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Research ArticleArticle

Position Statement: A Pragmatic Approach for Medical Cannabis and Patients with Rheumatic Diseases

Mary-Ann Fitzcharles, Omid Zahedi Niaki, Winfried Hauser, Glen Hazlewood and the Canadian Rheumatology Association
The Journal of Rheumatology January 2019, jrheum.181120; DOI: https://doi.org/10.3899/jrheum.181120
Mary-Ann Fitzcharles
From the Alan Edwards Pain Management Unit, and the Division of Rheumatology, McGill University Health Centre, Montreal, Quebec; Division of Rheumatology, University of Alberta, Calgary, Alberta, Canada; Department Internal Medicine I, Klinikum Saarbrücken, Saarbrücken; Department of Psychosomatic Medicine and Psychotherapy, Technische Universität München, Munich, Germany. M.A. Fitzcharles, MB ChB, Alan Edwards Pain Management Unit, and Division of Rheumatology, McGill University Health Centre; O. Zahedi Niaki, MD, Division of Rheumatology, McGill University Health Centre; W. Hauser, Dr. med., Department Internal Medicine I, Klinikum Saarbrücken, and Department of Psychosomatic Medicine and Psychotherapy, Technische Universität München; G. Hazlewood, MD, Division of Rheumatology, University of Alberta. Address correspondence to Dr. M.A. Fitzcharles, Montreal General Hospital, McGill University Health Centre, 1650 Cedar Ave., Montreal, Quebec H3G 1A4, Canada. E-mail: mary-ann.fitzcharles@muhc.mcgill.ca. Accepted for publication November 27, 2018.
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Omid Zahedi Niaki
From the Alan Edwards Pain Management Unit, and the Division of Rheumatology, McGill University Health Centre, Montreal, Quebec; Division of Rheumatology, University of Alberta, Calgary, Alberta, Canada; Department Internal Medicine I, Klinikum Saarbrücken, Saarbrücken; Department of Psychosomatic Medicine and Psychotherapy, Technische Universität München, Munich, Germany. M.A. Fitzcharles, MB ChB, Alan Edwards Pain Management Unit, and Division of Rheumatology, McGill University Health Centre; O. Zahedi Niaki, MD, Division of Rheumatology, McGill University Health Centre; W. Hauser, Dr. med., Department Internal Medicine I, Klinikum Saarbrücken, and Department of Psychosomatic Medicine and Psychotherapy, Technische Universität München; G. Hazlewood, MD, Division of Rheumatology, University of Alberta. Address correspondence to Dr. M.A. Fitzcharles, Montreal General Hospital, McGill University Health Centre, 1650 Cedar Ave., Montreal, Quebec H3G 1A4, Canada. E-mail: mary-ann.fitzcharles@muhc.mcgill.ca. Accepted for publication November 27, 2018.
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Winfried Hauser
From the Alan Edwards Pain Management Unit, and the Division of Rheumatology, McGill University Health Centre, Montreal, Quebec; Division of Rheumatology, University of Alberta, Calgary, Alberta, Canada; Department Internal Medicine I, Klinikum Saarbrücken, Saarbrücken; Department of Psychosomatic Medicine and Psychotherapy, Technische Universität München, Munich, Germany. M.A. Fitzcharles, MB ChB, Alan Edwards Pain Management Unit, and Division of Rheumatology, McGill University Health Centre; O. Zahedi Niaki, MD, Division of Rheumatology, McGill University Health Centre; W. Hauser, Dr. med., Department Internal Medicine I, Klinikum Saarbrücken, and Department of Psychosomatic Medicine and Psychotherapy, Technische Universität München; G. Hazlewood, MD, Division of Rheumatology, University of Alberta. Address correspondence to Dr. M.A. Fitzcharles, Montreal General Hospital, McGill University Health Centre, 1650 Cedar Ave., Montreal, Quebec H3G 1A4, Canada. E-mail: mary-ann.fitzcharles@muhc.mcgill.ca. Accepted for publication November 27, 2018.
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Glen Hazlewood
From the Alan Edwards Pain Management Unit, and the Division of Rheumatology, McGill University Health Centre, Montreal, Quebec; Division of Rheumatology, University of Alberta, Calgary, Alberta, Canada; Department Internal Medicine I, Klinikum Saarbrücken, Saarbrücken; Department of Psychosomatic Medicine and Psychotherapy, Technische Universität München, Munich, Germany. M.A. Fitzcharles, MB ChB, Alan Edwards Pain Management Unit, and Division of Rheumatology, McGill University Health Centre; O. Zahedi Niaki, MD, Division of Rheumatology, McGill University Health Centre; W. Hauser, Dr. med., Department Internal Medicine I, Klinikum Saarbrücken, and Department of Psychosomatic Medicine and Psychotherapy, Technische Universität München; G. Hazlewood, MD, Division of Rheumatology, University of Alberta. Address correspondence to Dr. M.A. Fitzcharles, Montreal General Hospital, McGill University Health Centre, 1650 Cedar Ave., Montreal, Quebec H3G 1A4, Canada. E-mail: mary-ann.fitzcharles@muhc.mcgill.ca. Accepted for publication November 27, 2018.
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From the Alan Edwards Pain Management Unit, and the Division of Rheumatology, McGill University Health Centre, Montreal, Quebec; Division of Rheumatology, University of Alberta, Calgary, Alberta, Canada; Department Internal Medicine I, Klinikum Saarbrücken, Saarbrücken; Department of Psychosomatic Medicine and Psychotherapy, Technische Universität München, Munich, Germany. M.A. Fitzcharles, MB ChB, Alan Edwards Pain Management Unit, and Division of Rheumatology, McGill University Health Centre; O. Zahedi Niaki, MD, Division of Rheumatology, McGill University Health Centre; W. Hauser, Dr. med., Department Internal Medicine I, Klinikum Saarbrücken, and Department of Psychosomatic Medicine and Psychotherapy, Technische Universität München; G. Hazlewood, MD, Division of Rheumatology, University of Alberta. Address correspondence to Dr. M.A. Fitzcharles, Montreal General Hospital, McGill University Health Centre, 1650 Cedar Ave., Montreal, Quebec H3G 1A4, Canada. E-mail: mary-ann.fitzcharles@muhc.mcgill.ca. Accepted for publication November 27, 2018.
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Abstract

