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Growing Demand: Medicinal Cannabis for Arthritis

In July, the Arthritis Foundation discovered an astonishing number of American survey respondents—79 percent—reported they were either currently or formerly relying on cannabidiol (CBD), or were curious about it. Due to the overwhelming results from this national survey, the Foundation decided to address the elephant in the room: arthritis patients are relying on cannabis for the treatment of their symptoms, whether it comes physician recommended or not. 

These surprising survey results (and likely the recent changes to national regulations on hemp) resulted in the Arthritis Foundation issuing the first-ever guidelines on the use of the non-intoxicating compound CBD for adults with arthritis. The new set of guidelines was the first attempt to fill the gap between legislation, clinical research, and public use. 

As one of the first national organizations to support the safe use of hemp-sourced cannabinoids for relief from arthritis, the Foundation is slowly working to move the needle towards medical acceptance of this cannabis-derived cannabinoid. Within RYAH Data’s ecosystem of data, there is also strong evidence that CBD-rich strains specifically are useful for treating the symptoms of the disease. 

To date, the research is preliminary and inconclusive; this is despite the overwhelming patient use of the flower. Here is what the research tells us thus far. 

Scientific Support Behind Cannabinoids for Arthritis

As with much of the research into the many therapeutic characteristics of the plant, the study of cannabinoids for arthritis is limited in scope. From what is published, CBD in particular seems well suited to reduce the painful effects of the disease. Animal models even suggest it slows down the disease’s progression.

As early as 2000, a team of researchers led by A. M. Malfait found that an oral application of CBD reduced the signs of an animal model of arthritis. Their research, published by the Proceedings of the National Academies of Sciences, showed how this plant-sourced compound could protect joints against severe damage, as well as reduce internal evidence of the disease.

Internal evidence included a reduction in type II collagen-specific proliferation as well as IFN-γ production. The research also produced evidence that CBD can lower the tumor necrosis factor by knee synovial cells. As is often the case with CBD-based therapies, they discovered a bell-shaped dose dependency.

A few years later, in 2005, D. R. Blake from the Royal National Hospital for Rheumatic Diseases explored the safety, tolerability, and effectiveness of pharmaceutical preparation of the plant (Sativex) for treatment of pain related to rheumatoid arthritis. Sativex is an oral spray containing approximately a 50:50 ratio of THC to CBD. Globally, it is approved for “symptomatic relief of neuropathic pain in adult patients with multiple sclerosis.”

Blake et al. designed a small placebo-controlled, randomized, double-blind, parallel-group study with 58 participants who had pain associated with rheumatoid arthritis. Patients received a dose of Sativex in the evening and were assessed the following morning. 

Blake’s research team found “statistically significant improvements in pain on movement, pain at rest, quality of sleep, DAS28 [disease activity], and the [Short-Form McGill Pain Questionnaire].” Also worth noting, this study found no adverse related withdrawals nor serious side effects. Any side effects observed were mild or moderate. 

A Quandary For Physicians

In the last decade, there have been several more randomized, controlled clinical trials, but these were limited in scope. In an editorial piece for Clinical Rheumatology, writers Glen S. Hazlewood, Omid Zahedi Niaki, and Mary-Ann Fitzcharles concluded from these studies that “there was inconsistent evidence for superiority of cannabinoids over controls, noting that cannabinoids were generally well tolerated, but with some troublesome side effects.”

Their balanced argument concisely represents the challenging circumstances under which all physicians work these days. On an increasing basis, physicians delicately balance patient use of and demand for the plant with the little scientific evidence.

As Hazlewood et al. explained in their piece, “The medical community is in a quandary: on the one hand, Cannabis is strongly popularized as a neglected, but valuable therapy, and on the other hand, there remains a paucity of sound clinical data that can inform clinical care.” This predicament, which will likely only increase as more patients become familiar and comfortable with the plant and access becomes easier. 

As per the results of the aforementioned survey by the Arthritis Foundation, many people with arthritis are at the very least curious about the anti-inflammatory and immunosuppressive characteristics of CBD. Many are already experimenting with it.

According to a report from  the U.S. Laboratory of Medicine, this cannabinoid has a relatively benign nature and a good safety profile and  is very likely that patients will continue to seek it out as a way to decrease the symptoms of inflammation and arthritis, whether or not their physicians recommend it.

From RYAH’s dataset, we see similar CBD-centered trends. Patients within this ecosystem report the use of cannabis for inflammation and arthritis. According to the Arthritis Foundation, the disease tends to appear after the age of 30. If age is controlled for, inflammation and arthritis are the 7th and 8th most common conditions reported for those 30 years and older.

The strain preference for those with arthritis who are reporting to RYAH Data is in line with the survey findings from the Arthritis Foundation. Patients with an inflammatory condition prefer CBD-rich strains of flower over those with moderate to high levels of THC. The top five strains recorded by patients in RYAH Data for arthritic symptom relief are all CBD-rich, save for one. These include ACDC, Cannatonic, Harlequin, and the all-CBD strain, Charlotte’s Web.

As reported in the RYAH Data September Report on Cannabis and Pain, THC is the biggest influence over pain relief, and CBD has little impact. However, digging into the information paints a different picture. For inflammatory and autoimmune conditions like arthritis, CBD makes the most significant impact on symptom relief. 

Again, this is pulled from patient reports within RYAH Data, and there is still a need for the long-term and well-controlled clinical studies on cannabinoid effectiveness.

Patients Moving the Needle Forward, With or Without Physician Support

When it comes to the medicinal use of cannabis for inflammatory conditions like arthritis, there are a few trends colliding: 

  1. Arthritis develops between the ages of 30 and 60, with women more than twice as likely as men to develop the disease. 
  2. One of the fastest-growing demographics of medicinal cannabis consumers are those over the age of 55. Another is among women.
  3. There is growing access to medical cannabis across the country and around the world. Patients are more open than ever before to experimenting with the plant for the treatment of a variety of conditions.

Taken together, these trends suggest that patients with arthritis will be turning to the plant in record numbers over the coming years. Already in Canada, a country with a decades-old medical cannabis program, reports tell us that more than two thirds of the 200,000 registered patients rely on the plant for arthritis. 

As always, more research is needed across the board for medicinal use of the plant; however, the future of the plant for the treatment of arthritis seems already laid out.

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