Kaleb Michaud, PhD, on Skyrocketing Cannabis Use Among People with Rheumatic Diseases

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U.S.-wide study found cannabis use tripled; may highlight unmet needs in pain control and mental health

Cannabis use among people with rheumatic diseases (RMDs) tripled between 2014 and 2019.

That's according to the first US-wide study designed to evaluate the prevalence of cannabis use in a large population of people with RMDs. The findings appear in Arthritis Care & Research.

Among 11,006 survey respondents, cannabis use increased from 6.3% in 2014 to 18.4% in 2019. The greatest prevalence of use occurred in states where cannabis use has been legalized.

In both years, a clear majority of users (74% in 2014; 62% in 2019) reported that cannabis helped relieve their arthritis symptoms.

Cannabis users were more likely to be taking weak opioids (OR 1.2 [1.0, 1.5]; P=0.03) and or have a history of smoking tobacco (OR 1.7 [1.5, 2.1]; P<0.001).

Kaleb Michaud, PhD, a rheumatology researcher with the University of Nebraska Medical Center, served as a study coauthor. He discussed the study and its findings with MedPage Today. The exchange has been edited for length and clarity.

What knowledge gap was your study designed to address, and why did you believe this was the right time to examine the use of cannabis in people with RMDs?

Michaud: There has been a dramatic increase in the use of cannabis, which is often cited as a way of handling pain. And we know that people with RMDs often experience chronic pain that isn't always well controlled.

There were no good studies on how many people with RMDs use cannabis, or that described patterns of cannabis use in this population.

What were your key findings?

Michaud: Cannabis ever-use in people with RMDs tripled in our US-wide cohort. People who reported using cannabis had overall worse RMD symptoms -- a finding that likely speaks to the existence of unmet needs in pain relief and pain medication options.

Did anything surprise you about the study or its findings?

Michaud: It may not be surprising to some, but cannabis users had worse mental health than those who didn't use cannabis. This speaks to another set of unmet needs -- addressing the anxiety and depression that so often go hand-in-hand with chronic pain.

Do you believe there is still a stigma surrounding cannabis that is counterproductive to more widespread use for those with RMDs?

Michaud: Most definitely. Many physicians see cannabis use as either an herbal supplement that doesn't concern them or as an illegal product they should not discuss. I don't condone the use of cannabis, as we just don't know the full effect with safety and efficacy, but I certainly don't blame people for wanting to try to find relief.

How is the shifting landscape around cannabis use likely to change perceptions and use?

Michaud: Rheumatologists and physicians in states that allow the legal use of medical and recreational cannabis are playing catch-up with what their patients are taking. They're finding some pros and some cons, but they need more evidence outside of their personal experience to help guide their treatment recommendations.

What suggestions might you have for clinicians based on these findings?

Michaud: It's important to know if your patients are using cannabis and why, since it may mean looking at changing treatment goals or finding additional help to improve sleep and mental health that may not come up in regular clinic visits.

It's ideal if you can capture the form (smoked, vaped, eaten, and so on) and composition (THC% vs CBD%) of the cannabis being used. Some studies are beginning to show the importance of these aspects.

Where is more study needed to better understand cannabis use in people with RMDs?

Michaud: Major issues exist with quality control with many of the cannabis products available in the US marketplace. So it's difficult to know what part of cannabis provides relief to those with RMDs. Proper clinical trials are needed as well as better tracking of cannabis use within the medical system.

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