Australian Study Finds Marijuana is Ineffective Cure for Chronic Pain

Australian Study Finds Marijuana is Ineffective Cure for Chronic Pain

A recent research by researchers at the University of New South Wales (UNSW) Sydney challenges the idea that cannabis could be effective for chronic non-cancer pain control.

Published in the July 2018 The Lancet Public Health journal, the study, titled “Effect of cannabis use in people with chronic non-cancer pain prescribed opioids: findings from a 4-year prospective cohort study,” found that participants who used cannabis experienced greater pain, weren’t working too with their pain, and had greater stress than those who didn’t use cannabis. The researchers also found no clear evidence that cannabis use decreased prescribed opioid use.

However, the researchers also discovered inconsistencies between their statistical evaluation and what participants reported.

“Chronic non-cancer pain is a complex issue. For most people, there’s unlikely to be a single effective therapy,” said lead author Gabrielle Campbell at a UNSW Sydney press release. “In our analysis of individuals living with chronic non-cancer pain that were prescribed pharmaceutical opioids, despite reporting perceived benefits from cannabis use, we found no strong evidence that cannabis use decreased participants’ pain or opioid use over time.

Participants were recruited through community pharmacies throughout Australia for the Pain and Opioids In Treatment study, which was  observed in participants with chronic non-cancer pain prescribed opioids. The participants completed baseline interviews and’d follow-ups with telephone interviews or self-completed admissions annually for four years. Recruitment took place from Aug. 13, 2012, to April 8, 2014, with 1,514 participants that completed the baseline interviews and were included in the analysis from Aug. 20, 2012, to April 14, 2014.

The most common forms of pain reported at baseline were neck or back pain, followed by arthritis.

The study, headed by the National Drug and Alcohol Research Centre (NDARC) at UNSW Sydney, was funded by the National Health and Medical Research Council and the Australian authorities.

According to the researchers, “this is one of the longest, in-depth, prospective studies of a community cohort of individuals with chronic non-cancer pain, analyzing the effects of cannabis use on pain and prescribed opioid use. ”

Though Australia legalized medical marijuana in 2016, the change didn’t really affect the research — meaning participants mostly used illegally produced cannabis.

Some experts expressed reservations about the research.

“This analysis is certainly about regarding the effectiveness of cannabis for non-cancer pain,” Dr. Jordan Tishler, a Massachusetts-area physician, president of the Association of Cannabis Specialists and CEO of inhaleMD, told Marijuana.com. “It was well-designed and had a reasonable number of subjects observed over a reasonable amount of time. Nonetheless, this is a prospective cohort study that can show strong relationships but can’t prove causality. In actuality, in their conversation they remark on other studies, randomized controlled studies — the only type that can show causality — that have shown benefit for pain. Their take is that those studies were too narrow in their inclusion criteria — a legitimate criticism — but none that validates their particular study further. ”

Tishler added that though one of the major conclusions was that the cannabis users had worse pain and felt more stress than non-users, it’s possible — that the researchers note — the cannabis users had worse pain at baseline and so were interested in cannabis to help in addition to their opioids more so than the non-users.

“The authors note that for most of the time throughout their analysis cannabis was fully illegal in Australia,” he said. “Does that mean that we don’t have any idea what kind of cannabis patients were using, in addition, it means, furthermore, that none of those patients were being followed and advised by a cannabis physician. We know that, like the other medications, cannabis may be used improperly and may have adverse outcomes. Only with careful dosing and monitoring can we reasonably expect benefit across a wide group. This study did not attempt to stratify patients by their dose or routine, which I would expect would have shown clear benefit to subgroups that were using cannabis in more moderate amounts. ”

Tishler said he has seen benefits of medicinal cannabis in his own practice, but results can vary.

“Cannabis appears to work well for a range of non-cancer type pain: inflammatory pain such as [rheumatoid arthritis]or Crohn’s, [as]well as mechanical pain such as osteoarthritis,” he said. It doesn’t appear to work for everybody, and there are risks and side effects like all meds. Some people tolerate it and do well, others occasionally don’t. Finally we have to regard cannabis as a medicine in a dispassionate manner so that we can utilize it appropriately for patients.

Osteopathic Dr. Michelle Weiner, pain management physician at South Florida’s Spine and Wellness Centers of America, said she isn’t impressed with the analysis and finds it is hard to reference when her daily clinical experience finds cannabis a safer, more effective solution to reduce esophageal use for pain.

“The writer glazes over the fact that 22 percent and 30 percent of the patients reported that they sometimes or regularly reduced their opioid medication when using cannabis at three-year and four-year followup respectively,” she said.

Dr. Blake Pearson, a practicing physician specializing in cannabinoid medicine in Ontario, Canada, and creator of GreenlyMed.com, said depending on the research design and methods, a substantial causal relationship between cannabis use and its effects on non-cancer chronic pain may ’t be established.

“This study did not investigate modes of ingestion, how much cannabis in grams was consumed, the formula — amount and ratio of CBD or THC present — or track frequency of dosing each day,” said Pearson. “also, but none of the research participants were under medical supervision for cannabis therapy. At the time this research happened, medical cannabis was still illegal in Australia, so these participants were using illegal street cannabis and could be considered “recreational users. ”  This is important for a number of reasons, among them, that cannabis used for recreational purposes generally doesn’t contain CBD — the cannabinoid that is effective for pain relief without causing impairment.

He said more research are crucial.

“Until we have more prospective, randomized controlled trials — the gold-standard in medical research — we will continue to go around in circles with the cannabis as medicine debate,” he said. “To legitimize cannabis as medicine and improve access for patients across the world who might benefit, more quality research is imperative.

Released at Wed, 11 Jul 2018 20:20:18 +0000

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