Medical Marijuana and Rheumatoid Arthritis: Pros and Cons of the Different Delivery Systems
Research is lacking, but some proponents say the effectiveness of medicinal cannabis treatments may vary in terms of RA joint pain. Which, if any, ones should you consider?
When it comes to medical marijuana, there are many more questions than answers. Even if you’ve discussed trying it for joint pain with your doctor — and gotten your documentation, and it is legal in your state — there’s still the issue of how to take it.
If you live in one of the 29 states that has decriminalized the use of marijuana for the treatment of certain medical problems, there are a lot of pain-relieving treatment options you haven’t heard much about. “Cannabis can be used as medicine in many ways, though not all types are equally effective,” says Jordan Tishler, MD, chief medical officer of InhaleMD, a holistic medical practice in the Boston area. “Low doses are also more effective and have fewer side effects, including intoxication,” he says, adding that in his opinion, cannabis can provide pain relief and an anti-inflammatory effect.
What Is the Best Way to Use Cannabis When You Have RA?
If you’re considering using cannabis for pain relief, you might be wondering how to take it. According to proponents, the delivery methods — that is, the ways in which one can use cannabis — don’t necessarily work equally. The delivery method you should use depends on your needs and what’s available to you. Here are the most common medicinal forms of marijuana, and the potential benefits and downsides of each.
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Potential Pros and Cons of 7 Marijuana Delivery Methods for People With RA
1. Topical Ointments
Pros: They don’t make you high, and you get fairly immediate pain relief in a targeted area — like painful joints or low-back pain — for a couple of hours.
Cons: Some people complain of the odor, and the effects don’t last as long as inhaling or ingesting it. Tishler doesn’t believe that they’re worth the money; in his experience, they “seldom work as advertised.”
The Verdict: “The huge advantage here is that you don’t have any psychoactive effect,” says Rav Ivker, DO, a holistic family physician in Boulder, Colorado and author of Cannabis for Chronic Pain: A Proven Prescription for Using Marijuana to Relieve Your Pain and Heal Your Life. “I have seen very few downsides with the topicals. The effects have a short duration, but when it wears off, you can just apply the ointment again.” Dr. Ivker is a fan of pain-relieving creams that contain a combination of CBD — one of the active cannabinoids in marijuana — and arnica.
2. Pills and Capsules
Pros: Dosage is consistent, it doesn’t require inhaling, and the pain-relieving effects can last for up to eight hours.
Cons: They can be expensive, and sometimes the medicinal effect doesn’t take place until an hour or two after ingesting it. “But cannabis is fat soluable, and it can be absorbed more quickly if you ingest it with a fatty food,” says Ivker.
The Verdict: Pills and capsules may be the most consistent delivery system. “I like these primarily because of the consistent dosing,” notes Ivker. “Tablets and capsules last a long time like an edible, but you know exactly how much medicine you’re getting every time you do it.”
Pros: They are odorless, involve no smoke or vapor, and are easy to administer. And the medicinal effects can last up to eight hours. “This is good if your pain is constant and severe,” says Dr. Tishler. You can find medical marijuana candy, such as gummy chews.
Cons: They affect everyone differently, and the THC isn’t usually evenly distributed throughout the product. In other words, you can eat the same-size piece of an edible two days in a row and have a very different effect. Plus, there’s the calories.
The Verdict: “I don’t like edibles because they are way too inconsistent,” says Ivker. “If we talk about marijuana as a medicine, you need to be able to depend on it doing what it’s supposed to do. Most of the patients that I have worked with have had a previous bad experience with an edible.”
4. Transdermal Patches
Pros: Transdermal patches are adhesive patches containing cannabinoids. The medication is absorbed through the skin and enters the bloodstream, affecting the entire body. The effect lasts for a long time. It delivers slow release, long-duration, pain-relieving cannabis into the bloodstream without the need for ingesting or inhaling it.
Cons: This is one of the most expensive delivery systems, and isn’t as effective for severe pain as other medical marijuana options, says Ivker.
The Verdict: “The cannabinoids in patches are absorbed within a half an hour, and if you don’t want to feel the effect anymore, you can peel off an adhesive patch and the effect will dissipate,” says Ivker. “And if you only have it on for a short time, you can use it again.”
Pros: It’s nearly odorless, easier on the lungs than smoking, and has an immediate medicinal effect. “Vaporizers are like miniature ovens,” says Ivker. “You are basically cooking. The ideal temperature for most vaporizers is 375 degrees, just like your oven. It heats the plant and you inhale a vapor, and it provides relief within two to three minutes, just like smoking it does.”
Cons: The best kind of vaporizing machines — those that use the plant and not a fluid — can be pricey (between $250 and $300). And vaporizers that use oil cartridges get very hot, which can be irritating to the throat and lungs.
The Verdict: “I recommend vaping to my patients,” says Ivker. Adds Tishler: “Vaporizing cannabis flower (not concentrates) produces little to none of the dangerous chemicals associated with tobacco smoke, so it is likely safer than smoking.”
