South African Research Team Says Cannabis is ‘Very Promising’ as an Opioid Replacement
by Bethan Rose
Some 46 million people across the United States are believed to suffer from rheumatic diseases. Triggered by imbalances in the immune system, rheumatology cases are typically identified as autoimmune and inflammatory diseases that attack the organs, muscles, joints, and bones.
Although rheumatism can have a detrimental impact on a person’s day-to-day life, the good news is that cannabis may offer a natural solution for patients of all ages and walks of life. Typically, rheumatic diseases are grouped under the umbrella term “arthritis.” Since cannabis has been shown to produce analgesic, or pain-relieving, effects, it’s no wonder why so many patients diagnosed with rheumatism are capitalizing on the legalization of medical and recreational cannabis across the U.S.
Notwithstanding the emerging sphere of evidence highlighting cannabis’ arthritis-fighting effects, such as this 2015 study, the use of cannabis in rheumatology is still a gray area that’s in the process of being explored. On the other hand, fresh data suggests that more patients with arthritic conditions are enjoying herbal cannabis-based remedies.
In a recently published study that was featured in the journal Arthritis Care & Research, a team of researchers carried out a trial with 11,006 patients. Each subject of the study (which included participants in FORWARD, The National Databank for Rheumatic Diseases) had been diagnosed with a certain type of arthritic condition.
Patients were asked about their consumption habits in 2014 and 2019. Based on the results, cannabis consumption rose from 6.3% in 2014 to 18.4% in 2019. Predictably, the most significant jump in cannabis consumption occurred in states with legal recreational cannabis markets.
The outcome of this study mirrors the results of a similar investigation that was carried out by a senior physician in the rheumatology division at the Louise and Alan Edwards Pain Management Center at McGill University Health Center Montreal. Alongside a team of colleagues, Mary-Ann Fitzcharles, MD, conducted an online survey of 1,047 Canadian patients with rheumatological conditions. After Canada enacted a legal adult-use cannabis market in October 2018, each of the recipients answered a specific set of questions about cannabis use.
According to the findings, which were featured in ACR Open Rheumatology, cannabis use tripled among patients in a post-legalization world. While further research is needed to fully understand the use of cannabis in rheumatology, Fitzcharles noted, “The preclinical models of pain and inflammation, even joint inflammation, have shown excellent effects of cannabinoids.”
In an effort to better understand the complex phenomenon of cannabinoid treatment for patients with rheumatic diseases, Donald Abrams, MD, professor at the University of California San Francisco’s department of medicine, fronted a research effort at the National Academies of Sciences, Engineering, and Medicine. Abrams conducted a comprehensive review of recent literature on cannabis and cannabinoids, analyzing 10,000 abstracts to determine the impact of cannabis on rheumatology patients.
“In the therapeutics chapter reviewed here, the report concluded that there was conclusive or substantial evidence that cannabis or cannabinoids are effective for the treatment of pain in adults,” Abrams wrote. “Moderate evidence was found for secondary sleep disturbances.”
Unfortunately, previous efforts to study the therapeutic benefits of cannabis for rheumatology have been severely stunted due to stringent laws across the U.S. “It is an impossible effort to try to study anything about cannabis because of the laws in this country,” said Abrams. Despite room for much more research on the subject, Abrams feels that cannabis is a “useful botanical” and, in comparison with alcohol and tobacco, could be a much safer alternative.
“Stop demonizing it,” said Abrams, who told reporters that further research must be carried out into the green plant as a way of exposing its true medicinal qualities—not only for rheumatology patients but also for patients with various other types of medical conditions and diseases.
Perhaps one of the best places to start regarding the study of cannabis’ therapeutic effects is the endocannabinoid system (ECS). As maintained by Ronald J. Rapoport, MD, FACR, the ECS may be closely related to a broad scope of medical conditions, including multiple sclerosis (MS) and dementia.
“The cannabinoids that are made in our body’s endocannabinoid system are involved in the normal functioning of such things as the nervous system,” said the chief of the rheumatology division at nonprofit, community-focused hospital Southcoast Health in Massachusetts. Rapoport stated that there are two confirmed receptor subtypes for cannabis in humans: CB1 and CB2 receptors. CB2 is not found as commonly in the ECS as CB1, but certain proof exists to suggest that CB2 attaches to immune cells.
“The cannabinoid CB1 receptor agonists may act on nociceptors in the dorsal horn of the spinal cord and may reduce pain because of this. The CB2 receptor may have a positive effect on reducing inflammation and autoimmunity,” Rapoport said. “The CB2 receptor has a high density on immune-modulating cells and may influence such things as immune cell migration and cytokine release,” he clarified, before turning his attention to a separate component of the ECS that may pique the interest of rheumatologists.
According to Rapoport, the CB2 receptor appears to be strongly associated with the nurturing of skeletal integrity since it is found abundantly in osteoblasts, osteocytes, and osteoclasts. “We have to emphasize that the CB2 selective agonist may be helpful not only in reducing inflammation but also potentially in reducing established hypersensitivity in such things as skin disorders and peripheral pain,” continued Rapoport, as he explained a method that the ECS executes to influence feelings of pain.
Regardless of the rise in cannabis use among rheumatology patients residing in recreational cannabis states, Fitzcharles admitted that it remains uncertain as to whether or not the results of the recent analysis are real or placebo-related.
“Most patients with rheumatic diseases are using cannabinoids primarily for pain management, with some experiencing added benefits of improved sleep,” Fitzcharles said. “However, while the effect on sleep is reported by many patients, the systematic reviews do not support an important effect on sleep. This may be in part explained that the formal studies have not been done or published.”
Rapoport believes that the preclinical evidence supporting cannabis use in rheumatology is “still not totally convincing.” Keeping this in mind, Fitzcharles warns rheumatology patients that cannabis (whatever form it comes in) should not be used to replace doctor-prescribed anti-rheumatic drugs.
As with many aspects of cannabis research, the study of cannabis and rheumatology is still in an early stage. Nonetheless, these initial findings are encouraging for the millions of people suffering daily from rheumatic diseases. Will cannabis ever be able to take the place of certain medications prescribed for these conditions? Only time will tell.
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