Abstract

Cannabis and endocannabinoid agonists have been safely used for decades by a large segment of the United States population for both recreational and medicinal purposes [1]. The medical use of cannabis products has been legislatively restricted for decades in the United States [2]. Due to widespread enthusiasm for cannabis in American Society, no authority can deny the wide margin of safety that exists, even for chronic use [3,4]. Newly enacted legislation over the last several years has decriminalized cannabis consumption and even legalized its use in some states for both recreation and medicinal purposes [5]. Most recently, clinicians’ guides to cannabidiol (CBD) and hemp oils have moved to the front seat of many prestigious clinical publications [6]. The translation of cannabinoids from herbal preparations into highly regulated prescription drugs is progressing very rapidly and healthcare practitioners must become familiar with its mechanisms and possible clinical applications [7]. These drugs and supplements may provide an unmet need in the management of patients with osteoarthritis and other musculoskeletal ailments. It may be time for a new gold standard in our approach to the clinical condition of arthritis where these pharmaceuticals play an important role.

Keywords: Endocannabinoids; Orthopedic Surgery; Musculoskeletal Medicine; Cannabis

References

1. Hutchinson KE., et al. “Cannabis and health research: Rapid progress requires innovative research designs”. Value Health 22.11 (2019): 1289-1294.
2. Corroon J., et al. “Indications and administration practices amongst medical cannabis healthcare providers: a cross-sectional survey”. BMC Family Practice 14 20.1 (2019): 174.
3. Zvonarev V., et al. “The public health concerns of marijuana legalization: An overview of current trends”. Cureus 30 11.9 (2019): e5806.
4. Burns TL and Ineck JR. “Cannabinoid analgesia as a potential new therapeutic option in the treatment of chronic pain”. Annals of Pharmacotherapy 40.2 (2006): 251-260. 
5. Meffert BN., et al. “Navigating blind in the green rush: Clinical considerations and harm reduction practices for cannabis”. Current Drug Abuse Reviews 1 (2019): 3-11.
6. VanDolah HJ., et al. “Clinician’s guide to cannabidiol and hemp oils”. Mayo Clinic Proceedings 94.9 (2019): 1840-1851.
7. Bruni N., et al. “Cannabinoid Delivery Systems for Pain and Inflammation Treatment”. Molecules 23.10 (2018): 2478. 
8. Carliner H., et al. “Cannabis use, attitudes, and legal status in the U.S: A review”. Preventive Medicine 104 (2017): 13-23.
9. Corroon J and Kight R. “Regulatory status of cannabidiol in the United States: A perspective”. Cannabis and Cannabinoid Research 27 3.1 (2018): 190-194.
10. VanDolah H., et al. “Clinician’s Guide to Cannabidiol and Hemp Oils”. Mayo Clinic Proceedings 94.9 (2019): 1840-1851. 
11. Herbst J and Musgrave. “Respiratory depression following an accidental overdose of a CBD-labeled product. A pediatric case report”. Journal of the American Pharmacists Association 60.1 (2019). 
12. Media: ‘Start Low and Go Slow’ – 3 Steps to Safely Consume Marijuana Edibles.
13. Chandra S., et al. “Cannabis Cultivation: Methodological issues for obtaining medical grade product”. Epilepsy and Behavior 70 (2017): 302-312.
14. Grof CPL. “Cannabis, from Plant to Pill”. British Journal of Clinical Pharmacology 84.11 (2018): 2463-2467.
15. Mead A. “The legal status of cannabis (marijuana) and cannabidiol under US law”. Epilepsy and Behavior 70 (2017): 288-291.
16. White CM. “A review of human studies assessing Cannabidiol (CBD) therapeutic action and potential”. The Journal of Clinical Pharmacology 59.7 (2019): 923-934.
17. Cogan PS. “On healthcare by popular appeal: Critical assessment of benefit and risk in cannabidiol based dietary supplements”. Expert Review of Clinical Pharmacology 12.6 (2019): 501-511.
18. Karst Allison. “Weighing the Benefits and Risks of Medical Marijuana Use: A Brief Review”. Pharmacy (Basel, Switzerland), MDPI (2018).
19. Singer L., et al. “The cannabidiol conundrum: potential benefits and risks of cannabidiol products for children”. Current Opinion in Pediatrics 10 (2019). 
