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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The Department of Justice has rescinded a DEA decision to fire a special agent who was let go due to a positive reading for CBD on a drug test.

DEA special agent Anthony L. Armour will be re-hired as a special agent and be reimbursed for back pay and legal expenses after a years-long court battle that stretches back to 2019 when a routine drug test showed he had been using CBD, which Armour maintained in court was for the purpose of treating chronic pain in lieu of highly-addictive opioid based painkillers.

“I’m excited to be getting back to work at DEA,” Armour said to The New York Times. “I hope to finish my career at DEA by helping its mission in taking dangerous drugs like fentanyl off the streets.”

Armour’s battle with chronic pain goes back to an injury he sustained during his college football career. He was also injured on the job as a DEA agent in a car crash during a surveillance operation, after which he suffered from back pain and a sprained neck. He ordered CBD products and a vaporizer from the internet, under the impression that he was not taking any illegal risks as the 2018 Farm Bill federally legalized hemp products. 

“For Armour and many others in this country, this change meant new opportunities—particularly as to CBD, a non-THC cannabinoid in the cannabis plant,” a portion of the lawsuit said. “Armour hoped CBD oils could play a role in his pain management. That he did is unsurprising. From Martha Stewart to Wrigley Field, CBD has become embedded in American culture.”

After he failed the drug test, Agent Armour turned the CBD products he had ordered into his superiors. Under federal law, hemp-derived products are defined as such if they contain less than 0.3% THC (please follow these handy-dandy little hyperlinks if you want more information on the clusterfuck of loopholes the Farm Bill created with regard to hemp-derived cannabis products). Of the three different hemp-based products Agent Armour turned in, court documents showed that two of them tested within the 0.3% THC range but one of them tested above the allowed threshold at 0.35%, which could be due to the notoriously unreliable potencies of hemp products and the methods by which they are tested.

The DEA even went so far as to double down on their decision years into the lawsuit in late August of 2023. They filed a court brief defending Agent Armour’s termination just days before the Department of Health and Human Services officially recommended the federal rescheduling of cannabis from Schedule 1 to Schedule 3. The DEA also issued an official notice to all DEA employees after Armour’s termination to avoid all CBD products despite their federally legal status.

“Mr. Armour was an outstanding DEA agent when he took a chance in 2019. He believed it was unlikely that CBD products would cause him to test positive for marijuana, but he knew it was possible, and he bought those unregulated products on the internet and consumed them anyway,” the DEA brief said. “Mr. Armour argues that he ‘displayed negligence or poor decision-making,’ and DEA properly held him accountable for his poor decisions when they resulted in a verified positive drug test. DEA lost trust in Mr. Armour and properly removed him.”

Despite a years-long fight to keep Agent Armour off the payroll the DEA has agreed to reinstate him and pay him $470,000 in back pay and legal fees, according to the New York Times who obtained a copy of the court filings from earlier this month. Agent Armour told the New York Times he still sees value in using CBD for pain management but that he will consult a medical professional for viable alternatives upon his return to work. 

“Federal drug testing policies—and importantly, attitudes about drug testing—have not caught up with the times. I’m not the only career law enforcement officer in this country with chronic pain, nor am I the only law enforcement officer that has turned to legal cannabis products to address pain,” Agent Armour said in court testimony in September. “Nobody should have to choose between suffering pain and serving our country.”

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It’s no secret that cannabis can work as an alternative to other longstanding medicinal options as it pertains to curbing and treating pain and related symptoms. A number of studies have already confirmed the efficacy of cannabis and its compounds as it relates to pain management, though a new study suggests that patients believe it may be even more effective than conventional treatments.

A recent survey of German patients published in the journal Frontiers in Medicine explored experiences with cannabis products, with more than 200 anonymous participant perspectives. As with many previous studies, patients largely reported reductions in their daily pain after starting cannabis therapy along with other benefits. 

Notably, they reported “greater satisfaction” with cannabis, calling it “more effective” than their previous treatments.

Exploring German Prescription Cannabis for Pain

Researchers note that part of the intent behind the research is to explore “perspectives of patients whose experiences are not well enough known to date.” 

Using a web-based survey of prescription cannabinoid patients, conducted between May 31, 2021 and June 2022, researchers conducted the research anonymously “to reduce treatment provider influence and stigma.” Subjects were asked to complete questionnaires regarding their cannabis therapy twice in the same session, once for the time of the survey and another for the period prior to their cannabis treatment.

Participants were asked to rate their daily pain levels, along with questions around the details of the cannabinoid prescription process — namely any issues they ran into obtaining the medication — and their general attitudes around cannabis.

Chronic pain was the most common diagnosis, with 72% of participants indicating that pain relief was the primary reason for their prescriptions.

