Present your research with us in Providence, RI on September 21-22! Abstract submissions are open until June 2nd!

Cannabis Science Conference Fall

On this month’s episode, we are joined by Nathan Johnson, PhD, the Co-Founder and CEO of VERNE Bioanalytics

Ep 15: Hot Topics in Cannabis Cultivation—Hop Latent Viroid, Genetics, and More

 Breaking the Reins: How One Mustang Found a Second Chance with CBD

Don't miss our November/December issue focused on veterans and medical cannabis advocacy

Cannabis Patient Care November/December

Don't miss our October issue focused on pediatric cancer

Cannabis Patient Care October

As part of Cannabis Science Conference Spring, Canna Boot Camp was held at ChemHistory, a premier quality control testing laboratory in Milwaukie, Oregon. In this onsite interview, we speak with Business Director Alex Hoggan about how he started his testing laboratory, insights into his role, plus his advice and hopes for the future of the cannabis industry.

For more details on Canna Boot Camp, read coverage from 

For full coverage of Cannabis Science Conference Spring 2023, read the highlights page 

Articles

Hear what the business director of a cannabis testing facility has to say about the future of the cannabis industry!

Insights from a Cannabis Laboratory Business Director: Navigating Opportunities in the Evolving Industry

Madeline Colli is the Associate Editor for Cannabis Patient Care and Cannabis Science and Technology magazines at MJH Life Sciences.

Cannabinoids have grown in popularity as a method of symptom and pain management for patients with cancer, making candid communication of care options between nurses and patients critical, according to Karen Hande, PhD, DNP, ANP-BC, CNE, FAANP, ANEF.

“Nurses have a role in guiding their patients and sharing with them the available evidence: which is very limited,” Hande, who recently presented on cannabinoids as part of the 2022 ONS Bridge, said in an interview. “We need to share [information] with them, and monitor, and document their use of cannabis and cannabinoids, similar to any other drug therapies that we would follow and educate our patients or caregivers about.”

, Hande, who practices at Vanderbilt-Ingram Cancer Center and specializes in oncology pain management, discussed the importance of nurses staying up to date on developments surrounding cannabinoids and relevant laws as well.

What is the appeal of cannabinoids for patients with cancer? How have consumer attitudes shifted and how has it become popular?

 It’s [become] a pretty popular option for people because they see it on billboards and they hear other people talking; other patients who may be sitting next to them and saying, “Hey, this is what I’m doing to try to feel better or to improve some sort of symptom.”

When you think about the general public [seeing] a store or a facility selling CBD [cannabidiol], it [may appear] that if they’re selling it, it must be safe, or it must be something that is supported or monitored and why not try it.

You cannot blame any [individual] who has cancer [for] trying to mitigate some sort of symptom. [To many,] it looks like it could be harmless. People are curious and [are] trying to manage unwanted symptoms, so they try it; family members also offer this as a mitigating strategy for their loved ones and try to support them with the best intentions.

How effective is it in managing pain and what information can help guide nurses when talking to patients about if cannabinoids are a good idea?

The utility of cannabis, cannabinoids, or cannabis-based medicines for the treatment of cancer is not demonstrated in any sort of data.

With an acceptable safety profile, cannabis may be useful in managing symptoms related to cancer or its treatment, but further clinical trials have to be conducted to evaluate whether the preclinical antitumor effects translate into benefit for cancer patients. We do not know right now.

Oncology nurses must familiarize themselves with the available database to be able to better advise their patients on the potential uses of this complimentary botanical therapy.

Are there any potential risks associated with cannabinoid use? As a nurse, what risks should you look out for especially because patients are not always forthcoming? What might you proactively talk to them about?

When [individuals] see it being sold, they [tend to] believe that this has been monitored or regulated, but it is not; [whether] it is pure CBD or not is not known.

There have been some trials that have been looking at the profile of CBD and the CBD that is being sold. [One] study has shown that there are several contaminants in the CBD that's being sold. So [patients] are just not sure what they are consuming.

We have to share that with patients—that we cannot say one way or the other that this is a benefit to them or a certain type of dose or a certain brand because we don’t know. [Manufacturers] can claim what they would like on the label—even though that’s really against the law to claim something that may not be true or evidence based.

As an oncology nurse, how would you recommend responding if a patient expresses interest in trying CBD products?

I would first affirm that, of course, [the patient is] interested.

This is all over the media, people see this on street corners—it looks very appealing. They may have had friends or family or a patient sitting next to them affirm some sort of benefit from a type of treatment of CBD.

I would [have them] affirm that and say, “Yes, I understand completely”. [Patients] are curious and want to understand and find something else that can help them. Don’t make them feel bad about it; I want them to understand this is a common experience for many patients.

[However,] I would say we do not have the evidence to support that this is of benefit. Also, we don’t have the evidence to support that [CBD products] do not have long-term adverse effects. I would say to them: this is what we know, and this is your decision to take this substance or not, but I cannot confirm it.

Would you encourage documenting patient use of cannabinoids—even in states where stigma is strong? How does undocumented patient use affect our understanding of cannabinoids?

I encourage nurses to ask patients to [both] start the dialogue and decrease the stigma.

Again, affirm that we recognize [individuals] are trying this. [We want to ask] are you trying it?; is this something that you're interested in? There is some negativity about taking CBD or cannabidiol [but] it’s not illegal; it's legal to take [CBD].

We want to have that documented because the challenge is if you do a urine drug screen, sometimes THC [tetrahydrocannabinol] can be positive in urine [samples].

