Medical cannabis and arthritis: What the research shows | Arthritis Talks

Added: 2026-05-31

[00:00:08]Hello everyone and thank you for joining arthritis talks medical cannabis and arthritis what research shows. I'm Dr. Sha Beavenon chief science officer at Arthritis Society Canada. I know that we've all come together here for this event from many places coast to coast. I am coming from Toronto which is the traditional territories of Missaga of the Credit First Nation, Anesnabek, Hiron Wenda and Hodnosoni indigenous peoples. I just want to take a moment to acknowledge that this is a meeting place and home to many First Nations, Inuit and Mate people.

[00:00:41]So medical cannabis is one of the most talked about topics in arthritis care today. Yet we know the science behind it is often misunderstood.

[00:00:50]People are curious about things like how medical cannabis interacts in the body, what the research actually supports, and what still needs to be studied. These are all questions that we are going to explore tonight. And we are really delighted to welcome back Dr. Jason McDougall from Dalhousy University, whose research into pain management, including medical cannabis, is really helping to answer these questions.

[00:01:14]as a reminder because we are discussing medical cannabis this evening. This webinar is really intended to those over the age of majority in their province.

[00:01:24]So before we get started, I want to first thank our event partners including our exclusive event presenting partner my many.ca for their support of tonight's webinar. Following the session, you will have the opportunity to join a virtual information booth where Dr. Dr. Hernand Aosta and pharmacist Michelle Tran from mymedi.ca will be available to answer more questions that we may not be able to get to tonight. You can access the poop booth by visiting arthritis.ca/booth.

[00:01:53]We'll also show that at the end of the webinar.

[00:01:56]Okay, so before we get started, a few logistics. First, this webinar is best viewed on a laptop or desktop computer.

[00:02:03]If you have any technical difficulties, just email arthritis [email protected] for help. If you have a question for our presenter, you can submit it through the Q&A button at the bottom middle of the screen. And we'll get to as many of those questions as that we can tonight.

[00:02:18]You can also click on the chat icon in the bottom middle of the screen to access the chat and connect to other participants as well as our chat moderator. If you find that distracting and you want to close out of the chat, just click the X icon to exit the window. To enable closed captioning, please click on the show captioning icon in your controls toolbar at the bottom of the screen.

[00:02:40]Okay, with that, we know that many questions that we received in advance followed similar themes. So, we'll get to those first before going to a live Q&A at the end of the session. So, with that, it is really my pleasure to welcome back Dr. Jason McDougall who is joining us from Halifax.

[00:02:55]So, Jason, welcome. Um, maybe you could first start just by explaining why is arthritis so complicated.

[00:03:03]Yes, thanks very much Sean and uh thank you to the Arthritis Society for the invitation to talk uh this evening. So yes, um cannabis and uh or treating any uh disease is is is complicated. Um particularly with arthritis, um there are a whole slew of potential drug therapies that are available for the over 100 different types of arthritis and they each have their own ability uh to reduce uh things like pain. Uh so their effectiveness can be different between the different drugs and each drug also uh comes along with its own side effects. So we're we're confronted with a whole slew of of different treatments uh to the extent that you know choosing the right treatment can sometimes be more painful than the actual pain itself.

[00:03:55]So why is arthritis so complex?

[00:03:59]Well, there are a lot of different factors that um are associated with arthritis. Um, of course, as I said, there's uh over 100 different types of arthritis.

[00:04:10]And some of the uh factors that can predispose us to uh the disease include things like age, although arthritis can strike down at any any age group. Uh it gets progressively more likely that we would suffer from uh some form of arthritis as we get older. And there are many different reasons that uh that can contribute uh to to arthritis uh such as uh obesity. Um changes in the biomechanics. So the shape of your joint can can dictate whether you're going to develop uh arthritis or not. Uh various different genetic components.

[00:04:50]And then there's uh a lot of sex differences. So males and females certainly uh have different uh responses to drugs. uh they have uh different contributing factors to their pain and their arthritis and then there are whole as I showed before a whole gamut of different drugs that are used to treat arthritis from the NSAIDs to the different biologics etc. So you can see it's it's an extremely uh complicated and which makes it interesting area to uh to try and study.

[00:05:23]>> Okay, thank you for that uh Dr. McDougall. Um what about how do people typically experience arthritis pain?

[00:05:31]>> Great. And thanks Sean. So yeah, arthritis pain so pain in itself is there's just not one type of pain. There are many different subtypes of pain. Um so if we think about arthritis uh there could be something called no susceptive pain. This is a very um immediate type of pain. Uh so when you're walking and you may have bone rubbing against bone that uh produces a kind of a grinding sort of pain and that's usually due to damage to the tissues within the joint or maybe altered biomechanics to those uh joints that give it this no susceptive grinding sort of pain.

[00:06:12]There's also inflammatory type of pain.

[00:06:15]So the accumulation of different uh chemicals within the joint which can sensitize those uh those nerves and this would lead to sort of a throbbing maybe burning type of of pain associated with arthritis.

[00:06:30]And then finally there's neuropathic pain. This is where there's damage to the nerves that are within our joint uh are actually injured in in some way um through either through a disease process or following some sort of trauma. And this nerve damage can give rise to a very specific sort of stabbing pins and needle sort of pain.

[00:06:52]So people living with arthritis could have one of these types of pain or two or three all three um or a combination of of of them all. So it's uh it's it's not pain is not just one thing there are many different types of pain which again adds to the complexity of trying to to treat uh these uh diseases.