20. Bowling CM and Glantz SA. “Conflict of interest provisions in state laws governing medial and adult use cannabis”. American Journal of Public Health 109.3 (2019): 423-426. 
21. Franco Vk Perucca E. “Pharmacological and Therapeutic Properties of Cannabidiol for Epilepsy”. Drugs 79.13 (2019): 1435-1454. 
22. Pacher P., et al. “The endocannabinoid system as an emerging target of pharmacotherapy”. Pharmacological Reviews 58.3 (2006): 389-462.
23. Wallace Alicia. “Patent No. 6,630,507: Why the U.S. Government Holds a Patent on Cannabis Plant Compounds”. The Denver Post, The Denver Post, 2 (2016). 
24. Appendino G., et al. “Cannabinoids: occurrence and medicinal chemistry”. Current Medicinal Chemistry 18.7 (2011): 1085-1099.
25. BenAmar M. “Cannabinoids in medicine: A review of their therapeutic potential”. Journal of Ethnopharmacology 105.1-2 (2006): 1-25.
26. R Rappaport. “Cannabinoids may complement rehabilitation, joint or spinal injections’ in Orthopedics” (2019).
27. S Chandra., et al. “Cannabis Sativa L.: Botany and Horticulture” (1970). 
28. Crofford and Leslie J. “Use of NSAIDs in Treating Patients with Arthritis”. Arthritis Research and Therapy BioMed Central (2013). 
29. Brune K. “Safety of anti-inflammatory treatment-New ways of thinking”. Rheumatology 43.1 (2004): i16-20.
30. Wong Rebecca SY. “Disease-Modifying Effects of Long-Term and Continuous Use of Nonsteroidal Anti-Inflammatory Drugs (NSAIDs) in Spondyloarthritis”. Advances in Pharmacological Sciences 29 (2019). 
31. Moore N., et al. “Adverse drug reactions and drug-drug interactions with over-the-counter NSAIDs”. Therapeutics and Clinical Risk Management 11 (2015): 1061–1075. 
32. Gowdey CW and Brennan M. “A review of fatalities as associated with NSAID treatment in Ontario”. Canadian Family Physician 32 (1986): 1931-1934.
33. McCarthy DM. “Prevention and treatment of gastrointestinal symptoms and complications due to NSAIDs”. Best Practice and Research: Clinical Gastroenterology 15.5 (2001): 755-773. 
34. Sostres, Carlos., et al. “Nonsteroidal Anti-Inflammatory Drugs and Upper and Lower Gastrointestinal Mucosal Damage”. Arthritis Research and Therapy, BioMed Central (2013).
35. Curtis Elizabeth., et al. “Safety of Cyclooxygenase-2 Inhibitors in Osteoarthritis: Outcomes of a Systematic Review and Meta-Analysis”. Drugs and Aging, Springer International Publishing (2019). 
36. Nissen SE., et al. “For the PRECISION Trial investigators. Cardiovascular safety of Celecoxib, Naproxen or Ibuprofen for arthritis”. The New England Journal of Medicine (2016): 2519-2529.
37. Pundole X., et al. “Utilization of biologic disease modifying anti-rheumatic drugs in patients with rheumatoid arthritis and cancer”. Clinical Rheumatology (2019). 
38. Bonn-Miller MO., et al. “Labeling Accuracy of Cannabidiol extracts sold online”. Journal of the American Medicine Association 318.17 (2017): 1708-1709.
39. Devane WA., et al. “Isolation and structure of a brain constituent that binds to the cannabinoid receptor”. Science 258.5090 (1992): 1946-1949.
40. Kight R. “Cannabis, Health Care and Federal Law”. American Journal of Endocannabinoid Medicine 1.1 (2019): 8-10.
41. “Physicians Explore Cannabinoids as Pain Management Solution”. Orthopedics Today 11 (2019): 10-12.
42. P Nagarkatti., et al. “Cannabinoids as Novel Anti-Inflammatory Drugs”. Future Medicinal Chemistry 1.7 (2009): 1333-1349. 
43. Russo EB and Marcu J. “Cannabis Pharmacology: the usual suspects and a few promising leads”. Advances in Pharmacology 80 (2017): 67-134. 
44. Pacher P and Kunos G. “Modulating the Endocannbinoid System in Human Health and Disease-successes and failures”. The FEBS Journal 280.9 (2013): 1918-1943.
45. MA Huestis ML Smith. “Cannabinoid Markers in Biological Fluids and Tissues: Revealing Intake”. Trends in Molecular Medicine (2017): S1471. 
46. Pacifici R., et al. “Evaluation of cannabinoids concentration and stability in standardized preparation of cannabis tea and cannabis oil by ultra-high performance liquid chromatography tandem mass spectroscopy”. Clinical Chemistry and Laboratory Medicine 28 55.10 (2017): 1555-1563.
47. Marcu J. “The Biochemical System Controlling the Effects of Cannabis: An Introduction”. HerbalEGram (2015): 12.6.