Germany is currently making waves in the global cannabis space for its pending legalization of recreational cannabis, though plant cannabis and cannabinoid treatments were legalized by prescription use in the country back in 2017. Cannabis medication is also typically only authorized when patients are unresponsive to traditional options.

Researchers also note a study finding that the most common reason for German cannabinoid prescriptions from 2017 to 2022 was for pain.

Patients Report MMJ Benefits for Pain Treatment and More, Despite Access Barriers

“The results of this cross-sectional study suggest that most of the surveyed outpatients treated with prescription cannabinoids in Germany subjectively experience health benefits and symptom reduction associated with these therapies,” researchers state in their discussion.

Across all diagnoses and symptom groups, authors report that participants shared positive effects on physical functioning, emotional states and quality of life. Additionally, they reported fewer problems around fulfilling their social roles and their pain symptoms were perceived to have a lesser impact on their daily lives. Satisfaction was rated by perceived effectiveness, side effects and overall satisfaction.

Researchers suggest that the stress-reducing effect of cannabis drugs could be a “significant mediating factor,” in that opioids may have “more ambivalent effects on stress regulation because the kappa opioid receptor signaling pathway is activated by stress stimuli that produce both aversion and dysphoria in humans and other animal species.”

Prior to cannabis therapy, participants generally had a neutral to slightly positive attitude toward cannabis, which shifted to “predominantly positive” during therapy. 

Most of the problems during the prescription process didn’t originate with physicians but rather with reimbursement issues involving health insurance providers. Approximately 25% of participants with statutory health insurance coverage reported that they opted to pay out of pocket.

“This is likely due to the current legal situation in Germany, where the prescription of cannabinoid medications is characterized by significant complexity and administrative hurdles, comparable to those encountered when prescribing off-label drugs, both for patients and practitioners,” researchers said.

‘Starting Points’ for Further Research

The study notes that comparable studies, in which German patients are directly questioned about cannabinoid therapy, are rare, with most surveys only questioning physicians. Those studies similarly found that pain was the main reason for cannabis prescriptions.

Standing apart from much of the current research in the region, researchers note risk of selection bias, in that patients may have been more willing to participate in the study due to successful treatments. They also note potential “expectation bias,” in that the high access barriers for cannabinoid therapies in Germany give many eligible patients high expectations, which could lead to a more favorable evaluation of such therapies, among other potential limitations.

“This observational study nevertheless provides starting points for further discussion in the context of planning clinical cannabinoid trials and formulating appropriate research questions, involving the patients’ perspectives,” researchers concluded.

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Former Pittsburgh Steeler Le’Veon Bell said in a recent podcast that he’d score touchdowns and win games—even if he smoked pot beforehand.

Bell, who is now a free agent, had short runs with the Kansas City Chiefs, Baltimore Ravens, and Tampa Bay Buccaneers after leaving the Pittsburgh Steelers—the place he truly calls home in his professional football career. CBS News reports that Bell spilled the details in a recent podcast about how often he’d smoke, even before the game.

During Bell’s run with the Steelers from 2013 to 2017, he chalked up 5,336 rushing yards, 2,660 receiving yards, and averaged 5.2 yards per touchdown. Bell also earned two All-Pro selections and had three 1,000-yard rushing seasons. In 2015 and 2016 he was voted as one of the NFL Top 100. He apparently rushed many of those touchdowns stoned.

On Episode 30 of the “Steel Here” podcast, Bell explained how he smoked pot before some of his best performances for the Steelers.

“Looking back, that’s what I did,” Bell said. “When I was playing football, I smoked. Even before the games, I’d smoke and I’d go out there and run for 150, two (touchdowns).”

In 2019, Bell signed a four-year, $52.5 million deal with the New York Jets, which didn’t last too long. Bell hasn’t played professional football since the 2021 season, but has no plans to retire from the league anytime soon. A contract dispute led to his departure with the Steelers, but he hopes to eventually retire with them.

“It literally was the guarantee. They weren’t budging off of it and I wasn’t budging off of it. I didn’t want to leave Pittsburgh,” Bell said. “At the end of the day, that’s where I was at. That’s where I got drafted at. Especially after going to different teams and seeing how it is, when a team has their guy, you’re their guy. I was Pittsburgh’s guy.”

In 2021, the National Football League (NFL) made significant changes to its guidelines, so now players are only required to drug test for cannabis just once at the beginning of training camp.

“I’m trying to retire with Pittsburgh,” Bell said. “But before I do that, I might be like, ‘Hey, let me get a couple carries in the preseason so I can show you all something.’”

The NFL and Pot Policy

The NFL is easing up on cannabis policies like most other major sport leagues. Last year, the NFL took another step forward by awarding funds to two cannabis research initiatives focused on the effectiveness of cannabis as a treatment for pain management.