[00:07:15]So, how is uh pain communicated from uh from our nerve cells up through our spinal cord and up up to the brain? What what's the communication process? What's the the pathway uh from from our joint to our brain?

[00:07:30]Well, there are um specialized nerves that are uh present within our joints.

[00:07:35]They're called noceptors. These are the nerves that are exquisitly sensitive to signaling pain responses. In actual fact, about 80% of the nerves in our joints are sensitive to pain. And so when these nerves get activated, they send impulses um along along the nerve fibers up towards the spinal cord. And then from the spinal cord, it'll move up towards your brain and activate various different regions of the brain that give you that that ouch response, the the pain response. There also other regions of the brain that give uh the effective or emotional component of pain and also activation of regions of the brain that uh are responsible for memory. So we remember um that the pains that that we have.

[00:08:24]But it's not a one-way street. Um the the pain pathway from from your joint up through your spinal cord to your brain, it's not a it's not a one-way street.

[00:08:33]They're actually impulses that are generated within your brain that uh are transmitted down to the spinal cord and these impulses can actually either amplify the pain or some impulses can actually dampen down the pain. So to think of it a little more um simplistically um if you think of your joint as as the transmitter sending the signals up towards your brain um the spinal cord is like a volume control system that can turn up the pain or turn down the pain.

[00:09:06]And we have these uh descending uh pathways coming from your brain to the spinal cord that are responsible for that volume control. And ultimately it's it's our brain and the different regions of our brain that will interpret these uh electrical signals from the nerves as as as the uh the pain uh response.

[00:09:29]And what we can do experimentally is we can actually listen in to those uh those nerve impulses and uh try and modulate how those nerve impulses are being transmitted. And we can do that through various different administration of various different drugs to try and dampen down those those pain signals.

[00:09:51]Okay. So let's move on to to cannabis.

[00:09:54]Um cannabis is a is a an extremely interesting uh plant uh very complicated very complex plant. Um there are main three main species of cannabis. Cannabis sativa, cannabis indica and cannabis ruderalis.

[00:10:10]And you could almost think of it as as like uh different types of wine. Uh there if you think of like a Merllo grape or a Svenon Blanc grape, they can all have different flavors associated with them. And that's the same with the the different strains of of cannabis. So cannabis sativa can have different components to it that will give very specific uh responses.

[00:10:36]As I said, the the cannabis plant is extremely difficult. There are over 500 different chemical entities that are are found within cannabis. These include the the canabonoids that we'll talk a little bit about today. But there also various different things like turpenoids and flavoronoids that give specific smells or odor uh and flavors to to cannabis.

[00:10:59]And we're finding out that these additional uh other compounds, the non-inabonoids, can also influence uh pain uh responses.

[00:11:09]If we focus just in on the canabonoids, there are over 120 different canabonoids that have been identified to date. And the two classic ones that we mainly talk about are delta 9 tetrahydroinabonol or THC and canabidol or CBD.

[00:11:27]And these canabonoids are found in the oils secreted by the the flowers of the of the cannabis plant, particularly in the in the female plants. And the interesting thing about cannabis is that the the chemicals that are present within the cannabis plant can only become biologically active in our bodies when when they're heated. So that's why uh cannabis is tends to be has to be vaporized either through smoking or through a vaporization process. or heated some way. When we're making things like various different butters or or or the or the cookies or whatever that contain cannabis, there has to be some heat involved to transform the chemicals into into the active components.

[00:12:12]So, let's look at the different ways that cannabis can be administered. So, um most commonly uh thought of is that cannabis is smoked or it's vaporized.

[00:12:24]And there are various different advantages and disadvantages of the modes of administration of cannabis.

[00:12:31]With respect to smoked or vaporization, uh the advantage is that there's a really rapid onset of an effect. You know, usually within it within a few minutes, uh you can feel the the effects of of the cannabis.

[00:12:45]It tends to be quite easy to dose. um patients would maybe need maybe one, two puffs, half a joint, something like that, uh before going to bed, for example, to help alleviate their pain.

[00:12:57]So, it's a it's a it's an easy way to to try and tighter or or dose the administration of the cannabis.

[00:13:05]Now, there are a lot of disadvantages of course from smoking and vaporization.

[00:13:09]Um, of course, smoking is not the safest mode of administering any drug. It'll cause irritation to your lungs and your tracheal and your whole respiratory system can be irritated by by um this aerosol intake of of cannabis.

[00:13:25]It's of course not appropriate for all all patients and there are various different solvents in the vaporizers and other hydrocarbons within the cannabis plant that could contribute in in a disadvantageous way. And if uh you're rolling joints for example, obviously a certain degree of dexterity is is required for that.

[00:13:49]Next, if we think about ingesting the the cannabis. So this is where we have our oils and the various different butters and the cookies and the brownies. Um the advantage of ingesting cannabis is that it's very convenient.

[00:14:02]Uh you don't have the the odors of of of smoking cannabis. Uh so ingestion is obviously very orderless and it can be quite a discreet way of administering uh your canabonoids.

[00:14:15]The main disadvantages of ingesting cannabis is that it becomes a little bit more difficult to dose. And one of the reasons for that is that it's it's got a slow absorption process. It has to get through your stomach and into your system. And so people may mistakenly ingest a little bit of cannabis, think, well, this isn't working. They take another bite of the cookie or they take a few more drops of oil and it keeps building up and then you're in a in a state that you may not necessarily wanted to be in in the first place.

