Many people with ankylosing spondylitis (AS) believe that cannabis can treat their pain. While some research suggests cannabis may help with chronic pain more generally, there is little research on its use for AS specifically.

Marijuana is also called cannabis. The term “marijuana” has roots in racism, so this article will use the term “cannabis” throughout.

Interest in the use of cannabis for AS is growing. A 2021 study with people with rheumatic diseases, including AS, found that 15.3% of them were using cannabis at the time of the study.

People often report that the drug eases their pain or helps with other symptoms related to chronic pain, such as anxiety and depression. Scientific research has not proven this claim. This does not mean that it is untrue — only that the evidence to date is mostly anecdotal.

Read on to learn more about using cannabis for AS.

A person holding cannabis in order to use it for ankylosing spondylitis.Share on Pinterest
VISUALSPECTRUM/Stocksy

People with AS often struggle to get full relief from their pain with standard treatments. Others may find that the side effects of medications are unpleasant. As a result, alternative treatments, such as cannabis, may be appealing.

Cannabis may have benefits for AS treatment by easing chronic pain. A 2021 systematic review and meta-analysis found that people consistently reported pain reduction with the use of cannabis.

At baseline, people rated their pain intensity at 8.2 on a 10-point scale, on average. After using cannabis, their pain rating was 5.6 on average.

People who used cannabis reported having higher pain intensity when they began using it. This suggests that people may turn to cannabis when other interventions do not provide adequate pain relief.

While the data suggests that cannabis might be helpful, the review relied on study participants’ subjective reports of pain and did not use measures that could prevent bias.

For example, researchers did not compare the results from using cannabis against a placebo, or use blinding so that participants would not know whether they were receiving a potential therapy or not. As a result, the data is promising but does not conclusively prove cannabis works for pain management.

A limited body of research suggests that cannabis products might help with chronic pain. However, not all forms of chronic pain are the same, and little research has directly tested cannabis for AS.

A clinical practice guideline in the British Medical Journal from 2021 emphasizes that the evidence supporting cannabis for chronic pain is weak.

In 2019, the Canadian Rheumatology Association also published a position statement on the use of cannabis for AS. It emphasized that:

  • there are no clinical trials of cannabis in people with rheumatological disorders
  • there is inadequate scientific evidence supporting any benefit of using cannabis
  • the risk of potential harm is high, especially given the lack of evidence supporting any specific benefits

There is no high quality scientific evidence supporting the use of cannabis for AS. However, there are many people who have tried it and reported their experiences. This is known as anecdotal evidence.

Some people report that cannabis:

  • reduces their pain
  • reduces anxiety or depression
  • is more effective than other treatments
  • does not cause the same side effects as prescription drugs

There are also reports that cannabidiol (CBD) may ease AS pain. This is a substance that comes from the cannabis plant. In one blog post from AnkylosingSpondylitis.net, a person who tried cannabis reports that their pain, stiffness, and anxiety dramatically decreased within 20 minutes of trying CBD oil.

These reports may indicate that cannabis or CBD are effective treatments, but a doctor cannot use them as a basis for making treatment recommendations. Without studies that confirm the benefits and safety of cannabis under controlled conditions, it is not possible to rule out the influence of factors that may skew results, such as:

  • the placebo effect
  • bias in favor of alternative medicine
  • the subjective nature of self-reported pain

This is not to say the reports are not valid or real — only that they cannot replace scientific study.

While evidence of cannabis’s benefits is weak, there is significant evidence documenting its potential side effects. The short-term effects may include:

  • confusion, or feeling “high” or intoxicated
  • feeling very sleepy
  • impaired judgment, which makes it difficult to safely drive or work
  • rapid heart rate
  • a potential increase in mental health symptoms, including psychosis

The Canadian Rheumatology Association has also expressed concern that researchers do not know the long-term risks of cannabis use.

As with any medical treatment, cannabis has benefits and drawbacks. It being from a plant does not necessarily mean it is entirely safe. Some people who use cannabis develop cannabis use disorder, which occurs when a person develops a dependence on the drug.

