The dilemma of medical marijuana use by rheumatology patients.

“Severe pain” is the most common reason for medicinal herbal cannabis use, with arthritis and musculoskeletal pain cited as the most prevalent specific medical condition (1,2). Eighty percent of marijuana users in a US pain clinic report use for myofascial pain, whereas up to one-third of persons in population studies in the UK and Australia reported use for treatment of arthritis pain (1–3). Similarly, “severe arthritis” is the diagnosis for 65% of Canadians authorized to possess cannabis for medicinal purposes as of June 2013 (4). Medical marijuana has, however, never been recommended by any rheumatology group worldwide for symptom relief in rheumatic conditions. As the health care professionals best placed to advise on issues of rheumatic diseases, rheumatologists must have a voice in the current debate concerning medical marijuana, hereafter identified as herbal cannabis. Advocacy for access to cannabinoid treatments has led to a societal groundswell, with regulatory bodies around the globe considering the legalization of herbal cannabis for medicinal use. Currently, herbal cannabis is legalized for medicinal use in 20 states in the US as well as in the District of Columbia. Physicians will therefore be caring for patients who may be self-medicating with herbal cannabis or may request medical advice about cannabis. In order to responsibly advise patients on any medical issue, and in particular herbal cannabis, it is essential that the health care professional has a competent knowledge of the subject based on sound scientific study. In this review, we examined the current evidence for dosing and administration, efficacy, and risks of herbal cannabis in rheumatic pain management, and thereby addressed practical issues confronting rheumatologists whose patients request advice. We confined our comments to herbal cannabis as it pertains to rheumatic conditions, acknowledging that evidence and information may differ for other conditions. We did not enter into the debate addressing the legalization of recreational herbal cannabis.