[00:14:48]And of course with all these preparations like butters and the cookies, etc., you know, it requires a certain degree of prep pre-preparation.

[00:14:57]Then let's move on to the uh the topicals. uh the topicals where we can apply it to the uh surface of the skin.

[00:15:04]Um again, easy to use. Um there tends to be a lot less systemic side effects or whole body effects uh when you when you apply the cannabis uh topically to to to the skin. And it it's very convenient that you can apply the cannabis directly to the area that's being affected. So if it's your knee joint, you can rub it on your knee joint. If it's your finger joints, you can rub it on your finger joints.

[00:15:31]The disadvantages though is that the duration and the onset of when this is actually going to work can be quite variable. And one of the reasons that is is that um these canabonoids um they they don't dissolve well in in in water.

[00:15:48]Um they're what are called lipophilic.

[00:15:50]They like to be in the fats and so it takes a long time for these canabonoids to penetrate the tissues and things like for for hipuh arthritis for example which is a deep uh more deep uh joint.

[00:16:04]It may take a longer period of time for these canabonoids to actually penetrate to the where where they need to have their effect.

[00:16:11]And of course it's not ideal for whole body pain. You wouldn't be able to slap uh topical cannabis all all over your body. So there are certain advantages and disadvantages for all of these uh modes of administration. And then finally there are a number of different oral sprays. Um so these are um usually a combination of uh THC and CBD um which can be uh sprayed sublingually so under the tongue. And the advantages of these oral sprays is that again they can have their desired effect quite rapidly.

[00:16:46]They're very convenient. You just carry around a small little uh spray bottle.

[00:16:53]Once again, we don't have the the smells associated with with smoking cannabis.

[00:16:57]So, it's odless and it can be quite a discreet way of administering uh your your canabonoid.

[00:17:05]The main disadvantages of these oil sprays is that it can tend to dry out the mouth and and they tend to have a fairly unpleasant taste associated with them.

[00:17:16]Well, thank you for that explanation, Jason. So, based on what you've just shared, what does the research say in terms of medical cannabis actually preventing pain and joint damage?

[00:17:29]>> Yeah. Um, so if we we look at some of the the biology of of canabonoids, uh, you know, there are three different classes of canabonoids. So the first one are the uh the phytoinabonoids that we're probably most familiar with and these are derived actually from the cannabis plant itself.

[00:17:49]There are then uh humanmade uh canabonoids. So these are made in the lab. They're synthetic. So we know the structures the chemical structures of what's in the plant and they can be tinkered with to make these synthetic canabonoids.

[00:18:02]And then our body produces their own type of cannabis so-called endockinabonoids.

[00:18:09]um very similar to the endorphins that that that we're familiar with which are the op endogenous opioids. So our body produces their own type of uh canabonoids.

[00:18:20]There are two uh main uh canabonoid receptors. So there's a CB-1 and CB-1 is primarily located on on our nerves and that could be nerves in your brain, nerves in the spinal cord or nerves right right throughout our body including our joints.

[00:18:38]And then there also CB2 receptors and CB2 receptors typically are more associated with the immune cells in our body. So indicating that the canabonoids could be involved in having regulation of inflammatory processes.

[00:18:56]So if we think about uh the sensation of of of pain as I mentioned as shown here, you know, there are nerve impulses traveling up our body from from our joints up through our spinal cord to our brain and also those descending modulatory processes which can tune up or tune down the the pain impulses.

[00:19:17]And what we uh can do experimentally and what we do in my lab is uh we can uh make recordings uh electrical recordings. So we can actually focus in and zoom in on those electrical impulses that are traveling uh through through the nerves.

[00:19:35]And during pain these the number of impulses that the way that nerve is is firing is is is increased. And what we try to do is we can administer various different uh canabonoids locally to the joint to try and reduce the number of those nerve impulses traveling up the uh up the pain pathway.

[00:19:58]So I just want to show you some uh some data that we collected um a number of years ago uh where we looked at canabidol. We have looked at other canabonoids and we've looked at some of the tarpen as well, but I thought I'd just focus today on uh on CBD.

[00:20:14]So, what I'm showing here is um is movement of the of a joint. This is done in um an anesthetized animals and we um rotate and move that joint for about 5 seconds. And then you can see in the in the top trace here those electrical impulses and those electrical impulses would be transmitted up to the brain and interpreted as pain.

[00:20:37]Now when we locally administered just to the joint uh CBD canabidial those the firing of those pain sensing nerves was dramatically reduced. So it tells us that the that the pain signals are not as abundant when uh traveling along the uh the pain pathway. So we were able to locally block the uh the pain signals using uh CBD.

[00:21:04]So it can reduce that uh joint nerve activity. So locally within the joints we were also the the first to show um that it can repair damage to the nerve.

[00:21:16]So if you recall at the beginning I mentioned this neuropathic pain uh which is a pain associated with damage to the nervous system. And what I'm I'm showing in these traces these are electron microraphs. So high magnification of nerve bundles uh supplying our our joints and you can I could point out in in in the osteoarthritis group on the on the left the um the coating of the joint is is reduced. It's it's very very thin and there are instances here in in this image of of nerves that have actually showing quite uh severe damage to them indicating that there's a neuropathic component in this in this osteoarthritis model. However, when we treated the animals with CBD that that coating of the of the nerve which is very important to protect the nerve um is is is maintained. it's increased and the number of those damaged nerve fibers was also dramatically redu reduced by the uh CBD treatment. So we were able to find that uh treating arthritic joints with canabido canabadial can actually repair the nerves and thereby reduce neuropathic types of pain.