Pros: These liquids, usually administered with a dropper, have historical gravitas, since “through the first three decades of the 20 th century, tinctures were the only method of administration of medicinal cannabis in this country,” says Ivker. It is also easier for the user to experiment and determine the exact dosage that works best for their individual symptoms. And the pain-relieving effects last twice as long as inhaling, with none of the lung irritation.
Cons: The effect is not as immediate as inhaling; it can take as long as 45 minutes for the effects to kick in. Tishler doesn’t believe that they’re worth the money, either; as with the ointments, in his experience, they also “seldom work as advertised.”
The Verdict: While some people swear by tinctures, others don’t. Many argue that tinctures provide consistent and individualized dosing. “When you prescribe a prescription drug, you’re just guessing on the dosage. But here you can determine exactly how much works well for you,” says Ivker. He suggests starting by taking four or five drops under the tongue and waiting an hour to see how you feel. If after an hour and a half you don’t feel relief, you can take more.
7. Smoking a Joint or Pipe
Pros: It’s easy to get access to it, less expensive than other medical marijuana delivery systems, and inhaling cannabis has an immediate pain-relieving effect.
Cons: “It’s the most unhealthy method of administration because it irritates the respiratory tract, and smoke contains toxins that contribute to more inflammation throughout the body,” says Ivker.
Smoking is a risk for many diseases, including heart and lung disease. Women with rheumatoid arthritis already face an increased risk for progressive lung diseases, such as emphysema; any type of smoke is especially problematic for people with RA.
Another downside is that the duration of action is short, usually only two or three hours.
The Verdict: “It’s the most popular delivery system, but I discourage people from doing it,” says Ivker. Tishler agrees that any risks outweigh benefits for people with RA. “Cannabis smoke contains many of the same carcinogens and poisonous gases as tobacco smoke. There is every reason to believe that it would be just as harmful.”
Tishler notes that while studies have suggested there aren’t any irreversible negative effects of smoking cannabis, they are inconclusive. Don’t smoke, period.
Rheumatoid arthritis pain may be lessened by marijuana, but not all delivery methods are equal. Learn about the best and worst way to use medical marijuana to help ease RA pain.
Marijuana for Rheumatoid Arthritis Joint Pain: Pros and Cons
The medical establishment is largely against treating rheumatoid arthritis pain with cannabis, citing a lack of evidence. But not all scientists agree.
Despite the legalization of medical marijuana in 28 states, mainstream scientific research has yet to back the idea of using it to treat the symptoms of rheumatic pain. A review of marijuana treatment studies published in Arthritis Care & Research in May 2014 concluded that the risk/benefit profile for herbal cannabis “is inferior to all other analgesic classes other than opioids,” and that there is a lack of scientific evidence showing that it helps reduce pain in people who live with rheumatic conditions such as rheumatoid arthritis.
More Evidence of Risk Than Benefits
Study author Mary Ann Fitzcharles, MD, and her colleagues wrote that while there is good evidence that cannabinoids can help with other chronic pain conditions — such as cancer and neuropathic pain — those pain types have “a different underlying mechanism” than rheumatic conditions. They also state that medicinal marijuana should never be smoked, and that there is also the potential for addiction.
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Who Uses Medical Marijuana for Pain?
But people living with rheumatic diseases — conditions that affect joints and connective tissue, like rheumatoid arthritis — often endure severe pain, and many of them use marijuana. One study published in the September-October 2009 issue of the Journal of Opioid Management found that 80 percent of medical marijuana users in a U.S. pain clinic were using cannabis to treat myofascial pain — pain that affects muscle and tissue. Among medicinal marijuana users in Canada, 65 percent said they use medicinal marijuana for severe arthritis.
The Case for Marijuana Use In Rheumatoid Arthritis Treatment
And medical marijuana scientific advocates say there’s absolutely nothing wrong with that. “Chronic pain is a symptom of rheumatoid arthritis, and when it comes to chronic pain, we have 9,000 patient years of data showing that THC [the active ingredient in cannabis] effectively treats it,” says Jahan Marcu, PhD, chief scientific officer for Americans for Safe Access, an organization that works to ensure safe and legal access to cannabis for therapeutic use and research. “Cannabinoids stop the transmission of pain and decrease inflammation, and that’s very important for people with joint issues.”
Specific Risks That Worry Rheumatologists
But many rheumatologists remain cautious. Mahsa Tehrani, MD, a rheumatologist in Washington, D.C., doesn’t recommend medical marijuana to her patients because of the dearth of reliable evidence — and the risk of mental and heart-related side effects. Some of these issues, such as depression and heart disease, are serious health conditions — complications for which people with rheumatoid arthritis already face an increased risk.
“Given the known risks of psychiatric side effects as well as heart problems reported with marijuana, recommending this drug for rheumatic conditions seems questionable,” said Dr. Tehrani, who wasn’t involved in the 2014 review.
If you live in a state where medical marijuana is available, have a conversation with your doctors to see if it’s a treatment therapy they would recommend for you.
Experts don’t recommend medical marijuana for rheumatoid arthritis pain, citing a lack of evidence. But as some patients see it, risks abound with all treatments. Learn about arthritis treatments at EverydayHealth.com