Medical cannabis improves patients’ quality of life more than any other treatment for chronic pain, says a panel of leading experts.
Medical cannabis is among the most effective treatments for people with long-term, problematic neuropathic pain, according to the new paper.
Researchers used the latest assessment methods to measure the effectiveness of commonly used drugs’ at managing pain and improving patients’ quality of life, against side effects.
Medical cannabis was found to have the best overall benefit-safety balance for patients, with its ability to reduce pain and improve the quality of life for patients with chronic neuropathic pain (CNP).
The paper also finds that it is safer overall than other commonly prescribed medications, and that patients taking cannabis-based medications would be less likely to experience many of the side effects associated with more established treatments.
One in 11 people in the UK suffer from chronic neuropathic pain – including conditions such as nerve damage, sciatica or severe numbing in hands and feet – that substantially impacts on their quality of life.
A panel made up of international clinicians, experts and patients, used a multicriteria decision analysis (MCDA) model to compare the safety of cannabis products to those of the nine drugs that are most commonly prescribed for CNP.
Cannabis-based products containing a 1:1 ratio of THC and CBD, were found to have a higher benefit-safety profile than commonly used medications such as Amitriptyline and Tramadol.
The patient’s perspective
Authors concluded that medical cannabis contributes more to CNP patients’ quality of life and is more favourable in terms of side-effects such as cognitive impairment, dizziness, constipation, affect disorders, overdose toxicity, respiratory depression, withdrawal, and dependency.
Patient representative Abby Hughes, who took part in the study, said the patient contribution was “crucial” in highlighting the importance of quality of life compared to reduction in pain.
“It is crucial patients were able, for the first time in an MCDA setting, to share their lived-experience in a study identifying the benefit-safety balance of neuropathic pain medications. After all, we are the ones experiencing pain and seeking pain relief for a better quality of life,” said Hughes.
“Sharing our experiences equated to the difference in quality of life actually being judged as more clinically important to patients than the difference in pain relief.”
She continued: “Interestingly, with the benefits of 12 neuropathic pain medications mapped out, cannabis takes the lead.
“The safety was also mapped out, identifying adverse and serious adverse events, from constipation to overdose toxicity.
“Cannabis came out as equal or better in safety. Whilst ibuprofen came out as just as safe, it was also least effective, weighted as zero for pain relief and quality of life benefits.”
The report comes just weeks after the International Association for the Study of Pain (IASP) said it could ‘not endorse’ the general use of cannabinoids to treat pain, due to a lack of evidence from ‘high quality research’.
The Faculty of Pain Medicine at the Australian and New Zealand College of Anaesthetists (ANZCA) has also advised against prescribing cannabis for patients with chronic, non-cancer pain unless they are enrolled in a clinical trial.
A co-author of the CNP and cannabinoids study, Professor Mike Barnes, who has been critical of the IASP statement, said these findings go some way to “refute” its conclusions.
“I wish those writing such reports actually spoke to real patients deriving real benefit from cannabinoids for chronic pain,” said Prof Barnes.
“They should try to move beyond the narrow pharmaceutical paradigm, understand the plant and not forget that a doctors’ primary duty is to help their patients.
“This study illustrates the efficacy and safety of cannabis and goes some way to refute the conclusions of the report of the IASP which said there was insufficient evidence to prescribe cannabinoids for pain.”
His co-author, Dr Anne Katrin Schlag, head of research for Drug Science, the UK-based charity which commissioned the paper, told Cannabis Health the team anticipated that the findings would be “controversial”.
“This is another way of broadening the scientific evidence base, rather than solely sticking to randomised control trial (RCT) data,” said Dr Schlag.
“What is very important here is that the study is a comparison between different pain medications, including medical cannabis.
“While medical cannabis was not found to be the best at reducing pain, when taking quality of life into account and patients being able to function, eat and sleep well, then for the average person, cannabinoids tend to work better than the opioids, which tend to have serious side effects.”
Another blow for chronic pain patients
Last week, in another blow for chronic pain patients, the National Institute of Health and Care Excellence (NICE) released new guidance advising UK doctors not to prescribe conventional painkillers including opioids and paracetamol for chronic primary pain.
Instead it is recommended that patients with these conditions are offered a “range of treatments” to manage their pain, including exercise, CBT and acupuncture.
With access to cannabis medicines still restricted in the UK, there has been a backlash from patients who fear being left without any viable options.
Dr Schlag continued: “For patients experiencing severe chronic pain there should be the option of opioid based pain medications.
“Exercise and psychological therapies all have a place and will have lots of benefits for some people, but it is likely there will always be people who need stronger medications.”
She added: “At Drug Science we would like to see cannabis added to the current pharmacotherapy in relation to pain.