[00:22:35]Um, canabadol can also um reduce uh uh joint inflammation. And what I'm going to show you here is um a a short little video of of a blood vessel that we look down a microscope and we look at the blood vessels in in the knee joint. And you'll see lots of little white dots.

[00:22:54]And all those little white dots are um are white blood cells.

[00:22:59]And uh if I'll just start the video. So this is an osteoarthritic knee and this is the control situation. So here's the blood vessel and all these little white dots or white blood cells and you can see that they're sticking to the surface of the of the blood vessel. in pro-inflammatory. But then when we treated the the joints with canabidial, you can see the blood is flowing a lot more freely and you get less of the the sticking of these uh of these white blood cells to the intimal surface of the of the blood vessel.

[00:23:34]So that indicated that canabidial was having an anti-inflammatory effect.

[00:23:40]Finally, uh, other people have have looked at the role of canabidial and what it actually does to the to the structures of the joint. And so this is a a study that was done over 25 years ago now where this was done in mice and mice with rheumatoid arthritis and they gave uh canabidial daily for 10 days orally and they found that the the damage that was done to the joint was actually being reversed by the canabidial treatment. So there's certainly um a lot of scientific evidence to show that canabadial and it's been shown for some of the other canabonoids uh can reduce pain. It can reduce nerve damage. It can have anti-inflammatory effects and in in a few instances we able to see a reversal of some of the damage that arthritis has done to the joint.

[00:24:36]>> That was really interesting Jason. need to see the cannibidials working in real time there. Um, so based on what we know, what are the key areas of research from your point of view that we really need to understand better when it comes to medical cannabis and for people living with arthritis?

[00:24:53]>> Yeah, this is where it gets a little bit more uh confusing when we move to the to the clinical trials um involving cannabis.

[00:25:01]So if I just focus in on canabidadial again, you know, just scanning the literature and looking at some of the clinical trials, the doses that I use are are a huge range, anything from 20 mg to 600 mg per day. So a huge range of canabidial has been has been tested.

[00:25:21]Um different studies have looked at different modes of administration. So the things that I talked about before, the inhalation of canabonoids, ingestion, oral, topicals, um there's various different mixtures of of THC with uh with with uh CBD, sometimes in a 1:1 ratio, a 1:2 ratio.

[00:25:42]It tends to be quite all over the place.

[00:25:46]And then when you look at the the effects of these medical cannabis on on pain, some studies say it has a very small effect. Some studies say that it has no effect and other studies says it has a huge effect on on an individual's pain.

[00:26:02]Um, when we look at the function of of our joints, how how they're able to move, there's maybe some improvement.

[00:26:10]Uh, certainly sleep seems to be uh hugely improved with in these clinical trials. It seems to be um classically shown across most of them that there was an improvement in an individual's ability to sleep at night, which is huge. And then as far as quality of life, again there's seems to be uh some sort of improvement. So there's quite a lot of confusion over the over the clinical trials thus far. So So why is that?

[00:26:38]Well, first of all, there's really quite a limited number of studies. Um, if you compare it to things like uh cancer research or or diabetes or or uh clinical trials looking at hypertension, you know, when you look at pain and arthritis and cannabis, they're really very h only a relatively handful number of of studies that have have looked at this.

[00:27:03]when you again the number of patients who are involved in these studies tends to be relatively small and quite often there's no positive comparator. So when you're doing a clinical trial you always want to um compare it to your to your competitor and and a lot of the clinical trials they don't compare it to things like an NSAID you know non-steroidal anti-inflammatory to see to see if it's better or worse. uh so sometimes that's quite often missing as I said at the beginning that you know there's not one type of pain there are many different types of pain and an individual may have different uh mixtures of the of those types of pain however with a lot of the the clinical studies into cannabis you know they they've just bundled everybody together and maybe we need to tease out and look at individuals who have a certain type of pain or combination of pains that cannabis may be more effective for for them.

[00:28:02]It's of course very difficult to uh blind a patient especially if there's any sort of psychoactive canabonoid on board. Um so blinding is always an important component of of clinical studies and when it comes to to cannabis uh research uh blinding an individual as to whether they're getting a placebo versus the canabonoid can be quite uh complex.

[00:28:25]And then there seems to be very little anyway standardization of the of the constituents of of the can cannabis compounds that have that have been delivered in in some of the clinical studies. So, for example, you know, they they forget about the tarpen or the flavoronoids or other canabonoids that aren't THC and CBD because those are the two that we seem to focus on. And we forget about all the other compounds that are associated with cannabis that could each individually be having an effect, but also could be interacting with each other to either make it a bigger effect or or a smaller effect.

[00:29:01]and and uh I think there needs to be better standardization of of looking at these different components which you can imagine is is a huge undertaking.

[00:29:12]>> Okay. So Jason given your experience as a as a researcher I think our audience would probably love to hear a little bit about what other promising treatments you see on the horizon for people with arthritis.