This has consequences if you’re giving them opioid treatment and have to do urine drug screens. In some states, an illegal substance such as THC may have negative consequences. I have had a lot of patients who take CBD but do not use THC and their urine drug screen or drug screens are positive. They end up being very concerned because they did not realize that they [would test] positive for THC. I explain to them that the CBD products that they were consuming may have had detectable levels of THC in it—which, therefore, turns their urine positive for marijuana or THC.

It's important to have that data in their chart, so they recognize that there is a possibility of what can happen, but I try not to discourage them or give them stigma about it because then patients aren’t going to tell you anything.

To read the full article, visit Oncology Nursing News: 

https://www.oncnursingnews.com/view/interest-in-cannabinoids-continues-to-grow-among-patients-with-cancer

Our sister publication, Oncology Nursing News recently published an interview with Karen Hande, PhD, DNP, ANP-BC, CNE, FAANP, ANEF, where she discusses increased patient interest in cannabinoids and how oncology nurses can steer pain management conversations to keep patients informed.

Interest in Cannabinoids Continues to Grow Among Patients With Cancer

Led by expert program chairs and an educational steering committee, the first Cannabis Science Conference of 2023 returned to its roots in Portland, Oregon! To kick off the event, we held the pre-conference cannabis education workshop—the Canna Boot Camp—where attendees gained hands-on knowledge and experience in several aspects of the cannabis industry. The two-day conference featured two keynote speakers, several panel discussions, and plenty of insightful research from the four tracks: analytical science, medical cannabis, cultivation, and psychedelics. The exhibit hall provided attendees more opportunities to connect and collaborate with industry experts at various booths and poster presentations. Below we share some additional highlights from the event.

Canna Boot Camp Class of Spring 2023 at ChemHistory.

The full day, pre-conference Canna Boot Camp workshop was held at ChemHistory, a premier quality control testing laboratory in Milwaukie, Oregon. Attendees visited four interactive zones to learn about topics ranging from sample prep methods to in depth cultivation work and medical cannabis education as well as hands-on analytical testing. Each zone offered the chance to get a firsthand perspective, ask questions, and learn something new.

Thank you to ChemHistory, Fritsch, Spex CertiPrep, Milestone, Medical Marijuana 411, Christian West and Zac Hildenbrand for providing an in-depth learning experience for us!

Watch our onsite interview with ChemHistory Business Director Alex Hoggan 

Cannabis Science Conference Spring: Day One

Dr. Dustin Sulak, DO, presenting “Low and Ultra-Low Doses of Cannabinoids: Are We Missing the Sweet Spot?”

Dustin Sulak, DO, launched the first day of the conference with an engaging presentation titled “Low and Ultra-Low Doses of Cannabinoids: Are We Missing the Sweet Spot?” Dr. Sulak examined several preclinical studies with ultra-low doses of cannabinoids—such as tetrahydrocannabinol (THC), tetrahydrocannabinolic acid (THCA), and cannabidiolic acid (CBDA)— explaining how the cannabinoids could be working with or against each other. He also compared methods and results from human studies with diabetes, pediatric epilepsy, fibromyalgia, as well as experience from his own practice. He concluded with his recommendations for researchers, cannabis medicine producers, clinicians, and patients. See a 

Following Dr. Sulak’s presentation, the analytical track held a fireside chat discussion with a group of esteemed panelists led by moderator Patrick Bird, MS, Sr. Manager, Scientific Affairs, bioMerieux, on ways to reduce microbial product failure rates. The panel featured Heather Krug, Regulatory Programs Branch Chief, Colorado State Public Health Lab; Antionette Duncan, Sr. Director Quality Assurance, Curaleaf; Chris Hudalla, President and CEO, ProVerde Labs; Steve Jetter, Program Analyst for Cannabis and Psilocybin Policy, Oregon Health Authority’s Oregon Environmental Laboratory Accreditation Program (ORELAP); and Shane Flynn, Senior Director Laboratory Proficiency Testing, AOAC. The analytical science track covered a wide variety of topics throughout the day, such as analyses of aerosol generation and collection and delivery systems with Dr. Mark Crosswhite, laboratory testing, cannabinoid extraction, cannabis compliance, and evaluation and examination of terpenes. Watch a 

quick clip of analytical track program chair Dr. Julie Kowalski

 on what she looked forward to at the conference.

Moderated by program chair Cherissa Jackson, RN, the medical track included studies on cannabis and obesity, breast cancer, chronic pain, and precision cannabinoid medicine, plus a panel discussion on results from the first NIH funded population-based study of medical cannabis. To end the track on day one, Eloise Theisen, RN, Chief Nursing Officer and Board President of Leaf 411, presented case reviews of cannabis to reduce opioid intake in palliative care. For more on her presentation, watch our 

To stay up to date on the latest information and to view photos from the conference, connect with us on 

The cultivation track, led by program chair Dr. Zacaraiah Hildenbrand, covered cannabis-specific plant nutrition, solutions to lower CapEx and OpEx costs, 3D printed construction, and finding a source and solution to microbe contamination presented by Carly Bader. Get an in-depth look into her presentation and insights in our recent 

For the first presentation of the day in the psychedelics track, program chair Dr. Denise Vidot presented her research from “Cardiovascular Disease Risk Among Cannabis + Psilocybin Co-Consumers.” The track also featured topics such as content variety in psilocybe cubensis strains, and using HPLC to analyze psychoactive alkaloids.

