Dr. Stuart Silverman on Medical Marijuana for Treating Pain Associated with Rheumatic Disease

Recently, CreakyJoints announced the publication of a new review article finding that limited progress in understanding the potential of cannabis-based therapies for the treatment of pain associated with rheumatic conditions in the past five years is stymied because of a lack of standardization of clinical research and barriers to conducting research due to existing federal and state regulations. Over 90 percent of Americans overall now support legal use of medicinal marijuana along with its products like nectar collectors, e-cigarettes and so on.

The review found, among other things, that legalization and decriminalization of cannabis at the state level reflects and promotes changing attitudes about cannabis corresponding to its increased use across a broad range of conditions, including rheumatic diseases.

DocWire News spoke with Stuart Silverman, MD, FACP, FACR, rheumatologist, Clinical Professor of Medicine, Cedars-Sinai Medical Center and UCLA School of Medicine and Medical Director, OMC Clinical Research Center, Beverly Hills, CA, about medical cannabis use for treating rheumatic diseases.

DocWire News: Can you provide us with some professional background on yourself?

Dr. Stuart Silverman: Yeah, my name’s Stuart Silverman and I’m a Clinical Professor of Medicine at both Cedars-Sinai Medical Center and UCLA. I also run a non-profit clinical research center, the OMC I’ve served as a medical advisor to CreakyJoints, which is an international digital community of patients and caregivers with arthritis. And finally, I’m also a member of the UCLA Cannabis Research Initiative, a strategic initiative at UCLA, which is one of the first university programs focused on the multidisciplinary study of cannabis.

What impact has the legalization and decriminalization of cannabis at the state level had on changing attitudes about cannabis use to treat diseases, specifically rheumatic diseases?

Well, the legalization of medical cannabis across the United States and it’s not all states, right now it’s about three quarters of all the states have approval for medical and/or recreational use, coupled with increased public advocacy and interest by patients in a substance that reportedly has therapeutic benefit has propelled rates of self-medication with cannabis in patients of all kinds of medical backgrounds and conditions.

We’ll be talking mostly about rheumatic diseases. Unfortunately, we’re to a difficult point because while the patients are very interested in cannabis nationally, many clinicians don’t feel comfortable recommending or guiding cannabis use because they don’t understand how it might work. There’s the lack of robust published evidence about its safety and advocacy and they’re not trained on best clinical practices. And we don’t have guidelines in the US to date. And nevertheless, patients, they continue to self-medicate and sometimes it’s not under the oversight of a clinician, they do it on their own, which is the way we usually would do it.

Are there any data that back the efficacy of medical marijuana to treat rheumatic diseases?

There’s some good preclinical data, but there’s an absence right now of good randomized controlled trials and prospective studies. Most of the studies, which we covered in our recent review were actually reviews or observational studies.

What recommendations would you give rheumatologists and healthcare providers in general for discussing medicinal cannabis with their patients in an empathetic, and non-biased manner?

That’s a great start actually that the patients and the rheumatologists need to work together as a team to weigh the lack of proven benefit that we just discussed in terms of perspective trials against the risk of the cannabis use, but still might want to consider it. But I think as you point out, the first step really is to have a open-minded physician.

I myself often find that patients don’t tell my nurse or myself that they’ve used cannabis until I say, “You know, cannabis is something that some people use” and they say, “Yes, by the way I am using.” And so, it’s really important that I as a clinician and other clinicians remain empathetic as you point out and provide guidance. We need to make sure patients understand that there isn’t a lot of data, that it is not an alternative standard of care and guideline-based treatments, which need to be continued.

And that the available dosing of the cannabis can be variable, that we need to understand why the patient wants to use it, whether it’s sleep or pain, and then we need to offer them non-pharmacologic treatment first. But some patients are going to say, “I really would like to try cannabis” and we need to work with them.

What are some key takeaways that you would like to leave our audience with?

Well, I think that clinicians need to understand that despite a lack of scientific evidence to support a clear-cut benefit and the risk of harm, some individuals, some of our patients are going to still prefer to try medical cannabis over our other options, particularly opioids as well. And I think this is an important step and I think we need to work together with our patients to discuss with them that as I pointed out earlier that they’ve tried first the FDA approved medicines, that they’ve tried non-pharmacologic mechanisms of action of drip medications. And then work with them to monitor them and follow them, being aware that there are clear-cut benefits that may be occurring, but there are also quick cut harms that may occur. It’s not for everyone, but I do work with my patients and become part of a team with them as they try cannabis.

Any closing thoughts?

Yeah, I think one of the points is patients who are considering medical cannabis turn to a whole variety of sources. They turn as well to online information, research, print materials, but what they’re really looking for are trusted sources. And the two trusted sources are physicians, but also family and friends it turns out. And the point is that at the moment, patients are really most interested in discussing it with a physician because that’s the person that they trust. And the physicians need to be open to help them because that’s the person that they’re going to trust to get reliable information.