[00:29:25]>> Yeah. So, one of the things that we've been looking at recently, it's one of those uh seems on the surface a bit of a mad idea, was uh looking at ways could could we induce the our own body's uh canabonoid system that doesn't involve uh taking drugs. So, a non-farmacological approach. We know that things like exercise is going to improve increase our endorphins, but it also increases our endockinabonoids.

[00:29:54]um various different uh diets can can also interact with uh our ability to produce our own cannabis. And one of the things uh we've looked at recently is is uh this this phenomenon of of green light.

[00:30:09]So this is um a treatment where um the green light it's it's not applied to the skin or anything like that that you see with a lot of the other treatments. This is this is ambient green light. This is being in a room lit by uh by the color green. And there's been a lot of I shouldn't say a lot. There's there's been a number of uh preclinical so laboratory studies as well as clinical trials looking at the effect of green light for for the treatment of pain.

[00:30:39]So it has been shown to uh reduce pain in uh disorders such as migraine. It was it was first shown in in migraine that being exposed to to green light in in your environment can reduce the number of headache days and the intensity of an individual's migraine.

[00:30:56]Um it's been shown to be effective for fibromyalgia um low back pain and uh also postsurgical pain. So there are a handful of studies looking at at this green light and shown to be very effective at uh reducing these different types of pain. So with the assistance of the arthritis society and funding from the arthritis society we we we ask the question well does it have a beneficial effect in in arthritis?

[00:31:27]So we'll start with our um our laboratory studies our preclinical studies. In these experiments, we we um had rats who had osteoarthritis and we put them in a room that was lit with with green light for about eight hours a day for 5 days. And what we found is that uh quite remarkably, we were quite surprised actually to be honest, is that it increased the production of endockinabonoids within within our body and that increase in endockinabonoids and other people have shown that there's increases in in endorphins etc. was reducing the arthritic pain and we were able to show that in in the laboratory.

[00:32:07]First of all, we then um uh are now going to look at uh where in the pain pathway this green light is having its effect. Is it having an effect in the joint? Is it having an effect in the spinal cord? Or is it having an effect in the brain? That's something that we're very much interested in trying to to look at next.

[00:32:29]We've recently also just finished a small clinical trial like a pilot clinical trial looking at the effect of green light therapy in osteoarthritis patients. So in this study um there were only about 18 participants and age range from 52 to 77 years of age and these um volunteers uh uh were exposed to a green light for an about an hour a day for for 10 weeks and the light had to be within 1 to 2 meters of them. But you you don't directly look at the light. you you can sit in a room and you can you can read a book, you can listen to music, um you can do other activities um under the green light. Uh but it has to go through the visual system. You can't sleep or or have your eyes closed.

[00:33:21]Um you can't be on your phone because that gives out different wavelengths of light and you can't watch the TV un unfortunately uh because that gives out different wavelengths of light. But there are other things you can do for for an a day with under the screen light therapy. And what we found in in these osteoarthritis patients is that it it decreased their pain. It seemed to improve their mood uh mood, sorry. And it also uh reduced uh the medication in some instances. Some some patients were able to reduce their pain medications just by being exposed to this green light for an hour a day for for a number of weeks.

[00:34:00]So we're now following up those studies again um through the thanks to the arthritis society uh with with funding from them to look at functional MRI. So now we're wanting to actually look in into the brains of people who are being exposed to the green light to see if there are any changes within within the the processing and the connections within the brain that's responsible for this green light therapy.

[00:34:27]So how how does green light therapy work? Well, to but we're still trying to work it out and we're still trying to gain more and more evidence to make it more clinically acceptable as a as a an adjunct therapy for for pain control.

[00:34:40]But this is what we we know so far is that the green light it has to enter the eye. It it it's not applying to the to the joint or to the joints affected. Uh it has to go through the visual system and through various different pathways again that we're still trying to work out. It activates specific regions of the brain and activation of those regions of the brain send those descending uh impulses now to the spinal cord and within the spinal cord there is um release of endockinabonoids and that buildup of endockinabonoids is what's dampening down the pain. So this is still work in progress and uh we need to validate this and and uh and we're looking more more centrally now. So looking at the the spinal cord and the brain to see see what this green light is actually is actually doing.

[00:35:35]So um just to wrap up let's the preclinical so the laboratory stuff versus the clinical stuff versus importantly at the end of the day the patients uh voice for cannabis use and arthritis.

[00:35:49]Well from the pre-clinical the laboratory studies it it seems really quite clear. It seems to be very effective at reducing pain, inflammation, nerve damage, and potentially improving the structural deterioration that's associated with arthritis. That that seems to be fairly clear with it within uh our animal studies.

[00:36:09]When we come to the clinic though, the clinical studies, there still seems to be a bit of a bit of a question mark going on here. We're still not sure about that and and maybe more uh clinical trials including more patients um and maybe better controlled clinical trials will help uh get us to that answer.

[00:36:30]And then as far as the patient is concerned, well, who knows? It's it's a it's not a drug for everybody. Um, we hear a lot of great things about use of medical cannabis to treat arthritis and we hear that it doesn't do very much for some some individuals.

[00:36:48]So, with the with the patient perspective, I I want to draw your attention to um a report that came out just last month actually by the Canadian Arthritis Patient Alliance. Um, and there's the uh the the web address is at the bottom, but you can go to the uh the Canadian Arthritis Patient Alliance website, and I'm sure the the report is is available uh for download there. And I just want to give you a few of the highlights from this from this excellent uh report that was that was generated by the uh by the alliance.

