Patients with osteoarthritis reported a reduction in pain associated with the disease when using medical cannabis, according to the results of a recently published study by British researchers. 

Osteoarthritis (OA) is a degenerative disease of the joints characterized by the wearing down of cartilage at the ends of bones. The condition is the most common form of arthritis, affecting more than 32.5 million adults in the United States, according to data from the Centers for Disease Control and Prevention. OA occurs most frequently in the hands, knees and hips, causing pain, swelling and stiffness. In extreme cases, OA can cause reduced function or disability, with patients unable to work or perform daily tasks.

Because there is no cure for OA, doctors treat the symptoms of the disease with various therapies, including over-the-counter medications and prescription drugs. Weight loss, increasing activity and physical therapy are also commonly employed therapies. In more severe cases, additional strategies including supportive devices such as canes or crutches can be used, as well as surgical options such as joint replacement.

In a study published last month in the peer-reviewed Journal of Pain & Palliative Care Pharmacotherapy, a team of British researchers notes that the pain associated with osteoarthritis can be disabling and affect quality of life because of “mood disturbance, interference with social relations, and diminished cognitive function.” However, the opioids and non-steroidal anti-inflammatory drugs (NSAIDs) commonly used to treat OA are not appropriate for long-term use because of potentially dangerous side effects. As a result, the use of medical cannabis treatments is attracting widespread interest among patients and healthcare professionals.

In a report on the study, the National Organization for the Reform of Marijuana Laws (NORML) explains that British medical specialists have been allowed to prescribe cannabis-based medicines to patients who have not responded to conventional medications. The researchers investigated the effectiveness of using cannabis-based medicinal products (CBMPs) including flower and oil extracts in a group of OA patients enrolled in the UK Medical Cannabis Registry.

Improvements Noted Through Duration of One-Year Study

The researchers assessed the change reported by participants using medical cannabis over one year. An analysis of the data revealed that patients reported symptom improvements at one month, three months, six months, and at one year, indicating a sustained improvement of symptoms throughout the study.

“Commencement of CBMP treatment was associated with reductions in pain-specific PROMs [patient-reported outcome measures] at all time points in patients with osteoarthritis,” the researchers wrote in the study.

The researchers documented few serious side effects or adverse events (AEs) associated with cannabis experienced by participants in the study. Most reported side effects were mild or moderate, with dry mouth, drowsiness and constipation being the most commonly reported.

“AEs were mainly mild or moderate in severity,”  researchers wrote. “Fatigue was the most common AE in this study.”

The authors noted several limitations of the research, including the lack of a placebo group to compare results. Additionally, the “study was subject to significant selection bias because patients received treatment from the same private clinic; hence, inclusion was limited to those who could afford treatment,” among other limitations.

Overall, the researchers found that medical cannabis treatments were an effective treatment for OA, with participants in the study reporting reduced pain and better health-related quality of life (HRQoL). Causality could not be established, however, leading the researchers to call for randomized clinical trials (RCTs) investigating the use of cannabis formulations for the treatment of OA.

“These results suggest an improvement in pain-related outcomes for patients with osteoarthritis following the initiation of CBMP treatment. Furthermore, there was an improvement in general HRQoL metrics across the follow-up period. CBMPs also appeared to be well-tolerated at 12-month follow-up,” the researchers wrote, adding, “Hence, this study supports the development of RCTs for CBMP use in osteoarthritis.”

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Researchers in Italy have found evidence that cannabis was used by residents of Milan hundreds of years ago by studying bones from a 17th-century cemetery. In a report on the research, the scientists surmise that weed was likely used recreationally, noting that hospital records from the time do not include cannabis in an inventory of medicinal plants used in Milan in the 1600s.

Medical records from the Middle Ages show that cannabis was used in Europe as an anesthetic and as a treatment for gout, urinary infections and other medical conditions. But in 1484, cannabis was banned in what is now Italy by a decree issued by Pope Innocent VIII. In it, the pope referred to cannabis as an “unholy sacrament” and banned the use of the herb by all Catholics. 

