Medical Marijuana: Studies Find No Benefit For Ra

[bobandtorey]

Rheumatologists should not currently be recommending the use of medical marijuana to their patients for relief of chronic pain, researchers stated.

 

Among the reasons for this advice are acute and chronic risks, a lack of evidence for efficacy, and the absence of data on appropriate dosing, accordi

 

ng to Mary-Ann Fitzcharles, MD, of McGill University in Montreal, and colleagues.

 

"Advocacy for access to cannabinoid treatments has led to a societal groundswell with regulatory bodies around the globe considering the legalization of herbal cannabis for medicinal

use," Fitzcharles and colleagues wrote online in Arthritis Care & Research.

 

And with 20 states now having legalized it, rheumatologists need to be prepared to answer patients' questions based on the best available information and evidence, the authors stated.

 

Surveys have suggested that arthritis pain is one of the most common reasons patients use medical marijuana, and has been the stated diagnosis for two-thirds of Canadians who are

authorized users.

The plant has been used for centuries for pain relief, as well as for effects on sleep and mood that are largely mediated through the interaction of tetrahydrocannabinol (THC) with

receptors of the endocannabinoid system.

One major obstacle to the acceptance of medical use is the wide variation of active compounds in the plant, with THC concentration ranging from 1% to 30% of the plant and blood

levels among individuals who inhale it that range from an estimated 7 ng/mL to 100 ng/mL.

 

In addition, even in locales where legal, most users obtain marijuana illegally, the researchers reported.

 

"Therefore, the lack of the most elementary requirements for responsible drug administration must call into question any use of herbal cannabis for rheumatic pain treatment at this time,"

they stated.

Evidence for efficacy in rheumatologic disease is sparse to date. One randomized trial tested a cannabis-based medicine known as nabiximol (Sativex) in 58 patients with rheumatoid

arthritis, and found significant benefits for morning pain both with movement and at rest, sleep quality, disease activity scores, and patients' experience of pain.

 

In two studies of another synthetic form of THC, patients with fibromyalgia had improvements in pain and sleep benefits similar to what was seen for amitriptyline.

 

Otherwise, surveys have relied on self diagnosis and treatment, and no formal study of the plant-based safety or efficacy in rheumatology has been done.

 

"While there is good evidence for efficacy of cannabinoids for treating some chronic pain conditions, such as cancer and neuropathic pain, these pain types have different underlying

mechanisms from the mostly peripheral/nociceptive pain in rheumatic diseases," the researchers pointed out.

Among the potential hazards associated with marijuana use are effects on cognitive and psychomotor functioning, with slowing of reaction times and motor control and impairments in

short term memory that can persist for hours.

A particular concern is for driving. The authors noted that relevant impairments can last up to a full day after a single ingestion, according to Health Canada, and emphasized the

importance of driving for preservation of function and independence among patients with conditions such as arthritis.

 

Other risks include possible effects on mood, and particularly depression, and the possibility of dependence. In addition, a long-term study of Swedish youth found that frequent users

had a more than two-fold increased risk of lung cancer.

Finally, Fitzcharles and colleagues stated that the advocacy and use of medical marijuana has created a "dilemma" for healthcare professionals, in that clinicians must caution patients

 

about risks based on inadequate data and if they choose to "prescribe" marijuana, they must be competent in that treatment and have "reasonable knowledge of cannabinoid molecules

and the endocannabinoid system."

"In the state of Colorado almost half of recommendations [for medical marijuana] had been made by only 15 physicians. Motives for this medical behavior should be questioned and

raises ethical concerns," the authors cautioned.

"Simply acceding to patient demands for a treatment on the basis of popular advocacy, without comprehensive knowledge of an agent, does not adhere to the ethical standards of medical

practice," they wrote.

But clinicians still can help their patients with pain, according to Scott Krakower, DO, a psychiatrist at Zucker Hillside Hospital in Glen Oaks, N.Y.

 

"You want to understand where they're coming from and help them navigate the path to alternatives. For example, you might help them with finding ways of reducing their stress or

other triggers that in turn will help with their pain," Krakower told MedPage Today.

 

"Rheumatologists should advocate for further study of individual cannabinoid molecules whereby dosing can be accurately controlled and efficacy and safety can be assessed using

standard scientific method," Fitzcharles and colleagues concluded.

 

http://www.medpagetoday.com/Rheumatology/Arthritis/44560

 

[trichcycler]

I call B.S.  why would any person out to support health and pain free existence deny relief using a naturally occurring ancient pain relief flower?  Seems like modern day torture to me.

[GregS]

I call B.S.  why would any person out to support health and pain free existence deny relief using a naturally occurring ancient pain relief flower?  Seems like modern day torture to me.

The only torture here is to the logic.

[t-pain]

theres no "study" on RA and marijuana, only 1000s of people who say it works for them.

 

wonder if theres any study on drinking water, how do we know drinking water will quench peoples' thirst? we dont.

water is deadly, it kills thousands each year (drownings). water can cause burns (if too hot) or hypothermia if too cold.

water kills children and even babies every day around the world. when will water be placed in the controlled substances act?

[trichcycler]

please explain?

 

The medical researchers stated ""Therefore, the lack of the most elementary requirements for responsible drug administration must call into question any use of herbal cannabis for rheumatic pain treatment at this time,"

 

I see that medical recommendation as torture to the patients that are unable to find needed pain relief  in their therapy for RA, while others are finding this relief with cannabis use.

 

Do you think it to be logical to allow people to suffer needlessly because of a recommendation like the one mentioned in the article? 

 

or you are referring to the logic of the article?

The only torture here is to the logic.

