From the Alan Edwards Pain Management Unit, and the Division of Rheumatology, McGill University Health Centre, Montreal, Quebec; Division of Rheumatology, University of Alberta, Calgary, Alberta, Canada; Department Internal Medicine I, Klinikum Saarbrücken, Saarbrücken; Department of Psychosomatic Medicine and Psychotherapy, Technische Universität München, Munich, Germany.
M.A. Fitzcharles, MB ChB, Alan Edwards Pain Management Unit, and Division of Rheumatology, McGill University Health Centre; O. Zahedi Niaki, MD, Division of Rheumatology, McGill University Health Centre; W. Hauser, Dr. med., Department Internal Medicine I, Klinikum Saarbrücken, and Department of Psychosomatic Medicine and Psychotherapy, Technische Universität München; G. Hazlewood, MD, Division of Rheumatology, University of Alberta.
J Rheumatol. 2019 May;46(5):532-538. doi: 10.3899/jrheum.181120. Epub 2019 Jan 15.
Pain is one reason some rheumatology patients may consider use of medical cannabis, a product increasingly perceived as a safe and neglected natural treatment option for many conditions. Legalization of recreational cannabis in Canada will promote access to cannabis. Physicians must therefore provide patients with the best evidence-based information regarding the medicinal effects and harm of cannabis.
The Canadian Rheumatology Association (CRA) mandated the development of a position statement for medical cannabis and the rheumatology patient. The current literature regarding the effects of medical cannabis for rheumatology patients was assessed, and a pragmatic position statement to facilitate patient care was developed by the Therapeutics Committee of the CRA and approved by the CRA board.
There are no clinical trials of medical cannabis in rheumatology patients. Evidence is insufficient about the benefit of pharmaceutical cannabinoids in fibromyalgia, osteoarthritis, rheumatoid arthritis, and back pain, but there is evidence of a high risk of harm. Extrapolating from other conditions, medical cannabis may provide some symptom relief for some patients. Short-term risks of psychomotor effects can be anticipated, but longterm risks have not been determined and are of concern.
Despite lack of evidence for use of medical cannabis in rheumatology patients, we acknowledge the need to provide empathetic and pragmatic guidance for patient care. This position statement aims to facilitate the dialogue between patients and healthcare professionals in a mutually respectful manner to ensure harm reduction for patients and society.
疼痛是一些风湿病患者考虑使用医用大麻的原因之一，医用大麻作为一种安全且被忽视的天然治疗选择，对许多疾病都有疗效。加拿大休闲用大麻合法化将促进大麻的获取。因此，医生必须为患者提供有关大麻药用功效和危害的最佳循证信息。
加拿大风湿病学会（CRA）授权制定医用大麻和风湿病患者的立场声明。评估了有关医用大麻对风湿病患者影响的现有文献，并由 CRA 治疗委员会制定了一项实用的立场声明，以促进患者护理，并经 CRA 董事会批准。
没有针对风湿病患者的医用大麻临床试验。在纤维肌痛、骨关节炎、类风湿关节炎和背痛方面，药用大麻素的益处证据不足，但有高危害风险的证据。从其他疾病推断，医用大麻可能为一些患者提供一些症状缓解。可以预期短期的精神运动效应风险，但长期风险尚未确定，令人担忧。
尽管缺乏医用大麻在风湿病患者中使用的证据，但我们承认有必要为患者护理提供富有同情心和实用的指导。本立场声明旨在以相互尊重的方式促进患者和医疗保健专业人员之间的对话，以确保患者和社会的危害最小化。