“There are thousands of patient reported outcomes from those who are using cannabis and cannabinoid products successfully to treat pain, including from our own forthcoming Project Twenty21 findings which are due to be published shortly.”
Building a convincing case
Project Twenty 21, which launched in November 2019, is Drug Science’s landmark study which aims to widen access to medicinal cannabis, enrolling up to 20,000 patients to build Europe’s largest body of evidence for its safety and efficacy.
Drug Science CEO, David Badcock said he hoped this latest paper would encourage regulatory bodies to consider the growing evidence behind medical cannabis and take steps to improve access for patients.
“Since being made legal in 2018, many patients suffering from neuropathic pain have told us that cannabis based medicinal products are effective in reducing their pain and its negative impacts on their everyday lives,” he commented.
“We are pleased to say that this paper corroborates what many patients have been saying for many years, and helps to build a convincing case for more widespread prescription of medical cannabis on the NHS.”
Hughes, who is able to access a prescription for medical cannabis through Project Twenty21, echoed these sentiments, adding: “It is hoped NICE will consider reevaluating their guidelines on medical cannabis, recognising that for many patients cannabis provides a better quality of life, provides better pain relief, and has a better safety profile than many other neuropathic pain medications currently prescribed.”
You can read the full report here
Ireland to fund patient’s medical cannabis up front
Campaigner Vera Twomey described “relief” that her determination has finally paid off.
Campaigner Vera Twomey has described her “relief” as the Irish Government agrees to fund medical cannabis patient’s prescriptions up front.
Eligible medical cannabis patients in Ireland will now have their medication paid for up front, after months of pressure on the Government from campaigners.
Health Minister Stephen Donnelly announced on Monday 19 July that the refund system for patients who obtain their prescribed cannabis-based products from the Netherlands, will now be replaced by a direct payment system.
The HSE will pay the dispensing pharmacy in the Netherlands directly, rather than the burden falling to the patients and their families, who were then required to apply for a refund.
Vera Twomey, whose daughter Ava Barry, 11, has a severe form of epilepsy known as Dravet syndrome, is among 40 patients who have now been granted an individual ministerial licence to import Bedrocan oil to Ireland.
But the family were paying 10,000 Euros up front every three months for Ava’s prescription and waiting up to five weeks for it to be refunded.
Twomey, who has four other children, has previously spoken of the huge financial strain this system placed on her family.
Over the last 16 months she has relentlessly called for action, making dozens of phone calls daily to politicians and lobbying ministers on social media with the backing of thousands of supporters in Ireland and across the world.
Twomey, who received a phone call from Ireland’s Prime Minister, Micheál Martin on Monday confirming the news, says she is “delighted” that her determination has finally paid off.
“There’s a sense of relief that we have accomplished this, but also a little bit of shock because we have been trying to resolve it for so long,” she told Cannabis Health.
Twomey’s activism gained national attention in 2017 when she walked from her home in Cork to Leinster House in Dublin to ask former Health Minister Simon Harris to grant access to medical cannabis for her daughter.
Initially having to travel to the Netherlands to collect the prescription herself, during the pandemic Twomey successfully campaigned to secure the permanent delivery of Bedrocan oils for Ava and other patients.
Now she says she is looking forward to focusing on her family and putting the phone down for a while.
“I don’t think anybody who has gone through this fight, seeing the injustice that we have had to deal with could ever walk away,” she said.
“But at the same time, I’ve made a lot of sacrifices and for the moment at least, I need to give 100 percent to my other children, to do normal things and be a family.”
But the fight in Ireland isn’t over.
The Irish Government announced the provision of funding for the Medical Cannabis Access Programme (MCAP) in January – almost two years after it was introduced – but only four low dose cannabis-based medicines are covered by the programme, for people living with one of three qualifying conditions.
“There are other issues – we still need expansion and improvement in medical cannabis access, the journey is over by any means, but we’re at the beginning and getting Bedrocan recognised as a medicine that is funded up front is very important.
“I think the Irish are actually miles ahead of the British on this one and I hope [politicians] will take notice and catch up.”
She added: “The greatest gift you’ll ever receive is to lose your fear, then you can accomplish anything with focus and determination.
“If you have the determination to keep going you will get there. It’s not going to be easy, they are not going to make it easy but it can be done.”
Patients eligible for the direct payment system are those suffering from one of three stated conditions; spasticity associated with multiple sclerosis, intractable nausea and vomiting associated with chemotherapy and severe, refractory (treatment-resistant) epilepsy.
The HSE says it will be contacting patients directly.
Health Minister, Mr Donnelly, commented: “I am delighted that the HSE and Transvaal Apotheek in the Netherlands are implementing a new process which will give peace of mind to the seventeen patients and their families who until now have been using the refund process.”
Kanabo’s cannabis vaporiser for metered dosing launches in UK
The VapePod will give thousands of UK patients access to pain relief in a metered dose.
