Medical Marijuana and Arthritis

There has long been a debate over legalizing marijuana, but never before has there been more attention focused on medical marijuana. I don't just mean among the general public. There are well-respected, highly-visible doctors in the conversation. In 2013, CNN's Dr. Sanjay Gupta publicly said that science backs up the need for medical marijuana. He also said, "I understand there is a concern that if you legalize it, kids will use it recreationally, and I don't want young people to do that, but our concern for their safety shouldn't keep patients who need this from getting access."

Dr. Gupta apologized for not previously digging deep enough when he looked for research on the subject. Instead, he admittedly fell in line like a good soldier agreeing with the Assistant Secretary of Health, Dr. Roger O. Egeberg, who on August 14, 1970, wrote a letter recommending that the plant, marijuana, be classified as a schedule 1 substance. It has remained that way for nearly 45 years. Schedule 1 is defined as "the most dangerous" drugs "with no currently accepted medical use."

As Gupta was preparing for a documentary, he revisited that letter and dug for more research, looking for anything he had previously missed as well as the latest findings. His new search through the U.S. National Library of Medicine unearthed nearly 2,000 more recent scientific papers on marijuana—with 6 percent of those investigating benefits. The rest were studies that focused on potential harm. Perhaps a skewed approach? It at least raises that question.

Dr. Gupta also reminds us that until 1943, marijuana was part of the United States drug pharmacopeia. It was prescribed for various conditions, one of which was neuropathic pain. So, with a bit of the history in hand, as well as a bit of the current conversation, let's look at where we stand today.

Medical Marijuana for Rheumatic Conditions

The effectiveness and safety of medical marijuana for rheumatic conditions, such as rheumatoid arthritis, lupus, and fibromyalgia, is not currently supported by medical evidence. An article published in March 2014 in Arthritis Care & Research advises doctors to discourage arthritis patients from using medical marijuana.

According to the aforementioned Arthritis Care & Research article, that conclusion was drawn despite the fact that research has revealed 80 percent of marijuana users in a U.S. pain clinic were using the drug to control myofascial pain; in the United Kingdom and Australia, up to 33 percent of people were using marijuana to treat arthritis pain; and, in June 2013, the office of Information Commissioner of Canada listed severe arthritis as the reason 65 percent of Canadians were allowed to possess medical marijuana.

Authors of the study stated that, at this time, they cannot recommend the use of herbal cannabis (marijuana) for arthritis pain because there is a lack of efficacy data, potential harm from its use, and there are other safe and effective options for treating arthritis. They specifically point to these facts:

• Concentrations of THC (tetrahydrocannabinol) vary in the plant material by as much as 33 percent, and absorption rates can vary between 2 percent and 56 percent, making dosing unreliable and difficult.
• While cannabis can be ingested, most prefer to inhale it, raising the issue of adverse effects on the respiratory system.
• Short or long-term efficacy studies are lacking for rheumatic conditions.
• Studies that favor the use for cancer or neuropathic pain cannot be extrapolated to include arthritis because of different pain mechanisms.
• There is a risk of impaired cognitive and psychomotor function with marijuana use.
• Long-term marijuana use may lead to mental illness, dependence, addiction, and memory problems.
• There is an increased risk of depression among users of marijuana compared to non-users.

The Bottom Line

Despite the federal ban on marijuana, California became the first state to legalize its medical use in 1995. By 2017, 28 states and the District of Columbia have voted to approve marijuana for medical use. More states are expected to do the same. The tally of states is ever-changing. What has long been more of a political debate than a scientific debate seems to be shifting towards the latter. Even as this plays out, we must realize that a bridge must be crossed before there can be harmony between the science and the legalities of medical marijuana. While the goals of medical use of marijuana and recreational use are not the same (i.e., symptom relief versus getting high), opponents of medical marijuana point out that the boundary is often blurred.

In 2008, the American College of Physicians issued a position paper which stated that "Evidence not only supports the use of medical marijuana in certain conditions but also suggests numerous indications for cannabinoids. Additional research is needed to further clarify the therapeutic value of cannabinoids and determine optimal routes of administration."

As we move forward, a better understanding of the endocannabinoid system (a group of neuromodulatory lipids and receptors in the brain that are involved in a variety of physiological processes) and how marijuana interacts with it would allow researchers to consider benefits and risks on a biochemical level.

Proponents of medical marijuana want the drug to be re-classified so that it has the same schedule status as other opiates and stimulants. Also, the federal government must allow for what has been referred to as "long-stifled research."