UK research finds GP support for cannabis as an alternative to opioids for chronic pain

New research suggests a growing awareness and interest in medical cannabis as an alternative to opioid medications among GPs practising in the UK.

Almost two-fifths (37%) of GPs believe that medical cannabis has the potential to reduce patient dependency on other medications and improve quality of life (41%), according to market research on 150 GPs across the UK.

The survey, carried out on behalf of Sapphire Clinics in May 2023*, also found that despite this just 2% have ever recommended it to a patient and more than two in five are aware that patients are choosing to self-medicate with cannabis accessed illegally. 

These latest figures come following the publication of a study on the effects of cannabis-based oils and dried flower on chronic pain, using data taken from 761 patients enrolled on the UK Medical Cannabis Registry.

The real-world data study found that patients treated with medical cannabis reported significant changes to their pain levels and overall quality of life, as well as a reduction in their use of prescribed opioids.

Meanwhile, side effects were rare, with fewer than one in five patients reporting adverse events, with over 85% described as mild or moderate in severity, as determined by a standardised classification used in clinical trials. 

GPs seek alternative to opioids

According to previous reports, more than half of GPs say they want to be able to offer an alternative to opioid medications, the use of which has escalated in recent years, despite increasing concerns around safety and addiction.

NHS data shows that a record 57 million opioid prescriptions were written in 2022, with as many as 28 million adults in the UK living with diagnosed pain conditions.The UK’s ageing population means that chronic pain is set to become an even greater issue, further exacerbating the need for safe and effective treatment. 

NICE guidelines state the risks outweigh the benefits of prescribing opioids in most causes of chronic non-cancer pain, with one in seven (14%) chronic pain patients prescribed opioids claiming they became dependent or addicted, and strong side effects preventing one in four (23%) from living a normal life.

Side effects are common in people prescribed opioids with between 50 to 80% of patients in clinical trials reporting at least one adverse effect. 

Despite this, 98% of GPs are reported to have prescribed them for pain in recent months and on average, GPs say that a chronic pain patient will be prescribed two opioid based medications before being offered any alternative therapy.

However, according to the new research, most GPs (52%) do want to be able to provide alternatives to opioids, but nearly two-thirds (61%) say they lack the options to do so.

Mounting evidence for medical cannabis and opioid reduction 

The recent study builds on the existing evidence suggesting that medical cannabis may be a viable alternative to opioids for managing chronic pain. 

Chronic pain is currently the most common diagnosis for which medical cannabis is prescribed in the UK, with patient numbers now thought to be around 25,000.

A separate study carried out by Drug Science using data from 800 cannabis patients on the registry T21, found ‘noteworthy’ reductions in opioid use among those with chronic pain.

The percentage of chronic pain patients who reported use of opioids reduced from 441 (55.1%) to 177 (22.1%) indicating that over half (59.9%) of those using opioids had stopped all use of these drugs.

“Given ongoing concerns about the over-prescribing and misuse of opioids, findings of a reduction in both the number of people using any prescribed opioids and in the mean dose of these drugs among chronic pain patients are noteworthy,” the authors say.

International research also links cannabis to a reduction in opioid use among chronic pain patients. 

Earlier this year, researchers in New York reported that in a sample of 8,000 chronic pain patients, daily morphine milligram intake decreased following cannabis therapy and this decline grew more significantly over time. Meanwhile, researchers from Washington State University and Legacy Research Institute in Portland, found a high-CBD whole-plant cannabis extract was able to ‘significantly’ reduce opioid reward in female rats.

A peer-reviewed study from September 2022, of patients using medical cannabis after its legalisation in the state of Florida, found that 79% of those who had been taking opioids were able to reduce or stop taking them entirely. 

Researchers at Sapphire Clinics are now recommending more funding for clinical trials to improve understanding of the impact of medical cannabis on chronic pain and ensure that GPs have access to the information they need to make an informed treatment decision for their patients

Dr Simon Erridge, head of research and access at Sapphire Clinics, commented: “An ageing population represents a pressing need to consider how chronic pain can be addressed, and it’s clear that currently GPs do not have enough information about the options available. 

“Our study goes some way to demonstrating the outcomes for eligible patients when prescribed medical cannabis, but much more data is needed to allow health care professionals to make informed decisions.”

The push for GP prescribing 

They have also called on the government to give GPs the same rights to prescribe medical cannabis as specialist consultants. 

An ongoing campaign, led by the Cannabis Industry Council, is urging regulators to amend current regulations which state that a prescription for cannabis must be initiated by a specialist consultant on the General Medical Council (GMC) register. GPs can only support prescribing under what is known as a shared-care agreement. 

With over 36,000 practicing GPs in the UK, experts believe that allowing them to initiate prescriptions  would open up access to medicinal cannabis for many more patients across the country.

Speaking about the campaign previously, Dr Sunil Arora, co-chair of the CIC Prescription Cannabis Working Group, said: “The current model where only consultants can prescribe medical cannabis is simply not working in the interests of the majority of patients or society at large. Allowing GPs to prescribe would expand patient access, reduce NHS waiting lists, and help cut crime.

“The Cannabis Industry Council urges regulators and policymakers to support these modest, but transformative proposals to allow GPs to prescribe to their patients.”

*GP data according to online and telephone research conducted by PCP Market Research on behalf of Sapphire Medical Clinics between 3-15 May 2023. Total sample 150 GPs in England, Wales, Scotland, and Northern Ireland. Consumer data according to online research conducted by Opinium Market Research on behalf of Sapphire Medical Clinics between 12-16 May 2023. Total sample 4,000 UK adults.

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