The NFL is currently exploring cannabis-based medicine for the treatment of pain, given that the alternative is usually opioids. The NFL announced in a press release on February 1, 2022 that it would be presenting $1 million to two different researchers at the University of California, San Diego (UCSD) and University of Regina (UR), which is located in Canada. Both research groups will be focusing on how cannabinoids can aid in general pain management, with a few other goal studies as well.

The NFL-NFLPA Joint Pain Management Committee (PMC) called for research proposals in June 2021, asking for researchers to assist with PMC’s knowledge about pain management and athletic performance.” The committee received a total of 106 submissions, which was narrowed down to 10 finalists by the NFL Research and Innovation Committee. 

In the meantime, players are likely smoking. It mirrors what has been said about other major sports leagues such as the National Basketball Association (NBA). (Jay Williams estimated that 80% of NBA players smoke weed; Al Harrington guesses the number is a bit higher.)

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South Africa’s first ethically-approved cannabis clinical trials have begun in Johannesburg with the goal to determine if cannabis can replace opioids for pain management, according to a June 21 press release. More and more, cannabis shows potential for reducing or replacing opioids for certain types of pain management.

Biodata, subsidiary of Labat Africa, “is the brainchild of Dr. Shiksha Gallow, a cannabis clinician, and the principal investigator in the trials, which took over 18 months to get official clearance,” the announcement reads. Dr. Gallow is a South African pioneer in the field of international medical cannabis research.

Researchers will observe 1,000 participants who have been taking opioids for pain management for at least three months and are prepared to switch to cannabis as an alternative. Two chemovars currently being used are Tallyman and Exodus—sourced from Labat’s Sweetwaters Aquaponics SAHPRA-licensed facility in the Eastern Cape. Aquaponics is a cultivation technique believed to allow for more benefits. The third strain to be introduced shortly, 9 Pound Hammer, will be next—chosen because of its high THC and CBG profile, and being rich in beta caryophyllene and myrcene.

“We are currently recruiting patients, and data-capturing all the questionnaires and feedback from the patients for the live study,” Dr. Gallow said. “It has been fairly slow. However, more options have been introduced in the live study as suggested by the patients in the pilot study. The pilot results of the study were very promising, as it showed 98% of the patients have some sort of pain relief from the cannabis.”

Researchers were able to wean patients off their opioid treatment. Flower contained a high amount of THC, 15-25 mg THC, with 0.5 mg of CBD. The Oil (1:1 ratio) balanced formulation contained 15-20 mg THC/15-20 mg CBD. In the pilot group of patients under 55 years old, they preferred to smoke flower, while patients over 55 years old preferred the oil. Patients who smoked cannabis gained relief almost immediately, while the oil took time.

Dr. Peter Grinspoon is a medical cannabis specialist at Massachusetts General Hospital and an instructor at Harvard Medical School, as well as the son of psychiatrist and longtime cannabis advocate Lester Grinspoon. You can watch him discuss America’s opioid crisis on HarvardX or similar topics on TEDx.

“First of all, I think cannabis is really good for mild to moderate pain,” Dr. Grinspoon tells High Times. “I don’t think it works for severe pain. So I think it depends a little bit on what the patient’s conditions are and how severe their pain is, and it’s not just a question of being on cannabis and opiates or off cannabis and opiates. Together, they work very well. Synergistically, they co-work on some of the same receptors.”

Grinspoon added that people who resort to that alternative can achieve a better quality of life, and cannabis is generally safer than opiates. “But I think for other people they’ll probably achieve a dose reduction, which will also be a huge harm reduction [benefit]. So again, it’s not really binary, like off opiates or not off opiates.”

There’s evidence showing other people have reduced opioid use with the help of cannabis—which is what makes it incredibly stupid to test people on opiates for cannabis because it is probably helping them.

“There’s no reason for a pain specialist to view it as the enemy,” he said.

“We don’t really know how effective opiates are,” Dr. Grinspoon added, since there are people under withdrawal symptoms who have pain that’s hard to separate from chronic pain. But then again, there are people with severe pain like phantom limb pain who absolutely need opioids.

“It’s either opiates non-steroidals which, you know, like your Advil, your Motrin, and those aren’t safe either,” Dr. Grinspoon says.

“Those things are really dangerous, and can cause heart attacks, gastric ulcers, and a lot of kidney damage. So the question is like, what is the least harmful medication to use for chronic pain? There’s no free lunch. All medications have side effects, cannabis certainly have side effects, but I always ask myself, ‘what is the least dangerous thing to use and often?’”

Cannabis is definitely safer than opiates, he said, and he wonders if in some cases it’s safer than the non-steroidals.

In the meantime, research showing the true potential for cannabis in the field of pain management is growing. Dr. Gallow’s team of researchers in South Africa renewed this study for another year.

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They’re legal, and patients say they help with endometriosis, menstrual cramps, and more—so why don’t we have vaginal cannabis suppositories in Canada yet?

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