Objective Pain is one reason some rheumatology patients may consider use of medical cannabis, a product increasingly perceived as a safe and neglected natural treatment option for many conditions. Legalization of recreational cannabis in Canada will promote access to cannabis. Physicians must therefore provide patients with the best evidence-based information regarding the medicinal effects and harm of cannabis.

Methods The Canadian Rheumatology Association (CRA) mandated the development of a position statement for medical cannabis and the rheumatology patient. The current literature regarding the effects of medical cannabis for rheumatology patients was assessed, and a pragmatic position statement to facilitate patient care was developed by the Therapeutics Committee of the CRA and approved by the CRA board.

Results There are no clinical trials of medical cannabis in rheumatology patients. Evidence is insufficient about the benefit of pharmaceutical cannabinoids in fibromyalgia, osteoarthritis, rheumatoid arthritis, and back pain, but there is evidence of a high risk of harm. Extrapolating from other conditions, medical cannabis may provide some symptom relief for some patients. Short-term risks of psychomotor effects can be anticipated, but longterm risks have not been determined and are of concern.

Conclusion Despite lack of evidence for use of medical cannabis in rheumatology patients, we acknowledge the need to provide empathetic and pragmatic guidance for patient care. This position statement aims to facilitate the dialogue between patients and healthcare professionals in a mutually respectful manner to ensure harm reduction for patients and society.

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Position Statement: A Pragmatic Approach for Medical Cannabis and Patients with Rheumatic Diseases
Mary-Ann Fitzcharles, Omid Zahedi Niaki, Winfried Hauser, Glen Hazlewood, the Canadian Rheumatology Association
The Journal of Rheumatology Jan 2019, jrheum.181120; DOI: 10.3899/jrheum.181120

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Position Statement: A Pragmatic Approach for Medical Cannabis and Patients with Rheumatic Diseases
Mary-Ann Fitzcharles, Omid Zahedi Niaki, Winfried Hauser, Glen Hazlewood, the Canadian Rheumatology Association
The Journal of Rheumatology Jan 2019, jrheum.181120; DOI: 10.3899/jrheum.181120
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