At the end of day one, a networking mixer held in the exhibit hall provided the opportunity for everyone to exchange knowledge in-person with speakers, attendees, and exhibitors and poster presentations from all facets of the cannabis industry.

Cannabis Science Conference Spring: Day Two

Dr. Sue Sisley began the second day of the conference with her informative presentation, “MDMA/Psychedelic Assisted Therapy: The Path to Potential FDA Approval.” She presented her recently published Phase 3 study on 3,4-Methyl​enedioxy​methamphetamine (MDMA)-assisted therapy for treating post-traumatic stress disorder (PTSD) and explained the results, safety data, addiction potential, dose, and treatment time. She also addressed issues of the cost of psychedelic therapy, the limited efficacy of current treatment options, and the economic and social impact of untreated PTSD in the US. She described the neurological effects of MDMA, the neurobiology of PTSD, and what a typical MDMA session looks like and how it seeks to get to the root of trauma. MDMA, Dr. Sisley said, acts as “a catalyst, not the real treatment.” She ended her presentation with the changes she would like to see made for the future of psychedelic therapy, plus a real-life example of treating PTSD in the police force. Questions from the audience included the possibility of training psychiatric nurses or social workers to bolster the number of current therapists, why the FDA is appearing to embrace MDMA faster than cannabis, and the uniqueness of a therapy protocol around a medication.

Dr. Sue Sisley presenting “MDMA/Psychedelic Assisted Therapy: The Path to Potential FDA Approval.”

One the second day of the analytical track, three different panel discussions covered the topics of the value of proficiency testing, which was moderated by program chair, Dr. Julie Kowalski; the standardizing and data sharing for the future of testing and quality control; and quality assurance and safety in cannabis psilocybin, and hemp, which was moderated by Kim Stuck. Watch our 

, CEO of Allay Consulting and author of the 

Across the medical track, patients, researchers, nurses, pharmacists, and doctors presented on topics such as impending cannabis regulation, cannabis in palliative care, the role of machine learning in treating autism spectrum disorder with cannabis, an integrative understanding of smoking cannabis, and the use of cannabinoids in outpatient primary care. Closing out the track, Jeremy Robbins, MS, gave a patient’s perspective on cannabis and spinal cord injury.

The psychedelics track was closed out on day two with an hour-long panel discussion that explored ketamine assisted psychotherapy from an integrative medical clinic perspective and included three experts from the AIMS Institute: Dr. Alison Draisin, PsyD, LMHC, Dr. Emily Whinkin, and Madeleine Turner, LMHC-A, Certified JAMP

 Transformational Coach. This panel will be covered in more detail in our upcoming psychedelics digital issue coming out in June 2023—stay tuned!

See the full list of presentations and agenda details 

In the cultivation track, James Schwartz elaborated on the danger of the 2018 Farm Bill, Kevin McKernan presented information on the genetics of hop latent viroid, and presentations also covered the expanded soil food web and hemp production in North Dakota.

Finally, the conference concluded with a screening of the film 

, with commentary from filmmaker Steve Ellmore. The film advocates for veteran access to medical cannabis, highlighting the research of Dr. Sisley and testimony from veterans, veteran family members, advocates, and more. For more on this important film, please read our 

Deep Dive interview with Cherissa Jackson, RN,

 medical track program chair, as she provides insights into veterans, medical cannabis, and why 

Join us for Cannabis Science Conference Fall in Providence, Rhode Island September 20-22, 2023 as the industry continues to move forward!

https://www.cannabisscienceconference.com/

Cannabis Science Conference Spring was held in Portland, Oregon from April 19-21, 2023. Here we provide a few highlights from the event.

Cannabis Science Conference Spring 2023: Keeping Science at the Forefront of the Industry

Arthritis is a common affliction, affecting almost one-quarter of the US population. Current treatments provide inadequate relief and have serious side effects. This article highlights the latest research surrounding cannabis as an alternative to currently available therapeutics. The research on cannabis for arthritis is consistent with the same greater medical and social acceptance of cannabis use more generally.

Arthritis affects joints, causing pain, swelling, and stiffness. According to the US Center for Disease Control and Prevention (CDC), arthritis is the leading cause of disability among US adults and affects some 58.5 million people, or 23.7% of US adults, more women than men (1). There are two main types of arthritis: osteoarthritis and rheumatoid arthritis.

 (OA), the most common type of arthritis, affects 32.5 million adults in the US (2). OA tends to occur more often in people: with a genetic predisposition; who are older, female, or have injured a joint; or who are heavier, and thus put more stress on knees, hips, and spine. OA involves wear-and-tear damage to a joint’s 

, which is the coating on the ends of bones that cushions movement between bones and enables smooth joint motion (see 

). Damage to cartilage causes bones to grind together, leading to pain, swelling, and stiffness. This wear and tear can occur over time, or it can be accelerated by joint injury or infection (3).

 (RA), the second most common type of arthritis, affects some 1.3 million people in the US (2). RA is an autoimmune disease, caused by a combination of elements, including genetic predisposition, environmental factors, and a dysfunctional immune system (4). In people with RA, the body’s immune system attacks the lining of the 

, which encloses all the joint parts, as seen in Figure 1. This membrane becomes inflamed and swollen, and as the disease progresses, it may cause destruction of cartilage and bone within the joint (3,4).

