Mary-Ann Fitzcharles1,2, Omid Zahedi Niaki3,4, Winfried Hauser3,4, Glen Hazlewood3,4. 1. From the Alan Edwards Pain Management Unit, and the Division of Rheumatology, McGill University Health Centre, Montreal, Quebec; Division of Rheumatology, University of Alberta, Calgary, Alberta, Canada; Department Internal Medicine I, Klinikum Saarbrücken, Saarbrücken; Department of Psychosomatic Medicine and Psychotherapy, Technische Universität München, Munich, Germany. mary-ann.fitzcharles@muhc.mcgill.ca. 2. M.A. Fitzcharles, MB ChB, Alan Edwards Pain Management Unit, and Division of Rheumatology, McGill University Health Centre; O. Zahedi Niaki, MD, Division of Rheumatology, McGill University Health Centre; W. Hauser, Dr. med., Department Internal Medicine I, Klinikum Saarbrücken, and Department of Psychosomatic Medicine and Psychotherapy, Technische Universität München; G. Hazlewood, MD, Division of Rheumatology, University of Alberta. mary-ann.fitzcharles@muhc.mcgill.ca. 3. From the Alan Edwards Pain Management Unit, and the Division of Rheumatology, McGill University Health Centre, Montreal, Quebec; Division of Rheumatology, University of Alberta, Calgary, Alberta, Canada; Department Internal Medicine I, Klinikum Saarbrücken, Saarbrücken; Department of Psychosomatic Medicine and Psychotherapy, Technische Universität München, Munich, Germany. 4. M.A. Fitzcharles, MB ChB, Alan Edwards Pain Management Unit, and Division of Rheumatology, McGill University Health Centre; O. Zahedi Niaki, MD, Division of Rheumatology, McGill University Health Centre; W. Hauser, Dr. med., Department Internal Medicine I, Klinikum Saarbrücken, and Department of Psychosomatic Medicine and Psychotherapy, Technische Universität München; G. Hazlewood, MD, Division of Rheumatology, University of Alberta.
Abstract
OBJECTIVE: Pain is one reason some rheumatology patients may consider use of medical cannabis, a product increasingly perceived as a safe and neglected natural treatment option for many conditions. Legalization of recreational cannabis in Canada will promote access to cannabis. Physicians must therefore provide patients with the best evidence-based information regarding the medicinal effects and harm of cannabis. METHODS: The Canadian Rheumatology Association (CRA) mandated the development of a position statement for medical cannabis and the rheumatology patient. The current literature regarding the effects of medical cannabis for rheumatology patients was assessed, and a pragmatic position statement to facilitate patient care was developed by the Therapeutics Committee of the CRA and approved by the CRA board. RESULTS: There are no clinical trials of medical cannabis in rheumatology patients. Evidence is insufficient about the benefit of pharmaceutical cannabinoids in fibromyalgia, osteoarthritis, rheumatoid arthritis, and back pain, but there is evidence of a high risk of harm. Extrapolating from other conditions, medical cannabis may provide some symptom relief for some patients. Short-term risks of psychomotor effects can be anticipated, but longterm risks have not been determined and are of concern. CONCLUSION: Despite lack of evidence for use of medical cannabis in rheumatology patients, we acknowledge the need to provide empathetic and pragmatic guidance for patient care. This position statement aims to facilitate the dialogue between patients and healthcare professionals in a mutually respectful manner to ensure harm reduction for patients and society.
OBJECTIVE:Pain is one reason some rheumatologypatients may consider use of medical cannabis, a product increasingly perceived as a safe and neglected natural treatment option for many conditions. Legalization of recreational cannabis in Canada will promote access to cannabis. Physicians must therefore provide patients with the best evidence-based information regarding the medicinal effects and harm of cannabis. METHODS: The Canadian Rheumatology Association (CRA) mandated the development of a position statement for medical cannabis and the rheumatologypatient. The current literature regarding the effects of medical cannabis for rheumatologypatients was assessed, and a pragmatic position statement to facilitate patient care was developed by the Therapeutics Committee of the CRA and approved by the CRA board. RESULTS: There are no clinical trials of medical cannabis in rheumatologypatients. Evidence is insufficient about the benefit of pharmaceutical cannabinoids in fibromyalgia, osteoarthritis, rheumatoid arthritis, and back pain, but there is evidence of a high risk of harm. Extrapolating from other conditions, medical cannabis may provide some symptom relief for some patients. Short-term risks of psychomotor effects can be anticipated, but longterm risks have not been determined and are of concern. CONCLUSION: Despite lack of evidence for use of medical cannabis in rheumatologypatients, we acknowledge the need to provide empathetic and pragmatic guidance for patient care. This position statement aims to facilitate the dialogue between patients and healthcare professionals in a mutually respectful manner to ensure harm reduction for patients and society.
Authors: Oliver Hendricks; Tonny Elmose Andersen; Afshin Ashouri Christiansen; Jette Primdahl; Ellen Margrethe Hauge; Torkell Ellingsen; Tina Ingrid Horsted; Anja Godske Bachmann; Anne Gitte Loft; Anders Bo Bojesen; Mikkel Østergaard; Merete Lund Hetland; Niels Steen Krogh; Kirsten Kaya Roessler; Kim Hørslev Petersen Journal: BMJ Open Date: 2019-06-04 Impact factor: 2.692