Edited June 4, 2014 by grassmatch

[jointedone]

Buncha CRAP.

[Norby]

They seem to not know the difference between a recommendation and prescribing.

 

  Why do drugs get recalled but for a lack of formal understanding of the workings of the medicine?  It seems to me that doctors do this all the time or relay the information that the medicine can be hazardous to their health, as much as causing death in rare cases.

 

And i don't have the time to go into the rest.

 

Wait one more,  worried about the effects on mood, esp. depression?  Are they worried it will be found out that it helps with that too?

 

Load of crap, agreed.

[GregS]

please explain?

 

The medical researchers stated ""Therefore, the lack of the most elementary requirements for responsible drug administration must call into question any use of herbal cannabis for rheumatic pain treatment at this time,"

 

I see that medical recommendation as torture to the patients that are unable to find needed pain relief  in their therapy for RA, while others are finding this relief with cannabis use.

 

Do you think it to be logical to allow people to suffer needlessly because of a recommendation like the one mentioned in the article? 

 

or you are referring to the logic of the article?

Your points are pertinent to my observation. Yes it is the logic of the article that I remarked about.

[Guanotea1]

According to the articles source material and quotations the article title is highly misleading:

"Some doctors are hesitant to perscribe MMJ for RA" would be a far better article title.

 

But that article headline wouldn't sell newspapers or generate the desired controversy. In essense MMJ does not fit into the paradigmn of big pharma which relies on consistent, controllable dosing of isolated compounds to generate enormous data sets for very carefully controlled trials. That data is then fed to doctors who later make recommendations. I can't argue with that.

 

But I can argue some of the articles finer points and especially with the conclusion as given by the original article title.

 

If a doctor feels comforable relying on the increasingly large pool of anecdotal and scientific data supporting MMJ I can't see how that makes him/her a bad doctor. In this case, I think the benefits are rather obvious and the downsides rather few. Pain management is all about the patients experience with pain - and in essense - that means that the data is qualitative and anecdotal. Cannabis has been around for a long time, used by many for all sorts of reasons, with very little measurable negative health and safety impact to society writ large. By now, after thousands of years of recorded history with this drug, I can say with confidence that MJ has very few negative health consequences. Can you say the same about many prescribed pain meds, especially newer compounds?

 

The "molecular" argument is bullshittake too. Many drugs currently on the market are not understood at the molecular level. Don't believe me? Look at the fine print on a small sample of prescribed medications and you'll find out what I'm saying is true. I forget the precise wording but essentially many currently prescribed medications say that the actual reason why the drug works is not well known. Maybe someone can help me with that wording? I think they call it "pathways" or something.

 

I trust a good, open-minded, doctor's judgement to recommend MMJ on a case-by-case basis. Today, many doctors come under big institutional policies, and of course malpractice insurance, that prevents them from making their own judgement call on MMJ. Besides that, because the evidence for MMJ is coming from abnormal channels - you would expect that only a few doctors to have the time/motivation/etc to tune in and digest the disjointed and incomplete information. Add to that the engineered hysteria surrounding MJ, it's legal status, and you may conclude nothing substative given the fact that most of the MMJ scripts come from just a few doctors. That is to be expected.

 

This article does not conclude, by any means, that MMJ is unhelpful for RA. It does give part of the story about why doctors might be disinclined to prescribe MMJ for RA.

Edited June 9, 2014 by Guanotea1

[bobandtorey]

According to the articles source material and quotations the article title is highly misleading:

"Some doctors are hesitant to perscribe MMJ for RA" would be a far better article title.

 

But that article headline wouldn't sell newspapers or generate the desired controversy. In essense MMJ does not fit into the paradigmn of big pharma which relies on consistent, controllable dosing of isolated compounds to generate enormous data sets for very carefully controlled trials. That data is then fed to doctors who later make recommendations. I can't argue with that.

 

But I can argue some of the articles finer points and especially with the conclusion as given by the original article title.

 

If a doctor feels comforable relying on the increasingly large pool of anecdotal and scientific data supporting MMJ I can't see how that makes him/her a bad doctor. In this case, I think the benefits are rather obvious and the downsides rather few. Pain management is all about the patients experience with pain - and in essense - that means that the data is qualitative and anecdotal. Cannabis has been around for a long time, used by many for all sorts of reasons, with very little measurable negative health and safety impact to society writ large. By now, after thousands of years of recorded history with this drug, I can say with confidence that MJ has very few negative health consequences. Can you say the same about many prescribed pain meds, especially newer compounds?

 

The "molecular" argument is bullshittake too. Many drugs currently on the market are not understood at the molecular level. Don't believe me? Look at the fine print on a small sample of prescribed medications and you'll find out what I'm saying is true. I forget the precise wording but essentially many currently prescribed medications say that the actual reason why the drug works is not well known. Maybe someone can help me with that wording? I think they call it "pathways" or something.

 

I trust a good, open-minded, doctor's judgement to recommend MMJ on a case-by-case basis. Today, many doctors come under big institutional policies, and of course malpractice insurance, that prevents them from making their own judgement call on MMJ. Besides that, because the evidence for MMJ is coming from abnormal channels - you would expect that only a few doctors to have the time/motivation/etc to tune in and digest the disjointed and incomplete information. Add to that the engineered hysteria surrounding MJ, it's legal status, and you may conclude nothing substative given the fact that most of the MMJ scripts come from just a few doctors. That is to be expected.

 

This article does not conclude, by any means, that MMJ is unhelpful for RA. It does give part of the story about why doctors might be disinclined to prescribe MMJ for RA.

 

 

Thank you i agree