Mild-to-moderate OA pain is generally treated with non-steroidal anti-inflammatory drugs (NSAIDs), but chronic use of NSAIDs may cause gastrointestinal (GI) or kidney problems. People who do not respond to NSAIDs or who suffer from severe OA pain may use opiates, but on-going opioid use may lead to tolerance and dependence (5).

There are four classes of therapeutics used to treat RA: biologic response modifiers (biologics), corticosteroids, disease-modifying antirheumatic drugs (DMARDs), and NSAIDs (6). All of these therapeutics have the potential to cause side effects, especially with long-term use. More specifically, biologics may be carcinogenic; corticosteroids may cause osteoporosis, infections, and GI problems; DMARDs may cause liver damage; and as just discussed, NSAIDs may cause GI or kidney problems (7,8).

Patients would clearly benefit from the availability of alternative treatments for both OA and RA that are safe and effective, especially with long-term use.

Cannabis Mechanisms of Action for Arthritis

As noted, OA and RA involve pain, inflammation, and potential damage to cartilage or bone. Additionally, OA and RA patients often suffer from arthritis-induced insomnia, anxiety, and depression. We want to understand how cannabis can be used to address all these different symptoms of OA and RA.

Let’s start by understanding more generally how cannabis creates its effects in our bodies. The endocannabinoid system (ECS) is the body system that cannabis acts on to create its effects. Our ECS consists of three distinct components.

, communicate with cells to tell them whether and how to act. Anandamide (AEA) and 2-AG are the primary neurotransmitters generated by our bodies that are part of the ECS. Our bodies use AEA to modulate pain and inflammation (9). Tetrahydrocannabinol (THC) and cannabidiol (CBD) in cannabis act as neurotransmitters on our ECS, and like AEA, both of these cannabinoids also modulate pain and inflammation (5).

The second component of our ECS is a set of 

 produced by our bodies that break down neurotransmitters after they have served their purpose. Fatty acid amide hydrolase (FAAH) is the enzyme that breaks down AEA and THC, preventing them from acting.

The last component of our ECS is the collection of 

 upon which neurotransmitters act. Receptors receive the signals communicated by neurotransmitters and direct cells to act accordingly. The primary receptors for the ECS are CB1 receptors and CB2 receptors. While CB1 receptors are located throughout the body, they are densely populated throughout the brain and spinal cord. CB2 receptors are also located throughout the body, and they are densely populated within the immune system.

Now let’s turn to how cannabis can be used to act on our ECS to treat symptoms of OA and RA.

 (animal) studies have shown that CB1 and CB2 receptors, together with a variety of other receptors activated by cannabis, are located in joint tissues, such as cartilage, synovial membrane, and bone. Additionally, CB1 and CB2 receptors, together with higher-than-normal levels of AEA and 2-AG, have been found in synovial biopsies from patients with both advanced OA and RA. The presence of ECS receptors and neurotransmitters in joint tissues suggests our ECS plays a role in moderating both normal and arthritic joint functioning (5).

Mechanisms to Decrease Pain and Inflammation

As a quick aside, to review the body’s processes for inflammation and pain signal processing, any type of noxious stimulus in our bodies will cause inflammation. Our bodies respond by flooding the area with immune system cells to fight the stimulus or repair damage. The large number of cells in the area creates inflammation, and when those cells press against nerve endings, they cause the nerves to send signals to our brain. Our brain processes those signals, interprets them as pain, and communicates this information back to the nerve endings, which then throb or ache (10). Notably, all the excessive immune cells and activity in the area can also cause collateral damage to nearby tissue, which can exacerbate inflammation.

With that quick review in mind, there are several different mechanisms of action whereby cannabis can decrease pain and inflammation due to OA and RA. First, cannabis can reduce inflammation by reducing the flood of immune system cells to arthritic joints. That is, cannabis can activate CB2 receptors in arthritic joint tissue to modulate the flow of immune system cells in inflammation responses (5,11). Second, cannabis can reduce inflammation by reducing collateral tissue damage caused by OA or RA. Specifically, cannabis can activate CB2 receptors in joint tissue to modulate the flow of immune system cells in inflammation responses. By modulating inflammation, cannabis can reduce damage and destruction of arthritic joint tissues associated with excessive inflammation activity (5,11,12). Third, cannabis can reduce pain by reducing joint inflammation and thus pressure on nerve endings. It does this by activating CB2 receptors in arthritic joint tissues to prevent pain signals in the tissue from being sent to the brain (5). And fourth, cannabis can reduce pain by inhibiting pain processing signals received by the brain. Namely, cannabis can activate CB1 receptors in the brain to prevent processing of pain signals received from arthritic joint tissues (5).

Cannabis can reduce the burden of arthritis in patients by alleviating many of the comorbidities OA and RA patients often suffer from, including arthritis-induced insomnia, anxiety, and depression. Cannabis can reduce these conditions directly, by acting on CB1 and CB2 receptors in the brain (11). At the same time, by alleviating pain and inflammation associated with arthritis, cannabis can reduce arthritis-induced insomnia, anxiety, and depression.

As previously mentioned, our endogenously produced cannabinoid AEA can activate CB1 and CB2 receptors to reduce arthritis-induced pain, inflammation, insomnia, anxiety, and depression. As also previously mentioned, FAAH is the ECS enzyme that breaks down AEA and THC. Natural and synthetic cannabinoids are being researched for use in inhibiting FAAH production—to prevent the break-down of AEA and THC (5,11). These FAAH-inhibitors would thus make more AEA and THC available to inhibit or relieve pain, again either remotely in the brain or locally at the joints.

