Disclosures: Michaud reports no relevant financial disclosures. Coauthor Teresa A. Simon, MPH, of the Physicians Resource Center, in Toms River, New Jersey, reports consulting fees from Bristol Myers Squibb and Janssen.
July 28, 2021
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Cannabis use tripled in patients with rheumatic disease over 5 years

Disclosures: Michaud reports no relevant financial disclosures. Coauthor Teresa A. Simon, MPH, of the Physicians Resource Center, in Toms River, New Jersey, reports consulting fees from Bristol Myers Squibb and Janssen.
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Approximately 18% of patients in a rheumatic disease registry used cannabis in 2019, up from 6.3% in 2014, with the highest prevalence occurring in states where its use is legal, according to data published in Arthritis Care & Research.

“Everywhere I go I see signs advertising various forms or derivatives of cannabis, even in places where it may not be entirely legal,” Kaleb Michaud, PhD, of the University of Nebraska Medical Center, in Omaha, and codirector of FORWARD, The National Databank for Rheumatic Diseases, told Healio Rheumatology. “Our patients see these signs, too, and many of them are dissatisfied with their current health and are interested in trying new things to feel relief.”

Approximately 18% of U.S. patients with rheumatic diseases used cannabis in 2019, up from 6.3% in 2014, with the highest prevalence occurring in states where its use is legal, according to data derived from Wipfler K, et al. Arthritis Care Res. 2021;doi:10.1002/acr.24752.

“The problem is that most of our physicians and health professionals are unfamiliar with cannabis and any of its potential harms or benefits for our patient populations,” he added. “We felt it was important to first understand the overall gradient in use of cannabis by people with rheumatic diseases throughout the United States over the past several years, and better understand who was taking this.”

To analyze the use of cannabis among patients with rheumatic diseases in the United States, Michaud and colleagues analyzed data from patients enrolled in FORWARD. According to the researchers, FORWARD is a longitudinal study of rheumatic disease outcomes with participants, recruited primarily from rheumatologists in the United States, who complete semiannual questionnaires. These questionnaires cover treatment information, demographics, comorbidities and clinical status.

Kaleb Michaud

For this analysis, Michaud and colleagues included data from 11,006 respondents who completed questionnaires in 2014 and 2019, in particular answers to questions regarding their past and current cannabis use. No diagnoses were excluded, but the researchers assessed those with rheumatoid arthritis, osteoarthritis, fibromyalgia, systemic lupus erythematosus, psoriatic arthritis and ankylosing spondylitis in greater detail, due to larger sample sizes. To compare demographics, patient reported outcomes, medications, comorbidities and diagnoses between cannabis users and nonusers, the researchers used t-tests, Chi-square tests, logistic regression and geographic assessment.

According to the researchers, cannabis use increased from 6.3% in 2014 to 18.4% in 2019. Most who reported using cannabis — 74% in 2014 and 62% in 2019 — said the drug was effective in relieving arthritis symptoms. Users were more likely to take weak opioids (OR = 1.2; 95% CI, 1-1.5) and to have a history of smoking tobacco (OR = 1.7; 95% CI, 1.5-2.1). Those who used cannabis also demonstrated overall worse disease activity and scored higher on pain, fatigue, sleep, anxiety and depression, compared to nonusers in both 2014 and 2019.

“In almost every measure and dimension we have of worsening health status, those who used cannabis had clinically meaningful worse health status than those who did not use it,” Michaud said. “Similarly, those who started cannabis during 2014 to 2019 were more likely to have new comorbid conditions including cancer and depression — and they were less likely to be on non-opioid analgesic or TNF inhibitors.”

“Although more information is needed on effectiveness of cannabis as a treatment, this study provides early evidence of the accelerating use of cannabis in the rheumatology patient population — a threefold increase in 5 years — and likely use by those who may be less satisfied in their current health,” he added. “This adds to the needs of the health professionals to better address pain, fatigue and mental health as much as possible.”