Medical cannabis is not an alternative to standard care for any rheumatic disease, and rheumatologists should adhere to current treatment standards and guidelines for rheumatic disease management. There are no published studies of the effects of medical cannabis in patients with rheumatic diseases, and the few studies examining cannabinoid pharmaceutical products report limited benefits and high risk of adverse events. Medical cannabis should not be used in rheumatology patients under the age of 25 years. It is acknowledged that rheumatic disease patients may seek advice regarding use of medical cannabis, may currently be self-medicating with medical cannabis, or may request a prescription for medical cannabis. Common reasons that patients may consider use of medical cannabis are for pain relief and/or sleep promotion. Current treatment strategies for pain relief and sleep promotion including non-pharmacologic treatments must be tried before consideration of use of medical cannabis. Medical cannabis may provide symptom relief for some patients with rheumatic diseases. Short-term adverse events (including immediate psychomotor effects, dizziness, appetite changes, and effect on mood, and the rare serious side effects of disorientation and psychosis) are frequent with the use of medical cannabis and are likely to be similar to those reported for other disease populations. The longterm risks associated with medical cannabis use in patients with rheumatic diseases are unknown. Despite a patient’s understanding of the lack of any scientific evidence to support a benefit, and the increased risk of harm, some patients may prefer a trial of medical cannabis over other options, including opioids. Rheumatologists must endeavor to maintain an empathetic therapeutic relationship with their patients, avoid personal biases, and ensure harm reduction for both patients and society. There is an urgent need for further research regarding the effects of medical cannabis in rheumatic diseases.
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