Potential Problems with Cannabis for Arthritis

Researchers have identified two potential problems with the use of cannabis—specifically THC—to address OA and RA (5,11). First, when THC acts on CB1 receptors in the brain, it induces psychoactive effects, which many patients do not want to experience. And second, when THC acts on CB1 receptors outside the central nervous system (CNS), it induces pro-inflammatory effects.

Researchers have tried to address the first problem of psychoactivity by using cannabis to selectively activate CB1 receptors peripherally, only to be stymied by THC’s pro-inflammatory cardiovascular and metabolic side effects. In response, researchers have considered addressing THC’s pro-inflammatory effects by using natural or synthetic cannabinoids to inhibit CB1 receptor activation. Unfortunately, these substances caused unfavorable psychiatric side effects.

Ongoing research is attempting to figure out how to reduce THC-induced psychoactivity, while preventing THC-induced cardiovascular inflammation.

Miller and colleagues (5) stated: “Overall, there is strong support for the idea that the endocannabinoid system operates to limit pain in joint disease and that activation of this system with the appropriate cannabinoids is effective in limiting joint pain at both central and peripheral sites.” Specifically, mouse studies show that: CBD blocks arthritis progression by reducing joint swelling, pain, and tissue damage; CBD decreases joint damage and generates potent immunosuppressive and anti-inflammatory effects (13); and synthetic CBD reduces joint pain (5).

Surveys tend to be relatively less dependable than other types of clinical data because self-reported information is notoriously unreliable, respondents tend to be biased, and there is no control group to help correct for placebo effects. Nevertheless, survey data can provide some useful information.

There are many surveys of medical cannabis patients generally, and also of arthritis patients specifically, that have been conducted to better understand both the characteristics of people who use cannabis for medical conditions, as well as these patients’ experiences and outcomes with cannabis. I’d like to review three different sets of patient surveys.

Surveys of Medical Cannabis Dispensary Patients

The first set of studies questioned people in medical dispensaries about their use of cannabis to treat medical conditions. Since these are current medical users, their success rates are expected to be relatively high, because if cannabis weren’t helping them feel better, then they would presumably not continue to use it.

Survey respondents in Canada (2013) (14), Arizona (2015) (15), and Los Angeles, California (2014) (16) from similar time periods all had very similar characteristics: they were predominantly white males with higher levels of income and education, and roughly 15–25% report using cannabis primarily to treat arthritis.

Almost all survey respondents in the Canadian study who use cannabis for arthritis report using it to address sleep, pain, inflammation, and most also treat anxiety and depression. Some medical patients (not just arthritis patients) reported using cannabis recreationally prior to initiating its use for medical purposes.

The majority of survey respondents in the Arizona study who use cannabis to address symptoms from arthritis report: obtaining relief with cannabis, obtaining better relief from cannabis than that from other medications, and reducing their use of other medications because of cannabis. Respondents in the LA study reported that they had used cannabis recreationally before later using it therapeutically, and they also reported obtaining cannabis products from other (non-medical) sources in addition to dispensaries.

The second set of studies surveyed arthritis patients to understand the portion of patients that use cannabis to treat arthritis, the differences between patients who use cannabis for arthritis and those who don’t, and the outcomes achieved from using cannabis to treat arthritis.

The first two studies were conducted online, where one assessed CBD use by arthritis patients in the US (17) and the other assessed marijuana or CBD use by arthritis patients in Europe (18). In contrast to respondents in the dispensary studies who were predominantly male, the online study respondents were predominantly female. The results showed that 70% of US respondents had tried CBD and more than half of European respondents had tried either cannabis or CBD to treat their arthritis. The vast majority of respondents who had tried cannabis reported that it had improved their symptoms, and most respondents in the US reported decreasing or ceasing the use of other medications. Two-thirds of Europeans, but less than half of Americans, had spoken to their doctors about their use of cannabis.

The third set of studies reviewed also consist of a set of two studies of arthritis patients. These studies were both conducted at the same rheumatology clinic, assessing patterns of use first in 2014 (19) and then again in 2019 (20) to see how the patterns had changed. These two studies provide three sets of information: what are the differences between patients who use cannabis to treat their arthritis and those who do not, how have those differences between users and non-users changed over time, and how has the incidence of cannabis use by arthritis patients changed over time. Let’s take each of these in turn.

Both studies reported that patients who used cannabis for arthritis were more likely than non-users to be younger and unemployed or disabled, suffer from OA rather than RA, have greater levels of pain and disease severity, have greater use of opioids and other pain medications, be past or current cigarette smokers, and be past or current recreational cannabis users.

Relative to those in 2014, 2019 patients who use cannabis to treat arthritis tended to be older, more female, more likely to have RA rather than OA, and less likely to be disabled or unemployed; have lower levels of pain; and be less likely to use opioids, to be cigarette smokers, or to be recreational cannabis users (see 

Incidence of Medical Cannabis Use Over Time

Cannabis use by arthritis patients for medical uses doubled between 2014 and 2019 (see 

). The percentage of arthritis patients who had ever used cannabis for medical uses increased between 2014 and 2019, from 4.3% to 8.2%, and the percentage of patients who currently use cannabis for medical uses increased from 2.8% to 6.5%. The percentage of patients who currently use cannabis for recreational uses also doubled, from 2.1% to 4.9%.