[00:37:21]So, um they did in-depth interviews with seven people. Okay, not a lot of people, but still it's a um it's a in-depth interviews of people living with arthritis and these were individuals right across Canada who had experience of using medical cannabis for the for the treatment of their arthritis.

[00:37:41]The uh report and the the questions were wanting to explore the benefits and the potential challenges associated with cannabis use and really wanted to get the patient perspective here on how cannabis affected their daily lives as well as their ability to manage their uh pain symptoms and and the dis and the arthritis itself.

[00:38:04]And a consistent theme emerged across this uh across these interviews in that medical cannabis provided meaningful relief from the symptoms of chronic pain. And for for me the um the important word here is meaningful relief. So this was this was maybe individuals had tried multiple different uh um therapies to try and and treat their arthritis. However, with the medical cannabis, they received something that was very important for them.

[00:38:37]And I just want to throw out some of the some of the uh the quotes from from the patients who um took part in in this report. Um one individual said, you know, cannabis has been more effective than Tylenol Tylenol 3 or anti-depressants for my arthritis pain.

[00:38:54]Wow. I mean, that's that's a pretty pretty big statement.

[00:39:00]starting with low doses and adjusting gradually is key to managing my symptoms safely. And I think that's a very important key point as well when when if you're you're starting to think about um using cannabis to help manage your uh arthritis is that with with just with all drugs, you know, you need to start low and go slow. So start with a low concentration. If it's not working for you, maybe gradually increase the dose and and stay at that dose and and and then if it's not working, then maybe slightly a little bit more. So, but but you start low, you go slow and you stay at that level and only gradually over time increase uh increase dosage.

[00:39:44]Another quote, it helps me sleep and manage pain throughout the next day. So clearly cannabis is is helping people uh living with these chronic pain conditions uh get get a good night's sleep or a better night's sleep at least.

[00:40:01]So some of the barriers that that uh came out in this report well cost and coverage. Not all uh drug companies will uh sorry insurance companies will cover the cover the cost of uh of medical cannabis. Um, it was identified that individuals who live in in rural areas, they have a a very real concern that it costs a lot of money to to travel to to to various different dispensaries to be able to to get a hold of the get their hands on the on on the cannabis.

[00:40:33]Still, after all this time of of legalization and increasing increasing acceptance, I would say of of of cannabis in our in our society, there's still a very strong social stigma associated with that. And and we need to try and break break down those barriers.

[00:40:51]And to do that, there has to be better education. There has to be better advocacy. And of course, uh, something that's true to my heart is that there has to be really good, rigorous scientific research.

[00:41:04]Again, a few more quotes.

[00:41:07]I initially felt shy visiting a dispensary because of negative stereotypes, but now I prioritize my well-being. So even though they've felt shy about going to access the uh the the dispensary for the first time because of of the stigmas associated with it, this individual now is prioritizing their well-being as being more important.

[00:41:30]I rely on clinical clinic educators to navigate different strains and dosing and that's really key as well. We need to not only educate ourselves, but we also have to educate our caregivers as well as to the um the potential benefits and and limitations associated with with cannabis.

[00:41:54]Patients need datadriven guidance. Trial and error can be risky without proper education.

[00:42:00]Absolutely. I completely agree. We need to have rigorous uh science associated with that and that's what we try to do in in my lab and and many others to try and and generate that uh that that data that that science behind uh cannabis that would then make it a little bit more accessible uh to the to the public and also to to our caregivers as well. And that's very important and good rigorous clinical trials also um come comes into that as well.

[00:42:34]But I want to give of course as always I should give the the the patient perspective the final word to them and and this was one quote that uh that stuck out for me on reading this report and it said acceptance of cannabis varies but it should be recognized as a legitimate treatment option not just a recreational drug.

[00:42:59]So with that, I want to uh thank uh the people who I've collaborated with um on particularly on the on the green light study. Um Melissa O'Brien um introduced me to the to the area of of green light therapy and uh has been working with with with us uh to to study the uh the effect of green light in treating osteoarthritis.

[00:43:24]um Kareem Makita who's an anesthesiologist and works in the PL pain clinic here in uh in Halifax and Christo um who is our patient representative who is critical in help guiding us through our preclinical studies as well as our clinical studies um all all along the way uh with with this research um funding from uh the faculty of medicine here at at Dalhousy in the department of anesthesia here and particularly of course the Arthritis Society.

[00:43:59]You know, I I have to say that the Arthritis Society when they first funded me to look at cannabis for the treatment of arthritis, it was it was really quite a a bold move for them. You know, I I I used to be laughed at uh for for wanting to to study cannabis and arthritis and people would make jokes about it, but the I I really thank the Arthritis Society for for believing in us uh to to be able to to do these uh scientific research. Um and with that, I'll I'll leave it there.

[00:44:31]>> Thank you so much, Jason. Um thank you for sharing all of your knowledge with us tonight. And I will say that we are very very proud to support your work.

[00:44:38]So, thank you for doing this important work.

[00:44:40]>> Um, we're going to get to the live Q&A because we have received many questions.

[00:44:44]I just want to start off by saying that we do notice there's a number of questions um about how to access medical cannabis and dosage and things like that. So, these are really great questions, but what I'm going to do is just respecting Jason's expertise, I think I'm going to suggest that you know you head to the virtual information booth right after the session for mymedi.ca. Um, and they can answer lots of those questions for you. And also, of course, arthritis.ca CA has lots of great resources. Okay, so with that, Jason, um I'll put you on the hot seat for a few minutes. Um first question here, um you mentioned it a little bit in the context of clinical trials, but is there any evidence around, you know, how does medical cannabis compare to what we already know is kind of typical painkillers that people might be taking for arthritis?

