A general opinion is that marijuana is marijuana, but this is not true. Rheumatology network takes a conservative look into what rheumatologists should know about arthritis and cannabis oil.
The first point discussed in the article focuses on the different compounds in marijuana and mentions THC or Tetrahydrocannabinol, produced by heating 9-tetrahydrocannabinol (D9-THC). THC is known for its psychoactive as well as pain relieving effect.
Cannabidiol or CBD is mentioned for its counter psychoactive effect, and potential therapeutic application due to its effect on the immune system. CBD oil is obtained from hemp, and has THC values as low as 0.3%.
The article mentions the complex phenomenon of Cannabinoid actions involving cross-reactions with non-cannabinoid receptors, depending upon on the type of tissue, or whether other molecules such as opioids are present. It also discusses the postulated effects of CBD as an anti-inflammatory and anti-oxidative agent.
Evidence is lacking
Although the article cites a single study in patients with rheumatoid arthritis using the oro-mucosal spray, nabiximols, a combination of D9-THC and cannabidiol, no findings are mentioned. However, as the authors indicate, few trials involving the use of cannabis oil for arthritis have been completed, and there is a lack of scientific evidence to support its use.
Physicians lack confidence in their knowledge of cannabinoids, and have insufficient evidence to prescribe cannabis, as 92% reported a need for more education in a survey done in Colorado. In Canada, two thirds of rheumatologists felt they lacked confidence in their knowledge of the medical use of cannabinoids.
Furthermore the article states “herbal cannabis is not an innocuous substance.” It is a general statement based on the damage done to recreational users. It doesn’t distinguish hemp from high THC strains such as skunk, which is a popular recreational drug. The same yardstick can’t possibly be used to judge all cannabis varieties.
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Rheumatologists should instigate further studies
Lastly physicians, and in particular rheumatologists, are urged to proactively voice concerns about the use of cannabis to treat rheumatic pain. They should advocate further study of cannabinoids according to standard scientific methods to determine dosing, efficacy and safety.
Two study abstracts published for the National Institute of Health by PubMed show further findings:
Firstly in comparison with placebo, CBM (cannabis-based medicine) produced statistically significant improvements in pain with movement, pain at rest and quality of sleep.
Secondly data show that CBD, through its combined immunosuppressive and anti-inflammatory actions, has a potent anti-arthritic effect in CIA (collagen-induced arthritis).
Cannabis can fill the gap but needs evidence
Mary-Ann Fitzcharles, MD, an associate professor of medicine at the department of rheumatology and pain management, McGill University Montreal, is considered a leading expert on the use of cannabis in arthritis and fibromyalgia.
She says “There’s no question that cannabinoids have the potential to have an impact on the disease.” However, she adds that it is dangerous to turn to something with very little evidence and proof of efficacy.
Arthritis and cannabis oil
Patients with chronic pain need relief; current narcotics have side effects including addiction and impairment; and cannabis oil for arthritis might become the proven treatment to fill the gap.