In the 2019 study (20), researchers stated concerns that: “Most (80%) medical users were purchasing all or at least a portion of cannabis via a nonmedical route” and that “the treating physician was unaware of any cannabis use for two-thirds of the patients.” The researchers conceded that cannabis is not reimbursed by insurers, and cannabis purchased through nonmedical routes was generally much less expensive. Researchers were also concerned that many patients chose inhalation as their method of administration, while they noted that this may be a hold-over from their tendency to have had a history of smoking cigarettes. Finally, researchers noted that almost half of medical users in the 2019 study had discontinued their use of medical cannabis, due either to lack of effects or to unwanted side effects.

Only a few clinical trials of cannabis for arthritis have been conducted. One was a 2006 preliminary assessment of 58 patients conducted to assess the safety and efficacy of Sativex for RA, where Sativex is a cannabis therapeutic that received botanical drug approval in the UK in 2010. The study found Sativex improved pain and sleep (21). Another study, a randomized control trial (RCT), was conducted in 2022 on 18 patients to assess the efficacy of topical CBD for thumb joint arthritis. The study found CBD improved pain and disability (22). Finally, another 2022 RCT of 129 patients undertaken to assess the efficacy of CBD for OA and psoriatic arthritis found no effects on pain, sleep, depression, or anxiety (23). Three additional Canadian trials of cannabis for knee osteoarthritis have been registered with the National Institute of Health but have not (yet) been performed.

Arthritis is a common affliction, affecting almost one-quarter of the US population. Current treatments provide inadequate relief and have serious side effects. An alternative to currently available therapeutics that provides relief without undue side effects would, undoubtedly, be quite welcome. The ECS has been shown to modulate pain and inflammation, and endocannabinoid receptors have been shown to pervade joint tissues. There are thus clear mechanisms of action for cannabis to provide relief for arthritis patients. While placebo-controlled randomized trials are lacking, a few early studies show promise for cannabis and arthritis. Significantly, surveys show that many arthritis patients are already finding relief using cannabis to treat their symptoms of arthritis. Noteworthy is the fact that over time, medical cannabis users are coming from more mainstream parts of the population. That is, earlier (2014) arthritis patients who used medical cannabis tended to come from more marginalized populations: they tended to be younger males, they had greater levels of symptoms severity, and they had more experience with cigarettes and recreational cannabis use. However, relative to these earlier patients, more recent patients (2019) have tended to be slightly older, more female, less severely disabled, and less experienced with cigarettes or recreational cannabis use. The research on cannabis for arthritis is thus consistent with the same greater medical and social acceptance of cannabis use more generally.

Prevalence of Arthritis and Arthritis-attributable Activity Limitation - United States, 2016–2018 

https://www.cdc.gov/mmwr/volumes/70/wr/mm7040a2.htm

Rheumatoid Arthritis Prevalence: Statistics, Causes, and Risk Factors 

https://www.medicalnewstoday.com/articles/rheumatoid-arthritis-prevalence

https://www.mayoclinic.org/diseases-conditions/arthritis/symptoms-causes/syc-20350772

Synovial Fibroblasts: Key Players in Rheumatoid Arthritis. 

https://pubmed.ncbi.nlm.nih.gov/16567358/

Miller, R. J.; Miller, R. E. Is Cannabis an Effective Treatment for Joint Pain? 

https://pubmed.ncbi.nlm.nih.gov/28967368/

Lewis, S.; Lloyd, W. 10 Drugs Commonly Prescribed for Rheumatoid Arthritis 

https://www.healthgrades.com/right-care/rheumatoid-arthritis/10-drugs-commonly-prescribed-for-rheumatoid-arthritis

Kiefer, D.; Hein, D. Rheumatoid Arthritis Treatment Side Effects 

https://www.healthline.com/health/rheumatoid-arthritis/treatment-side-effects

Rice, J. B. Long-term Systemic Corticosteroid Exposure: A Systematic Literature Review 

https://pubmed.ncbi.nlm.nih.gov/29055500/

Scherma, M.; Masia, P.; Satta, V.; Fratta, W.; Fadda, P.; Tanda, G. Brain Activity of Anandamide: A Rewarding Bliss? 

https://www.nature.com/articles/s41401-018-0075-x

Fisher, R. Overview of Research on Cannabis for Chronic Pain 

https://www.e-digitaleditions.com/i/1466168-cannabis-patient-care-march-april-2022/11

Lowin, T. Joints for Joints: Cannabinoids in the Treatment of... : Current Opinion in Rheumatology 

https://journals.lww.com/co-rheumatology/Abstract/2019/05000/Joints_for_joints__cannabinoids_in_the_treatment.9.aspx

Lowin, T.; Tingting, R.; Zurmahr, J.; Classen, T.; Schneider, M.; Pongratz, G. Cannabidiol (CBD): A Killer for Inflammatory Rheumatoid Arthritis Synovial Fibroblasts 

https://www.nature.com/articles/s41419-020-02892-1

Malfait, A. M. The Nonpsychoactive Cannabis Constituent Cannabidiol is An Oral Anti-arthritic Therapeutic in Murine Collagen-induced Arthritis 

https://pubmed.ncbi.nlm.nih.gov/10920191/

Walsh, Z. Cannabis for Therapeutic Purposes: Patient Characteristics, Access, and Reasons for Use 

https://pubmed.ncbi.nlm.nih.gov/24095000/

Troutt, W. Medical Cannabis in Arizona: Patient Characteristics, Perceptions, and Impressions of Medical Cannabis Legalization 

https://pubmed.ncbi.nlm.nih.gov/26317379/

Grella, C. E. Patterns of Medical Marijuana Use Among Individuals Sampled from Medical Marijuana Dispensaries in Los Angeles 

https://www.tandfonline.com/doi/abs/10.1080/02791072.2014.944960?journalCode=ujpd20

