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Opioids and Cannabinoids for Osteoarthritis: Either, Both, or Neither

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Abstract

Purpose of the review

Pain is a prevailing symptom in osteoarthritis (OA) and greatly impacts quality of life. Pain-relieving strategies over thousands of years have included opioids and cannabinoids but require critical evaluation of efficacy and risks in this twenty-first century. This review will examine the most up-to-date evidence for use of these two categories of drugs.

Recent findings

Contrary to the previous concept that opioids would be advantageous for OA, the emerging evidence for true efficacy and overwhelming risks strongly supports recommendation against use. In contrast, cannabinoids, especially in the form of herbal cannabis, have been aggressively touted by advocacy, the media, and industry as an ideal and potentially less harmful panacea for many medical conditions, including relief of pain. There is currently absence of any sound study for effect of cannabinoids in management of pain associated with OA.

Summary

In this era of uncertainty about cannabinoids, rheumatologists must exercise extreme caution in counseling patients and emphasize the potential but largely unknown risks for those with OA wishing to use cannabis. Therefore, at this time, opioids in particular, and likely also cannabinoids, should only be considered for the rare patient with severe OA where suffering is extreme and surgical options are unavailable or too high risk.

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Correspondence to Mary-Ann Fitzcharles MB, ChB, MRCP(UK), FRCP(C).

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Barbacki, A., Fitzcharles, M. Opioids and Cannabinoids for Osteoarthritis: Either, Both, or Neither. Curr Treat Options in Rheum 6, 29–44 (2020). https://doi.org/10.1007/s40674-020-00140-3

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Keywords

  • Osteoarthritis
  • Medicinal herbal cannabis
  • Opioids
  • Efficacy
  • Risks