Marco Peruca, a former Italian senator and founder of Science for Democracy, led a referendum to legalize cannabis in Italy in 2021. He told reporters that the papal decree and other bans on cannabis throughout history have led to a stigma against the plant.

“This was a plant belonging to another culture and tradition that was intertwined with religion,” said Perduca, who says it traveled centuries ago to Italy from the eastern Mediterranean.

“So anything and everything that had to do with a non-purely Christian set of rules…was supposed to be linked with paganism and movements not only against the Church, but against the [Holy Roman] Empire.”

Definitive evidence of the use of cannabis in what is now Italy had not been found in the centuries that followed the papal ban. That changed, however, when researchers studied the femur bones from skeletons of people who lived in 1600s Milan. The remains had been buried in the Ca’ Granda Crypt, under a church annexed to the Ospedale Maggiore, the city’s most important hospital for the poor at the time, according to a report from the Canadian Broadcasting Corporation.

“We know that cannabis has been used in the past, but this is the first study ever to find traces of it in human bones,” said biologist and doctoral student Gaia Giordano at the University of Milan’s Laboratory of Forensic Anthropology and Odontology (LABANOF) and Laboratory of Toxicological Investigation. “This is an important finding, because there are very few laboratories that can examine bones to find traces of drugs.”

Study Investigates Historical Use of Recreational and Medicinal Plants

The research, which was published in the December issue of the peer-reviewed Journal of Archaeological Science, attempted to discover traces of plants used for medical or recreational purposes by residents of 17th-century Milan. The results of the research can help fill in the gaps in the historical records of plants used for medicinal or recreational purposes.

“Toxicological investigations on historical and archaeological remains are rare in literature but constitute a different and potent tool for reconstructing the past, and in particular for better understanding remedies and habits of past populations,” the researchers wrote in the introduction to the study. “Archeotoxicological analyses have been performed on hair samples collected from pre-Columbian Peruvian mummies revealing the presence of cocaine or nicotine.”

To conduct the research, scientists studied nine femur bones from the cemetery in Milan. Two of the bones, one from a woman in her 50s and another from a teenage boy, contained traces of the cannabinoids tetrahydrocannabinol (THC) and cannabidiol (CBD), direct evidence that the two people had used cannabis.

“The results obtained on bone samples showed the presence of two molecules, Delta-9-THC and CBD, highlighting the administration of cannabis,” the researchers wrote. “These results, to the best of our knowledge, constitute the first report on the detection of cannabis in historical and archaeological human osteological remains. Indeed, according to the literature, this plant has never been detected in ancient bone samples.”

The researchers note that the findings suggest that people of all ages and genders used cannabis at the time. An analysis of the medical records of the Ospedale Maggiore did not include cannabis among its records of healing plants used at the time, leading the researchers to conclude that cannabis was used recreationally. The researchers believe that cannabis may have been added to foods as a way to relax and escape the realities of the time.

“Life was especially tough in Milan in the 17th century,” archaeotoxicologist Domenico di Candia, who led the study, told the newspaper Corriere della Sera. “Famine, disease, poverty and almost nonexistent hygiene were widespread.”

Italy was a major producer of hemp for use in rope, textiles and paper for centuries. Peruca notes that the popularity of hemp in Italy throughout history makes it likely the plant was also used for its psychoactive effects.

“People used to smoke and make ‘decotta,’ or boiled water, with all kinds of leaves, so it is very difficult to identify what was the habit back then,” Peruca said. “But because hemp was used for so many industries, it’s possible that people knew those plants could also be smoked or drunk.”

This is not the first time the researchers have studied human remains to find evidence of historical drug use. In an earlier study, Giordano found traces of opium in cranial bones and well-preserved brain tissue.

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