Frane, N. Cannabidiol as a Treatment for Arthritis and Joint Pain: An Exploratory Cross-sectional Study. 

https://link.springer.com/content/pdf/10.1186/s42238-022-00154-9.pdf?pdf=button

Creaky Staff. 57% of Arthritis Patients Have Tried Marijuana or CBD for Medical Reasons (And More Than 90% Say It Helped) 

https://creakyjoints.org/eular-2019/medical-marijuana-cbd-usage-arthritis-patients-study/

Ste-Marie, P. Survey of Herbal Cannabis (Marijuana) Use in Rheumatology Clinic Attenders with A Rheumatologist Confirmed Diagnosis 

https://pubmed.ncbi.nlm.nih.gov/27842047/

Fitzcharles, M. Medical Cannabis Use by Rheumatology Patients Following Recreational Legalization: A Prospective Observational Study of 1000 Patients in Canada. 

https://onlinelibrary.wiley.com/doi/epdf/10.1002/acr2.11138

While placebo-controlled randomized trials are lacking, a few early studies show promise for cannabis and arthritis, and surveys show that many arthritis patients are already finding relief using cannabis to treat their symptoms.

Research on Cannabis for Arthritis

Finally getting relief with cannabis after years of battling life-changing crippling pain.

Sometimes the littlest things can make a big difference in your life. You turn your shopping cart left instead of right in the grocery store and run into an old friend. You end up in a movie theater sitting next to your favorite high school teacher and talk about the movie afterwards. Good things like that can happen—coincidences, luck, or karma. But bad things can happen too because, well, that’s life. And suddenly, your life becomes a struggle.

Take the case of Debi Wimberley (1), cannabis educator, life coach, founder, and CEO of a medical cannabis newsletter. In 1995, Debi dropped an empty coffee cup on the top of her foot. Doctors told her that the cup hit the small peripheral C-fiber nerve fibers that carry pain messages to the brain. The peripheral nervous system involves nerve signaling from the brain and spinal cord to all other parts of the body(2), which causes autonomic changes such as sweating and vasomotor abnormalities. Motor changes like weakness and dystonia, and trophic changes such as skin or bone atrophy, hair loss, and joint contractures, are all included. This nerve also controls the muscles in the leg that lift the ankle and toes upward. She experienced a shot of excruciating pain similar to an electrical shock that ran up her leg—and it never left. That excruciating pain was always there, every minute of every day, for years and years.

“I was certainly disabled and unable to work,” Wimberley said. “I had developed what they called complex regional pain syndrome (3) from the coffee cup incident. It’s called the suicide disease (4), and rightly so.”

She realized that her central nervous system had been “short circuited” from the coffee cup incident. “I developed the name for it called ‘The Princess and the Pea (5),’ because even with the CAM [controlled action motion] boot (6) on, I could feel a hair underneath my foot. I became super hypersensitive to anything. I couldn’t stand the wind if it just touched my leg or covers or anything. Everything I did revolved around protecting my leg. In the meantime, my skin had become very thin. You could just barely touch me and my skin opened up,” she said. “So, it wasn’t like I could just go out and be carefree.”

She ended up being prescribed an increasingly larger dose of Oxycontin for 20 years, up to 240 mg a day (a standard starting dose is 20 mg a day [7]). “Because of the opiate crisis, all of a sudden, my doctor decided he couldn’t come up with another alternative because he ran the risk of losing his job or his license. So, I just pretty much was left on my own,” Wimberley said.

At the time she was forced to stop Oxycontin, she was in the middle of contracting black lung disease, on top of chronic obstructive pulmonary disease (COPD), which was helped along because she was so sedentary at the time. Then she ruptured her left foot peroneal tendon, which happened when she situated herself onto a bar stool.“ I had no life. I actually needed a 24-hour caregiver,” she said.

She mentioned that she did try to do lots of hobbies during that time. “I taught myself a lot of things to do in my downtime. But being able to be successful at creating something and finishing it to the degree that I would be happy with it was very hard, because I was constantly having to think past the pain of electrical shocks constantly going through my body.”

Her disability didn’t just impact her, but everybody who was involved in her life. “I lost all of my friends. It's just what happens. It’s too hard to be friends with you. I’m not one that complained about it or talked about it because I learned really early on that if you’re always talking about it, you don’t feel good. No one wants to be around you. You have to learn to bury that and when you bury it, it lives inside of you and the thoughts that go on in your head.”

Wimberley was getting increasingly desperate to end her pain. She talked to doctors about amputating her leg, thinking if they could just cut it off, maybe the pain would end. “But because my nerve damage was controlled from the brain, not from the spine, that would have never worked,” she said. “It would have been like having phantom pain all the time.”

Wimberley was a trained medical technologist earlier in her career and said she had worked with two amazing doctors in the late 1970s in the cancer field who convinced her that maybe she needed to try cannabis because it could be beneficial to help her pain. “They were educating me on cannabis for cancer pain, and the importance of the role that it could play, and we kept trying to get it allowed for use as an experimental thing within our clinic, which they never did approve,” she said. “I live in Arizona, and it’s actually legal here, medically, so I started exploring it and teaching myself everything I could about it.” She first tried cannabis on December 18, 2015.