[00:45:27]>> Yeah. So, I have to uh premise all of my answers here is that I'm not a clinician. I uh you know should always uh talk to your uh care provider. Um I'm I'm a scientist but uh from from the scientific point of view you know cannabis is is a is a safe drug. It's it's a rel relatively safe drug. Um you know if you compare it to things like NSAIDs which have some pretty major side effects associated with them. If you're taking NSAIDs, for example, over a long period of time, it can have nasty effects on on your on your stomach, on your kidneys, etc. You know, can cannabis um when when taken responsibly for the treatment of arthritis, I think, is a relatively uh safe uh drug.

[00:46:12]However, we still do need more clinical trials and investigation uh just to confirm to confirm that. Um it it its effectiveness seems to vary. It's as I said before it's not for every every individual. Some people get great benefit from the different canabonoids.

[00:46:29]Um some people it has has no effect and of course there are side effects just like any drug there there are side effects associated with that. So you know if you if your job involves working with heavy machinery and things like that you know maybe um that has to be taken into consideration. Driving etc. These are all potential hazards um from certain types of cannabis, not all, but certain types of cannabis.

[00:46:55]>> Okay. Um if somebody were interested in enrolling in a clinical trial, how would they start that conversation? How would they do that?

[00:47:05]>> Um it's it it usually comes from the investigator um who is who has a a particular clinical question and uh basically you go about advertising, you know. So, keep a keep an eye out for for advertisements about being um accepted into a into a clinical trial. I'm sure the Arthritis Society is is uh able to to broker that as well between the patient and the and the researcher. Um so as as a researcher if I had a particular clinical question and I wanted to enroll patients you know I I would advertise it uh broadly as best I can and but also maybe brokering that through through the arthritis society I think would be extremely helpful.

[00:47:50]>> Okay. So not surprising there's lots of questions here about your research program Jason. So um first I'll ask um how do you know that the mice in your studies have osteoarthritis?

[00:48:02]Okay. Um, so we can we can look at the joints and um we can see that there maybe swelling of the joints. Um, they maybe aren't as able to to move around as freely and as as normally as as a as an as as a normal as a normal mouse. Um, they may show some signs of of pain. Um, so limping for example. So when we do our assessments, one of the things we look at is how how the animal moves. And there's something called um the grimma scale. It it looks at facial features.

[00:48:38]You know that this is used in in um non-verbal patients as well. So very small children uh non-verbal patients.

[00:48:46]uh the you there are certain telltale signs that facial expressions that we can also apply to the mice to to know if they have uh a type of arthritis that is painful to them.

[00:48:59]>> Um and is there a particular type of arthritis that you can study in your mice models? Most models um >> you can pretty much pretty much study anything. Yeah, there are models for for gout. There's models for uh low back pain, uh osteoarthritis, rheumatoid arthritis, spondoloarthopathies, you know, you name it. Uh we'll we'll try and model it in in an in an an animal model first. Yes.

[00:49:24]>> Okay. So, lots of interest in your green light therapy. Um, first of all, is there any downside to try, you know, if you have these lights at home, for example, is there any kind of negative I know that you're still in the research process and everything like that, but from your perspective, is there any concerns that people um should know about?

[00:49:42]>> No, I mean, it's a so it's a particular wavelength. It's it's 525 nanometers.

[00:49:49]It's very very simple. They're they are LED lights that um that they're not extremely bright or anything like that.

[00:49:56]Um, I I think the the main drawback is is really that you have to sit in a room and not watch television for an hour a day. Um, I think that's probably the main uh negative uh response that that I that I've come across. Um, but no, I I mean I we haven't seen any negative effects both in our patient populations as well as the animals. Um, it's it's just changing the color of the light that you're sitting in.

[00:50:25]Um where can you purchase the green light? I don't know if you want to recommend this from Yeah.

[00:50:31]>> Um so we actually get ours from the states but there were reasons for um coming uh getting them from down there is um but um it has to be a very that that specific wavelength that 525 is seems to be a sweet spot. Um, and if you, it's LED Supply down in the States. I shouldn't be advertising, but LED Supply. Um, they have a website and that's where we get our um, LEDs um, lights from.

[00:51:04]>> Okay. Um, this is a good question. Is there a correlation to green light? And then the same effect if you're surrounded by like the color green, plants, uh, forest, nature, paints, etc. Is there anything related to pain relief and or mental health that you that you know about?

[00:51:20]>> Yeah, I mean I mean that's where the green light idea one one of the ways that it came about is that um one of the uh originators in in studying this he he had a brother who uh lived with uh with chronic migraine and his brother told him that uh he felt um better when he was out in the countryside. He was out in green environments. Now, was that because he's walking around and feeling, you know, and exercising, getting fresh air, or was it something to do with the green? And that's when this this researcher um went and studied the effect of green light specifically on migraine pain and then it kind of exploded exploded from that. So getting out and being in green environments has certainly been shown to be beneficial for uh for for your mood, for your well-being and uh and potentially uh improving pain as well.

[00:52:17]>> Okay.

