The Australian Rheumatology Association (ARA) has updated its stance on medicinal cannabis, stating it does not recommend the routine use of cannabinoids to treat arthritis and other musculoskeletal conditions. 

Its latest position statement says: “The current body of evidence for the use of cannabinoids for the treatment of arthritis and other musculoskeletal conditions is limited and provides low-to-moderate certainty evidence for marginal benefits which, for many, may be offset by harmful effects.

“Research so far shows that only a small number of people treated with cannabinoids for painful conditions notice a small improvement in pain and sleep, and there is little or no improvement in their ability to participate in daily activities.”

However, the ARA does recognise that the use of cannabinoids as a therapy for persistent musculoskeletal pain is a topic of increasing interest to consumers, clinicians, researchers, and other stakeholders. 

“The ARA also acknowledges the importance of the lived experience of people with persistent musculoskeletal pain, many of whom have used cannabinoids for treatment of their pain or have considered doing so, and the current relative lack of highly effective and safe pharmacological options for the treatment of persistent pain.” 

The position statement calls for randomised placebo-controlled trials to determine the therapeutic usefulness of cannabis. 

Avecho CEO Dr Paul Gavin

Avecho Biotechnology recently announced a collaboration with the Lambert Initiative to conduct a proof-of-concept study into the efficacy of topically applied CBD in relieving symptoms of osteoarthritis.

CEO Dr Paul Gavin said: “I wholeheartedly agree with the ARA’s comment that there needs to be a firmer body of evidence around the use of cannabidiol in clinical practice for the treatment of arthritis and other musculoskeletal conditions and Avecho is actively contributing to this. 

He said the study with Lambert, which will start in the new year, was initiated “in response to growing demand from clinicians who are unsatisfied with pain management options for osteoarthritis of the hand, which demonstrates the interest in novel treatments for this therapeutic area”. 

Gavin added: “Through this study and others, our near-term goal is to work with reputable research partners to set a gold standard for randomised clinical trials and evidence generation in the CBD space, but always in safe and respectful collaboration with the patient groups we are seeking to help.”

Lambert Initiative postdoctoral research associate Dr Elizabeth Cairns also acknowledged gaps in the clinical literature surrounding cannabis and/or cannabinoid-based medicines for the treatment of arthritis and other musculoskeletal conditions. 

Lambert Initiative postdoctoral research associate Dr Elizabeth Cairns

She said: “This is exactly why we are aiming to help bridge this gap by performing high-quality clinical randomised controlled trials based on the wealth of preclinical evidence demonstrating efficacy, especially in arthritis and pain management.”

Lambert welcomed the ARA acknowledging the lived experience of Australians who use medicinal cannabis to treat their conditions. 

“According to the SAS-B access data provided by the TGA as of the end of August 2021, there have been 1,161 approvals for diseases of the musculoskeletal system and connective tissue, 4,755 approvals for neuropathic pain, and 97,400 approvals for unspecified non-cancer pain.”

However, she added: “We disagree that in general the harms and risks outweigh potential benefit, especially if healthcare practitioners have deemed that medicinal cannabis is a viable treatment option after conventional therapeutics have failed, and patients are monitored throughout their treatment as with other therapies. 

“The lack of significant reports of major negative health effects, given the very large number of SAS-B approvals for patients in these disease areas, supports this risk balance.

“We urge the ARA to instead consider the risks of potential alienation of patients from their healthcare providing teams if they do not feel supported [in their] use of medicinal cannabis, and may instead turn to unmonitored usage with non-legal products where the risk of unwanted effects is much higher.

“We look forward to working with medical organisations on how we can together best support patient-centred care.”

Hannah Adler

Hannah is a communications professional and early-career researcher in the disciplines of health communication and health sociology. She is a PhD student at Griffith University currently writing a...