每个人都有关节炎需要了解大麻
对于患有关节炎疼痛的人，医学大麻可以在没有传统治疗造成的副作用的情况下带来缓解。但它仍然无处不在。
“I actually don'tremember what it was like not to be in pain,” says Bridget Seritt, who has dealt with chronic illness since she was a small girl. “I have both types of arthritis—rheumatoid and osteoarthritis. I have Sjogren's syndrome. I have lupus, and I have Ehlers-Danlos syndrome, which is a genetic collagen disorder that affects all of my joints, ligaments, and tendons.”
When she lived in Georgia, her treatment centered on methotrexate, a drug used to slow down the progression of rheumatoid arthritis.
Unfortunately, Seritt experienced all three of the drug’s most common side effects—nausea, stomach upset, and fatigue—and, for a time, she used black-market cannabis to alleviate those symptoms. (Georgia didn’t have a medical-marijuana program at the time.) Seritt moved to Colorado in 2013, still taking “a handful of opiates and a whole bunch of prescription medications,” and quickly realized that, as a chronic-pain patient requiring high doses, the growing war on opioids might affect her options for relief sooner rather than later.
It didn’t take long: Her new pharmacy wasn’t always able to fill her full oxymorphone prescription on time. “I was consistently running out,” she says, which led to muscle spasms. Since cannabis was legal in Colorado, “I decided to see if it would help with pain and withdrawal. I smoked a couple of joints, but it didn’t do anything except help my insomnia.” That was good enough, and eventually she replaced smoking pot with making her own cannabis butter and topicals.
直到大约三个月后，Seritt注意到另一个变化：“我可以走得更好。我可以在更长的时间内活跃，我不需要恢复。“在2014年至2015年间，她从能够走到200英尺到徒步旅行。她积分医疗大麻。
Which States Allow Medical Marijuana for Arthritis?
If Seritt still lived in Georgia, she wouldn’t have achieved this level of relief without breaking the law. Currently, the state allows only cannabis oil with less than 5% THC—the chemical that causes most of pot’s psychoactive effects. In Colorado, however, some form of medical marijuana has beenlegal since 2000, and patients aren’t limited to low-THC oils. Instead, patients like Seritt have access to a seemingly endless variety of cannabis products with a wide range of potency, along with professional staff equipped to answer medical questions. Colorado also allows home cultivation of up to six plants per patient, so they can grow the specific strains they need to get results.
Though medical marijuana programs exist in 33 states and Washington, D.C., cannabis is still illegal in the eyes of the federal government. As a Schedule I drug according to the Controlled Substances Act (CSA), it’s considered a dangerous substance with "no currently accepted medical use." That means that doctors and patients complying with state laws still operate as federal outlaws, risking fines, arrest, even prison time.
Several bills in congress aim to erase cannabis from the CSA. Among them, Oregon Sen. Ron Wyden’s cleverly-titledS.420 Marijuana Revenue and Regulation Act;Hawaii Rep. Tulsi Gabbard’s March reintroduction of the 结束联邦大麻禁止法案;新泽西州.Cory Booker'sMarijuana Justice Act;和纽约森.charles schumer的Marijuana Freedom and Opportunity Act。Passing any of these bills would allow millions of Americans with arthritis to legally benefit from the plant’s therapeutic properties.
How Does Medical Marijuana Relieve Arthritis Pain?
Traditional arthritis treatments are rife with potentially dangerous side effects. Cases in point: Tylenol and non-steroidal anti-inflammatory drugs, or NSAIDs, can exacerbate liver and bleeding issues. Excessive doses of Tylenol can cause liver toxicity and high dose anti-inflammatory drugs, such as NSAIDs, can cause gastrointestinal bleeding and kidney problems.Disease-modifying anti-rheumatic drugs（DMARDS）和biologicscan interfere with the immune system's ability to fight infection. And, if those categories don’t work, patients are left with opioids, which can become habit-forming.
“If you put the opioids head-to-head with cannabis for mild to moderate pain, what we find is that they're about equal,” says Jordan Tishler, M.D., a Boston cannabis physician at Inhale MD, Harvard instructor of medicine, and president of the大麻专家协会。“在这种情况下，大麻可能同样有效，但这很安全。”
Scientific evidence confirming Dr. Tishler’s experience continues to grow, showing cannabis to be “remarkably helpful as a pain medication, interacting with receptors in multiple locations throughout the body,” he says. It also impacts pain processing in the spinal cord and brain. Preclinical data suggest that cannabinoidshave particular therapeutic potential for rheumatic diseases莱克阀门e rheumatoid arthritis and osteoarthritis (plus systemic sclerosis and fibromyalgia, too).