At the time, she was living at a pain threshold of 10, taking her 240 mg of Oxycontin each day. Her attempt at withdrawal from the drug was difficult, she said, even after it landed her in the hospital fighting for her life, unable to breathe for herself. “So, I had to find some kind of answers.”

She then used cannabis to get off of all her opiates and is now at a pain threshold level of three.

Wimberley said that she was shocked at how much those two amazing doctors knew about cannabis, especially in light of her training as a medical technologist. “I didn’t learn anything about this (cannabis) in my medical training,” she said. “I didn’t even learn about the plant, so it was very interesting to me.”

There were a lot of patients that were trying cannabis on their own, and that was something she and other doctors knew but couldn’t talk about. “Those patients would talk about how it would relieve their pain, and at least let them be able to relax and sleep,” Wimberley said. “When I was living in that kind of pain, I could never sleep more than four hours, and it was not a good four hours.”

Wimberley created a newsletter this year, 

 (ECN) (8), for anybody—such as the cannabis medical professional, educator, or coach who creates content about cannabis—to share cannabis news straight to the emails of people interested in it. “Communicating with anybody about cannabis is extremely hard, especially when we can’t advertise,” she explained. “So, I said let’s just go find the people that really want this information. And the thing I learned is that patients need education before we can even study it.”

Her medical background is what helped guide her. “Now I’m working to be a speaker and actually go out and talk about the importance of understanding your endocannabinoid system and the role that it plays in your health.”

With cannabis, she has eliminated 28 prescriptions, and has started improving her lungs.

Cannabis nurse Gloria Lynne Smith, RN-BC, BSN, NLC (9), knows all about people suffering with chronic pain like Debi, and the journey they must make to find wellness and true happiness in life.

Smith has an extensive background in the healthcare field, starting in her teens as an emergency medical technician. As a nurse, Smith has worked in specialties such as emergency medicine, telemetry, neurology, oncology, endoscopy, hospice, and the intensive care unit (ICU). Her mom is a nurse.

Smith worked as a bedside nurse until the COVID-19 pandemic hit. The stress it brought to her job forced her to quit that bedside job, and turn to other methods of providing care, including telehealth.

Smith spent years working with top multiple sclerosis (MS) doctors and was heavily involved with their medical cannabis program. “MS is classified as neuropathic pain,” she said. “So, what you would see in diabetes and things like that is a lot of nerve pain, because it’s inflammation of the nerves. And nerve pain is historically very hard to treat with medication.”

People with MS (10) suffer stabbing pains in the face, and a variety of sensations in the trunk and limbs, including feelings of burning, pins and needles, hugging and squeezing, with painful muscle spasms. Bladder and bowel problems can also occur. Smith explained how issues such as skeletal pain and muscular pain can be treated with over-the-counter analgesics that work well, followed by muscle relaxers and opioids if things get worse. “But nerve pain is so indirect to treat,” Smith added. “A person who has the sciatic pain always has that pain going down their leg. There’s just not a direct way to treat it.”

What she found is that cannabis is one of the only ways of providing predictable treatments for neuropathy, much better than the traditional drugs like Gabapentin (11). Gabapentin has a long list of side effects, including swelling of the face and throat, difficulty swallowing, and seizures. “There are a lot of people in their 70s, 80s, and 90s who got diagnosed with multiple sclerosis really late. They have all these symptoms that they weren’t able to treat very well.”

One of her favorite MS patient stories is about an elderly woman in her 80s who had bad nerve pain in her legs. She experienced difficulty sleeping. “When I finally convinced her to try cannabis, I remember her coming back in for a follow up and being just beside herself,” Smith stated. “She said to me something along the lines of ‘I forgot that I deserved to feel this good.’”

That elderly patient had been dealing with this unrelenting, unmanageable, untreatable pain for so long, and not able to sleep.

“We nurses always feel backed up against a wall, and that there are these barriers between us and helping our patients get cannabis. And I think at some point, we just get tired of it and say, well, let them get me in trouble,” she said. “It makes me proud to be a cannabis nurse, because it really embodies what a nurse is, where you want to help as much as you can.”

The lack of general knowledge in our health care professionals about cannabis as a medicine is really doing patients a large disservice, Smith added, especially around learning about the endocannabinoid system. “It’s really relevant science for anybody whether or not you’re trying to manage a symptom or disorder with cannabis,” Smith said. “The ultimate goal would be to teach everybody about their own endocannabinoid system and how they can positively affect it, and how they can regulate it, to enjoy balance, not only in a diseased area, but just for life and in their wellness.”

Smith works with the medical cannabis organization, Cannabis Nurses Network (CNN) (12), which was founded in 2015 and provides free educational and informational resources to the cannabis industry. CNN was directly involved in the authorship, lobbying, and passing of Ryan’s Law in California. A co-author of this law, Ken Sobel, is a legal counsel and educator for CNN.

California Governor Gavin Newsom signed Ryan’s Law on September 2, 2022 (13). The law requires healthcare facilities to allow the use of medical cannabis on their premises for terminally ill patients with a valid medical cannabis identification card or a recommendation from an attending physician.

The law was passed by the legislature with support from a diverse group of organizations including Americans for Safe Access (ASA) (14). It applies to all California health care facilities including acute care hospitals, special hospitals, skilled nursing facilities, congregate living health facilities, or hospice providers (excluding the emergency department of a health care facility, chemical dependency recovery hospitals, and state hospitals).

This article features real-life stories from a cannabis patient as well as an on-the-ground cannabis nurse.

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