Learn more about cannabis and addiction.

CBD is a compound in cannabis. It does not produce a “high” feeling. It is readily available in many U.S. states.

Tetrahydrocannabinol (THC) is the psychoactive component of cannabis, which means it makes a person feel high. There is currently no published research on whether CBD or THC is better for AS.

In 2019, researchers published a design for a study that would test CBD for AS. The study would include a placebo control, and then add THC to the design to assess which ingredient might be most helpful, and to weigh risks and side effects. Study results are not available at the time of writing.

Without scientific data, it is not possible to reliably compare the risks and benefits of CBD vs. THC for AS. Anecdotally, users of both products report relief, though THC users also report feeling high and sometimes mentally impaired.

Is CBD legal?The 2018 Farm Bill removed hemp from the legal definition of marijuana in the Controlled Substances Act. This made some hemp-derived CBD products with less than 0.3 percent THC federally legal. However, CBD products containing more than 0.3 percent THC still fall under the legal definition of marijuana, making them federally illegal but legal under some state laws. Be sure to check state laws, especially when traveling. Also, keep in mind that the FDA has not approved nonprescription CBD products, and some products may be inaccurately labeled.

There are a number of options for using cannabis:

  • Smoking: A person might use a pipe, roll a cigarette, or use other products to smoke and inhale cannabis. Some, but not all, evidence suggests that smoking cannabis may increase the risk of certain cancers, including lung cancer.
  • Vaping: This method vaporizes cannabis so a person can inhale it. It is similar to smoking, but vaporizer manufacturers claim it is safer because the smoke is cooler. Researchers do not yet know the long-term effects of vaping because it is relatively new.
  • Edibles: It is possible to eat cannabis products in sweets, gummies, and a variety of other foods. Edible CBD does not produce a high. The high from edible THC typically takes longer to appear and lasts longer. This can make it more difficult to control. It is also possible to take too much, resulting in poisoning.
  • Lotions and topical products: CBD is available in beauty products, lotions, shampoos, and many other products that come into contact with the skin. It is unclear whether these products have any effect on AS.

No science has proven that any specific way of using cannabis for AS is safe or effective. If a person wants to try it, they should proceed with caution and treat their use as experimental. There may be risks involved.

Some tips that may make trying cannabis safer include:

  • Getting medical advice: If possible, talk with a doctor knowledgeable about medical cannabis about the best and safest options for use.
  • Checking the safety: People who are pregnant or breastfeeding should not use cannabis. It is also important not to give cannabis or CBD products to children or teenagers.
  • Avoiding mixing drugs: Do not use cannabis with any other drugs. If a person takes prescription medications, talk with a doctor first. Cannabis may interact with other medications.
  • Choosing a safer method: Cannabis edibles have different risks from smoking or vaping the drug. People may feel more comfortable with this method. However, it is still worth noting that poisoning via edibles is a possibility.
  • Choosing the right setting: Only use cannabis or THC at a time when a person is not caring for children, driving, or doing anything that could cause danger in the event of a bad reaction.
  • Titration: Start with a small dose. Even if it does not work, it is better to start with a low dose and work upward rather than take a larger dose and experience negative effects.
  • Trying different timings: Consider using cannabis, CBD, or THC at different times of day to see which approach gets the best results.
  • Storing safely: Store cannabis products safely in a child- and pet-proof container. It is especially important to do this for CBD gummies. To a child, they may look like candy.

It is possible to use too much cannabis. If a person develops severe side effects or may be having a drug interaction, the Centers for Disease Control and Prevention (CDC) instructs people to call poison control at 800-222-1222. In an emergency, call 911 or local emergency services.

Cannabis may help with some forms of chronic pain. However, researchers have not used quality experimental designs to test it as a treatment for AS. For this reason, it remains an alternative treatment.

Nevertheless, some people report positive results with cannabis and CBD. It is possible that scientific research has not caught up to the lived experiences of people with AS. However, it is also important to note that anecdotal evidence is not always reliable.

People who want to try cannabis should proceed with caution, and whenever possible, work with a doctor who is knowledgeable about its use.