Here’s how it works: Cannabis contains dozens of cannabinoids, chemicals that interact with our body’s own endocannabinoid system, whichregulates inflammation and pain。THC is the most well-known (it’s what gets you high) and CBD is another. “The THC in cannabis is the primary pain reliever, so what I do as a doctor is find the smallest dose of the THC or cannabis that will do the job with the minimum side effects,” Dr. Tishler says. The most common side effect, unsurprisingly, is getting stoned. “All pain medications have side effects and cannabis is no different,” he says.
Like any other clinician, Dr. Tishler helps arthritis patients manage side effects through dosing, timing, and route of delivery. For example, forchronic pain, he might recommend an edible with 5 mg THC twice a day for long-lasting coverage, and a vaporizer for acute relief on an as-needed basis.
“One cannabinoid called THC-A—which is different from THC—is a better anti-inflammatory than THC or CBD,” he says. “When I treat somebody with an autoimmune disease like rheumatoid arthritis, I often try to add THC-A to the THC so that we're covering the underlying inflammation as well as deriving pain control.” Dr. Tishler supplements THC-A through an extract; Seritt gets her dose of THC-A and THC from a paste made from fresh plants that she grows herself.
Watch Our Interview with Dr. Tishler.
Why Do Medical Marijuana Programs Matter?
When it comes to CBD for arthritis, Dr. Tishler is unconvinced that the extract is particularly useful for pain at the available doses. (The most令人信服的研究到目前为止一直在啮齿动物中, not humans.)
“There's also the issue of how harmful hemp-derived CBD oils may be. Not because of the CBD, but because of whatever else might be in that bottle,” says Dr. Tishler, who cites traces of everything from pesticides and heavy metals to fentanyl, an anesthetic pharmaceutical.
The2018 Farm Bill loosened regulations通过从附表1药物列表中除去HEMP产品来衍生大麻衍生的CBD。美国食品和药物管理局（FDA）批准的只有一个CBD药物 -Epidiolex for severe epilepsy- 而FDA不调节补充剂，因此诈骗猖獗。宾夕法尼亚州医学最近的研究揭示了70％的跨国公司可用在线误标定了其CBD内容。这些正是Shenanigans医学大麻法律的类型是为了预防，为什么医疗计划很重要，即使对于具有法律休闲大麻的国家。
“医疗患者与娱乐大麻用户不同，”Tishler博士说。关节炎患者希望医学易于服用，精确地给药，并提供最不毒害的可靠结果。（不是一个娱乐用户对派对的想法。）
Having a medical system in place allows physicians to follow up on what patients are purchasing through the registry system. Medical dispensaries and dual-licensed shops are best equipped to answer patient questions about how to dose cannabis or what contraindications there might be.
“It’s completely inappropriate to have this type of advice coming out of the mouth of a budtender,” says Dr. Tishler.
医疗大麻计划还有其他优势。在像科罗拉多州的州，患者对大麻支付标准销售税，但不高的消费税或适用于休闲大麻销售的额外税收。Minors with qualifying conditions can also registeras medical marijuana patients, which isn’t addressed by the recreational model.
Advocating for Access
There are many reasons to keep an eye on upcoming cannabis bills, both federal and in your specific state. Even putting the overarching problem of federal prohibition aside, the state laws are a messy patchwork of contradicting rules. For example, cannabis is straight-up illegal—for any reason—in Idaho, Kansas, Nebraska, and South Dakota. There are33 states offering medical marijuana，但只有七个名称关节炎作为合格条件（阿肯色州，加利福尼亚州，康涅狄格州，夏威夷，伊利诺伊州，新墨西哥和纽约）。
有些国家通过让他们自行决定“其他医疗条件”来允许医生更多的余地。在某些州，甚至CBD油也是一个禁止的。在肯塔基州，只有参加临床试验或扩展访问计划的人员只允许拥有它;在密西西比州，只有具有衰弱的癫痫发作障碍的人才有资格。
The laws are constantly evolving. If access is important to you, contact your state legislators and congress members and let them know. There are dozens of pending marijuana bills and resolutions on the state and federal level right now. (Check out这个列表from NORML to see which ones affect you and the arthritis patients in your life. Then refresh your browser and do it again, as cannabis laws can rapidly change.)
Having a medical-marijuana program in place doesn’t necessarily guarantee unfettered access. Seritt, who makes her own cannabis medicine from homegrown plants, laments the passing ofHouse Bill 1220, which lowered the number of plants one residence could grow from 99 to a dozen, max. Her belief? “If your state program doesn’t allow access to fresh plants or cultivation, you don’t have real medical access.”