[00:52:18]Um okay. So in terms of um in terms of your green light study again, what would be sort of the next step? I know. So the question really is around are are clinicians recommending green light therapy for pain yet? So I guess it's a question really around what's next for your research? Um yeah.

[00:52:36]>> Yes. Um not really. I mean maybe the uh old research clinic that have that have used visual green light. So this is the ambient green light for um so but this is still a very very new and emerging area of researchers. only a handful of people across the world have have looked at uh at this type of approach to to reduce pain. So, um you know, it's it's all I can say from my experience, it's safe. It's it seems to be quite effective. Um it's maybe not going to replace um other other therapies. It could be an add-on therapy perhaps. Um and it it's cheap, which is always a good thing.

[00:53:16]>> Mhm. Okay. I think we have time for a couple questions. Uh back to medical cannabis I think here. Um so you showed that nice video of the of the white blood cells um plus or minus CBD. So the question really is do we what do we know about like how it's actually working from a biological standpoint in the body? And the question is um is it reducing the number of white blood cells um itself?

[00:53:38]>> Yeah. And it's not I don't think it's reducing the number of white blood cells. It's reducing how those white blood cells act. So, in a in an inflammation, an inflamed joint, for example, you know, those white blood cells, um, if I was able to slow down the video and show you it again, they do a very particular phenomenon in in an inflamed tissue, they start to slow down. They start to do this sort of rolling phenomenon and then they stick to the inside of the blood vessel. And then when they've stuck to the inside of your blood vessel, they kind of squeeze their way out into the tissue and they release this whole slew of of chemicals, inflammatory chemicals, which can cause damage and and chronic inflammation as well as pain. And since there are um the CB2 uh receptors found on the surface of these white blood cells, we think that uh that that the activation of those uh receptors is stopping it. And that that was the second half of the video is that it's stopping that that rolling. They're stopping from sticking that and they can't then get out in the tissue and cause pain and inflammation. That's one of the the mechanisms that we think that canabonoids are having this anti-inflammatory response.

[00:54:59]>> Okay.

[00:55:00]Um to your knowledge, are there any medical conditions for which it would not be advisable to consider medical cannabis for?

[00:55:09]>> Okay. I I would think certain maybe if you if there's an underlying psychiatric disorder perhaps um that may not be a a good treatment option for for individuals who maybe have a psychiatric disorder. Um um I'm thinking of of other possibilities as well. So we know that the canabonoids can drop blood pressure.

[00:55:34]So if you're somebody who is hypotensitive, so somebody who has uh low blood pressure, you know, the canabonoids could potentially drop your blood pressure uh even further. So those are the the two main ones that uh that really spring to my mind.

[00:55:53]>> Maybe my last question, this is really neat research.

[00:55:56]Is there anyone else in the world doing this doing this kind of work?

[00:56:00]>> Not unorthodated. Oh, actually I shouldn't say that. There's there's a um one person in the states who who's been looking at at arthritis, but for for other um are you talking cannabis here or green light?

[00:56:15]>> Either. How about both? Either both.

[00:56:16]>> Okay. Well, for the green light, the green light's easier. There's maybe one one or two other people um who are looking at it for specifically for arthritis. Um and as I said maybe a handful of others who are looking at other chronic uh pain conditions uh for for cannabis and the canabonoids there are a lot of researchers across the world who've been looking at this. I I mean I've been looking at I've been looking at arthritis for well for almost 30 years now and I've been looking at uh cannabis and canabonoids for for the last 15 years. So, um, there was been a lot of research and effort going into to try and understand the the science of medical cannabis.

[00:56:57]>> Okay, that's amazing, Jason. We're really excited to see what's next in terms of all the studies that you've touched on this evening. So, thank you again.

[00:57:04]>> Thank you very much, Sean, and thanks everybody for for attending and hope hope it was informative.

[00:57:10]>> That's wonderful. Uh, we would like to take a few minutes to get the audience's feedback on that note. So if you are live on the Zoom session, you'll see a poll question pop up with a few answer options. So just click on the response that reflects your thoughts. I feel more knowledgeable and empowered after attending the session.

[00:57:28]We will also be sending you an evaluation form when we email the recording and the slides. So if you weren't able to access that question, don't worry. You will have the opportunity to give us feedback at that time. And as I always say, we really do use the survey feedback to shape our arthritis talks webinars. So, please take a moment and tell us what you want to hear about. And tonight, you've heard what's possible when research is funded.

[00:57:51]But honestly, here's the reality. Last year, we were forced to leave 60% of strong peer-reviewed research proposals unfunded. Um, in reality, that's 39 projects, 39 ideas that just couldn't be funded because the resources weren't there.

[00:58:08]So, in short, we don't think we can afford to keep leaving science on the table. Until May 31st, your donation will be matched two times. So that means twice the research, twice the impact, and twice the hope. So if you do have the capacity to give, we really do encourage you to visit arthritis.ca/donate, and we would of course be very, very grateful. So once again, thank you to my.ca and all of our other partners for their support tonight. We will be concluding the arthritis talks portion of this webinar momentarily and we encourage you to visit my mediey's virtual information booth right after the webinar. U Dr. Aosta and pharmacist Michelle Tran will be available there to answer your questions about medical cannabis and really share how some of their patients have benefited from it.

[00:58:53]So to join the booth visit arthritis.ca/booth or click on the link in the chat. With that this does conclude tonight's arthritis talk. So behalf of all of us, on behalf of all of us, uh thank you so much for joining us and please do take care.