Cannabis company Kanabo’s new extract formula and vaporiser will give thousands of UK patients access to pain relief in a metered dose.
UK patients will be the first in Europe to have access to Kanabo’s vaporiser, the VapePod, and its new extract formula when is it delivered later this month.
The deal, in conjunction with LYPHE Group, will see patient’s of LYPHE Group’s ecosystem, including The Medical Cannabis Clinic and Dispensary Green, able to access the VapePod under the brand name NOIDECS.
Under the agreement, PharmaCann and Kanabo established a customised production line for Kanabo’s VapePods cartridges.
An alternative to cannabis flower
The VapePod is a medical-grade, handheld vaporiser which enables accurate and precise micro doses of cannabis extract, dispensing 1mg of formula for each inhalation.
This will benefit to patients as inhaling extracts rather than tinctures and oils allows for faster onset and higher bioavailability.
It will also allow clinicians to more confidently prescribe and monitor a patient’s dosage, as well as providing more accurate patient data.
Previously, cannabis patients in the UK have only been able to access medical cannabis dry flower and oil tinctures for which the majority of patients consume via inhalation due to fast onset time.
Kanabo’s medical line aims to enable patients to move away from the harmful act of smoking medical cannabis flowers as they can now take their medicine without inhaling soot, tar and carcinogens into the lungs.
Avihu Tamir, Kanabo’s CEO, said: “The VapePod is a world first allowing specialist consultants to prescribe a metered dose of medicinal cannabis that is healthier for patients than the alternative, which is typically smoking.
“Medical cannabis is a safer alternative to the conventional opiate solutions and other pain management treatments. This announcement ensures that thousands of UK patients have access to the most effective medicinal cannabis delivery system.
“The fact that the VapePod gives exactly 1mg on every inhalation is crucial for GPs because they can prescribe an exact dose which they haven’t been able to do before. For patients who want the similarity to smoking but know they are not inhaling soot and tar. There’s also the bioavailability factor too.
“The reason GPs haven’t been prescribing is the issue of dosing and flowers – they don’t feel comfortable asking patients to smoke. With Kanabo, they can prescribe exact dosing in a safe and consistent way.”
The medical extract formula, which is based on the Israeli medical cannabis pharmacopoeia as a recommendation for the treatment of pain management, has a purity of 70 percent THC with 15 percent minor cannabinoids and terpenes.
Earlier this year Kanabo became the second cannabis company to list on the London Stock Exchange.
Dean Friday, LYPHE’s CEO commented: “Kanabo are experts in novel delivery with their VapePod greatly improving onset times, and for our chronic pain patients we now have an alternative to flower vaporisation. This is the start of a revolution in medical cannabis application and we are delighted to be supplying it under the NOIDECS brand.”
Cancer survivors turn to cannabis for physical and mental health – study
Cancer survivors are more likely to use cannabis to help pain, anxiety, sleep and nausea.
Cancer survivors are frequently using cannabis to manage physical and mental health symptoms, says a new study.
Research from the US indicates that cancer survivors are more likely to use cannabis for symptoms such as pain, anxiety, trouble sleeping and nausea.
A team of investigators analysed results from a Covid-19 cannabis health study to examine changes to cannabis use, methods of cannabis delivery, and coping strategies among cancer survivors since the pandemic.
They found that individuals with a history of cancer are more likely to report cannabis use to manage mental health and pain symptoms.
This group of people were also more likely to report fear of a Covid-19 diagnosis, compared to adults without a history of cancer.
Data was collected from 158 responses between 21 March 2020 and 23 March 2021, from cancer survivors who identified as medicinal cannabis users.
These were then compared to medicinal cannabis users without a history of cancer of the same age.
According to the study, cancer survivors were more likely to report using cannabis as a way of managing nausea/vomiting, headaches or migraines, seizures, sleep problems or as an appetite stimulant.
Sixty one percent of respondents with a history of cancer used cannabis to manage anxiety symptoms and 54 percent for chronic pain.
Forty eight percent said they used it to manage depressive symptoms and 25 percent for PTSD, while smaller numbers used it for symptoms of another autoimmune disease, and irritable bowel syndrome.
While there were no differences in how often they used cannabis or their method of administration, cancer survivors were “more likely to have an advanced supply of cannabis”.
The findings support the need for more conversations between doctors and their patients about the use of cannabis, say those behind the study.
The authors concluded: “Overall, we observed that cancer survivors are frequently reporting the use of cannabis to manage both physical and mental health symptoms associated with their cancer diagnosis and that cancer survivors are more likely to report fear of a Covid-19 diagnosis compared to those without a history of cancer.
“Given the frequency of mental and physical health symptoms reported among cancer survivors during the Covid-19 pandemic period, clinician–patient interactions should include questions around cannabis use, particularly those with a history of cancer.”
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