The use of medical cannabis to treat pain in patients with rheumatism still raises many questions. Doctors gathered at the Brazilian Congress of Rheumatology, held in Goiânia last weekend, to discuss the pros and cons of using this substance for medical purposes.
“Cannabis is a plant that has been used by humans for about 13 thousand years. From the flower we extract cannabidiol, which is the main product with medical indications,” explained rheumatologist Selma da Costa Silva Merenlender, member of the media committee of the Brazilian Society of Rheumatology. “When we talk about medical cannabis, The main product we are referring to is cannabidiol (CBD), which is not addictive. This dependence is linked to the psychoactive principles of another component of the plant, tetrahydrocannabinol (THC), which is mostly found in the leaves and stems, and which is found in marijuana. He added that it is important to separate the marijuana contained in the leaf from CBD, which is the medical cannabinoid found in the flower.
Doctors and scientists have suggested using cannabis to treat some diseases, including resistant epilepsy, which has more advanced studies and shown good results. “In Brazil, first approval [do uso da substância] “That was specifically to treat refractory epilepsy in children, but there is already scientific evidence – and it is growing – for the use of medical cannabis for various neurological, rheumatic and immunological indications, weight control, anxiety and depression.”
In the case of resistant epilepsy, the use of the substance contributed to reducing seizures in children.
Among rheumatic diseases, medical cannabis is prescribed to treat chronic pain syndromes such as fibromyalgia and to treat pain associated with rheumatoid arthritis, ankylosing spondylitis, and psoriasis. “What medical cannabis does, in addition to removing pain, is balance the body, returning the patient to a previous state of illness, meaning they become less sick. But the disease is not cured. In the case of osteoporosis, for example, it improves the patient’s pain and quality of life.
But the topic is controversial. Although it is increasingly common for patients who use medical cannabis to report an improvement in their quality of life, such as São Paulo State Rep. Eduardo Sublice, who takes the drug to treat the effects of Parkinson’s disease, there are few scientific studies on the results. And also about risks. This happens mainly in the case of pain treatment, said Dr. Alessandra de Souza Braz, professor of rheumatology at the Federal University of Paraíba and member of the Pain, Fibromyalgia and Other Soft Tissue Syndromes committee. “We need to value medical cannabis, but when we value it, we have to know that there are pros and cons. No one prescribes a drug in rheumatology without knowing what it is good or bad.
In Brazil, the use of medical cannabis is not free: it must be prescribed by a doctor. Until 2015, for example, the sale of any product containing cannabidiol, a substance derived from hemp, was banned in the country. Then the National Health Surveillance Agency (Anvisa) included cannabidiol in the list of controlled substances. This means that companies interested in producing or selling derivatives of the substance must be registered with Anvisa and patients must provide a prescription to purchase the product.
There are currently only three ways to obtain CBD: in pharmacies, through associations or by import. There is still no policy for free supply of CBD-based products through the Unified Health System (SUS). There are projects underway in the National Congress that seek to ensure access to SUS for patients who need these treatments.
Alessandra, a doctor at João Pessoa, usually receives many patients who are already using the substance. “For severe neuropathic pain, for which other medications have failed, there is actually data from the literature that is very important. [falando sobre o uso da cannabis medicinal]. In the case of fibromyalgia, which is a multidimensional disease, the patient does not just feel pain. He has difficulty sleeping, sleep changes, mood changes, and memory changes. Patients with fibromyalgia who use the substance often report improvements in quality of life, mood, and even libido. However, the evidence that the substance works to relieve pain is still weak. “I’m not against [o uso da cannabis]But I want to know the correct use, have a definitive indication, and also study the adverse effects of the drug.
According to the doctor, it is also necessary to clarify that the use of this medicine is not free for everyone. For children, adolescents, pregnant women and the elderly, medical cannabis may pose risks related to, for example, memory, cardiovascular problems and even those associated with breast milk. “I am not against cannabis. I am against unintended use even to avoid burning steps.”
For Alessandra, there is a lack of further studies on the effects of medical cannabis, especially those related to pain treatment and side effects. “How am I going to encourage the use of a drug that has only been studied for a short period without evaluating the long-term risks?” he asked.
“Normally, when a drug is prescribed, it goes through four stages of study: pre-clinical, that is, before it is implemented in humans to see if it is safe and effective; The clinical stage, in humans, is initially performed on a small number of patients to see if it is safe, and then on a large number of patients to see if it is effective and safe. Then it enters the fourth stage, which is what we call marketing. “What worries me is that there is a need for standardization: what is the dose, what is the milligram and what is the correct dose?”, said the doctor from Paraíba, in an interview with the Brazilian News Agency.
Teenager Yasmin, 13, has been diagnosed with lupus, rheumatoid arthritis and Crohn’s disease. Her mother, Silmara Marques Pereira de Sousa, told the Brazilian News Agency that she has been suffering from joint pain, nausea and pain throughout her body for about two years.
A month ago, based on medical advice, Yasmin began using medical cannabis as a supplement to her treatments. “I thought it was great. Using cannabis has actually led to a decrease in the use of corticosteroids. She was taking 40mg and now she’s taking 5mg. There were ups and downs, but with cannabis, my sleep has improved a lot and my pain has reduced dramatically,” Selmara added. “She still feels pain, but she lives a calmer life than before.”
Rheumatologist Salma confirmed that cannabis treatments are not prescribed for every type of disease, but they can help in the traditional treatment of many problems, including fibromyalgia. This means that the substance can complement treatment, as it works to alleviate some of the symptoms associated with the disease. “Like any drug, it is [cannabis] It has its implications and restrictions.”
“In the context of fibromyalgia, improving the quality of life, sleep pattern and mood disturbance is as important as the pain outcome. “These patients sometimes move the pain to a secondary stage when everything else improves,” said one of the doctors from Rio de Janeiro, who attended the panel discussion. On this topic at the Goiânia Conference, which recommended the use of medical cannabis as a treatment.
More controversially, medical cannabis is still not widely available in Brazil, mainly due to the high cost of the substance. “In treatment [da Yasmim]“It is valid for three months, and it is about R$400 to R$700,” he informed Silmara, who hopes the cannabis will reach the United States.
According to Salma, what increases the price of the drug is preventing its cultivation in the country. “The access problem is linked to the price. The price is linked to the fact that the cultivation of cannabis is prohibited in Brazil, whether for recreational use, which is prohibited, or for medical use. It is necessary to import all the oil and dilute it here in Brazil. Of course this will be expensive. This is a limiting factor. Today, basic treatment costs, With the minimum dose of CBD, 200 or 300 R$ per month.
As a result, Alessandra states that only people with high incomes can access this drug. Therefore, the doctor stated that cannabis needs to be well studied and then regulated to improve access to the drug for the entire population.
*The reporter traveled at the invitation of the Brazilian Society of Rheumatology
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