Despite advances in treatments and outcomes among patients with rheumatic diseases, there is an unmet need in pain management. Cannabis has emerged as a potential opioid-sparing alternative, with arthritic pain as a commonly cited reason for medicinal cannabis use. However, little is known, and we set out to understand patterns of cannabis use in a US-wide rheumatic disease population.
The study included participants in FORWARD, The National Databank for Rheumatic Diseases. Participants were asked in 2014 and 2019 about their past and current cannabis use. Demographics, patient reported outcomes (PROs), medications, comorbidities, and diagnosis were compared between cannabis users and nonusers with t-tests, Chi-square tests, logistic regression, and geographic assessment.
Among 11,006 respondents, cannabis use increased from 6.3% in 2014 to 18.4% in 2019, with the greatest prevalence of use in states where cannabis use is legal. Most users (74% in 2014; 62% in 2019) reported that cannabis was effective for relief of arthritis symptoms. Cannabis users were more likely to be taking weak opioids (OR 1.2 [1.0, 1.5]; p=0.03) and to have a history of smoking tobacco (OR 1.7 [1.5, 2.1]; p<0.001), and had worse measures on all assessed PROs.
Reported cannabis use in this cohort increased significantly between 2014 and 2019. Characteristics of users suggest that those who try cannabis are feeling worse, and their pain management needs may not be adequately addressed by other therapies. The association between cannabis, opioids, and PROs highlight areas for future work.