiple decades for the scientific community to learn all that it currently knows about the health implications of tobacco and alcohol. In contrast, she argued, equivalent research on cannabis has been extremely difficult to complete because of its federal designation as a controlled substance. This means that researchers are having trouble getting legal access to cannabis to study, greatly slowing research progress and making much of the data that is available a lot less reliable.
Unfortunately, this means that many of the laws legalizing the use of cannabis have been passed faster than the scientific community can collect enough data to really help weigh the health, safety, and ethical ramifications of the laws. And given the huge tax revenue currently being made from cannabis sales in states where it has been made legal (for example, in 2016 Colorado reported $193.6 million) this trend isn’t likely to change in the future. Dr. Pacula concluded that there are still many more questions we need to understand about marijuana use before we can fully understand the implications for society.
Possibilities for treatment
Daniele Piomelli, director of the Institute for the Study of Cannabis at the University of California in Irvine, presented the evidence-based medical perspective on the use of cannabis as a possible treatment option. He discussed the effects of cannabinoids on central and peripheral nervous system function in great detail, and shared information on the diseases where cannabinoids have been formerly tested.
Dr. Piomellia argued that only a few therapeutic indications for cannabis are actually supported by data at this time. In January 2017, the National Academy of Sciences (NAS) released a report based on the review of 10,000 published studies. The report concluded there was substantial evidence of the effectiveness of cannabis for chronic pain, nausea and vomiting, and multiple sclerosis (MS).
But despite widely held assumptions about the other myriad benefits of cannabis, the NAS committee didn’t find enough evidence of effectiveness to support the use of cannabis for amyotrophic lateral sclerosis (ALS), epilepsy, Huntington’s disease, irritable bowel syndrome (IBS), or Parkinson’s disease. They actually found limited evidence of ineffectiveness for dementia, depression, and glaucoma. And for cancer there was insufficient evidence to support or refute the effectiveness of cannabis.
In conclusion, Dr. Piomelli maintained that the federal government needs to change the scheduling of marijuana to allow scientists to expand cannabis research and enhance data collection. Additional research might allow scientists to provide better insight on the implications of cannabis for society and to learn whether cannabis is an appropriate treatment option for the pain associated with RA.
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